“Porcelain veneers” or “dental veneers” are thin custom made shells or jackets designed to cover the fronts of teeth. These bonded jackets or laminates offer a durable way of creating or restoring beauty to a smile. They also can be used to re-establish function and strength. These thin sheets of ceramic are becoming a very popular treatment choice for cosmetic dentists. They only cover the parts of the tooth that have been damaged or that require a change of shape or color. They can be a far more conservative alternative to dental crowns. The more skilled dentists tend to remove less tooth structure.
Uses of Veneers:
- Close spaces between teeth, gaps, diastemas, “black triangles” between teeth
- Restore decay, Fixing heavily worn teeth, erosion, attrition
- Correcting the length and width of teeth
- Tooth straightening without braces
- Repair fractures and chips
- Brighten your teeth
- Replace bonding with veneers
- Create uniformity of tooth shapes
- Changing occlusion
- Improve oral health by closing spaces and preventing food impaction
Characteristics of a Porcelain Veneer
Laminates were originally developed as a way to save tooth structure while improving how the teeth look. These restorations can be as thin as 0.2mm. Often only a small amount of tooth reduction is needed. They always save more enamel than crowns. More structure is retained each time a tooth is fixed. The tooth will be stronger and able to be fixed again in the future. These restorations blend in very nicely with the natural tooth at the margin. This eliminates the dreaded “black line” commonly found on poorly done or old porcelain-on-metal-crowns. These restorations are bonded to place and are far less likely to leak or fail. These thin ceramic restorations can match the light transmitting properties of natural enamel. This allows our veneers to be invisible and as Dr. Fondriest says, “believably natural”.
Dental Veneers: Procedure and Process
There are three phases to a veneering procedure:
1) Evaluation and planning between doctor and patient:
First we ask you to share your goals and expectations with us. We will take photographs, models and possibly radiographs to plan the steps to achieve the desired outcome. Sometimes other specialists (e.g. orthodontists, periodontists) are brought in to help achieve perfect symmetry in your smile. A plan is settled and the exact length, shape, surface texture, shade, and position of every tooth is determined. The doctor and his lab technician partner will decide if any tooth structure needs to be removed.
2) Preparation of the mouth and impressions:
The dentist removes a small amount of enamel. Laminates can be created without drilling any tooth enamel. If aggressive changes in shape or position are desired drilling will be needed. Significant drilling will require temporaries to give you a nice interim smile. Impressions of the teeth and supporting structures are taken and sent to the laboratory. Photographs, measurements of the face, bite, and jaw movements are also sent. A detailed prescription is written by the doctor. A complete summary of what your dreams, desires, and expectations is sent to the dental laboratory. This informs the ceramist exactly what you want.
3) Delivery and bonding:
The dentist will confirm proper fit and appearance. Then the custom porcelain sheaths are bonded to the fronts of your teeth. The bonding agents are made of the same materials (composite) that tooth colored
fillings are made from. Satisfaction with the result is universally positive. You may need a short time to adapt phonetically if the tooth locations or lengths have been changed. This adaptation period varies from a few hours to several weeks.
How is a Dental Veneer made?
The dental veneer can be cad/cam milled from a large block of pre-sintered ceramic. No veneering porcelain is used. This method requires the least amount of expertise from the lab. It is also the simplest and cheapest type of laminate. These are often fabricated in the dentist’s office while the patient waits. This cuts out the laboratory middleman. Lumineers™ and DURAthin™ veneers are made this way. This method of fabrication cannot mimic the color variations found in natural teeth. Monolithic porcelain is one dimensional. Occasionally, surface stains are painted on.
A dental lab technician will mix water to the unfired ceramic powder to form a slurry. The ceramic technician then stacks the porcelain slurry into layers on top of a die replica of the tooth. Each powder layer is artfully chosen to closely represent the colorful layers found in the other teeth. Some layers are translucent and some layers have blended ratios of color. This technique will require the lab artist to fire or sinter the ceramic particles together in an oven. The high temperature transforms it into a dense glass-like state. This technique is done only by ultra high end labs and can deliver a beautiful result.
The lost wax technique:
A wax version of the restoration is invested or covered in plaster. The wax is then melted out of the investment with high temperatures. Then ceramic material melted into liquid form and forced under pressure into the plaster investment. The melted ceramic takes the shape of the lost wax pattern. Veneers made this way will often have stacked veneering porcelains added to them. This is to add desired natural optical characteristics. It also allows for very close shade matches with the proximal natural teeth.
What do porcelain veneers cost?
Prices can range greatly. Most patients have no idea of how variable the costs are. It depends on pre-operative symmetry of tissue, tooth alignment, and the bite relationship. It also depends on the amount of shape and length change requested. Laminates that fit better allow for easier brushing and flossing. Prices also vary based on the quality level of the ceramist. Many patients do not realize that dentists don’t usually make the dental veneer themselves. They contract with a specific type of lab technician called a ceramist to create the veneer for you.
Quality level of Ceramist influences Cost
Most ceramists are not certified dental technicians (CDTs). Fewer still are Master Ceramists (MDTs). As with every profession, there is a bell shaped curve of talent and outcome quality. The training level of the ceramist determines the quality of the veneer restorations. The ceramist will charge the dentist directly anywhere from $25 to $2000 for a single veneer. The restorative dentist then adds this lab fee to the overall cost to the patient. The cost to the patient also ranges greatly from as low as $1200/veneer to $3100/veneer. It is common to have 6-12 veneers done at a time.
What Role Does Translucency Play in the Look of a Dental Veneer?
Natural teeth are very translucent. Top-rated dentists make it their goal to create laminates that are just as translucent. There are many porcelain choices that serve well for different treatment agendas. Most of the porcelain selection is made solely by the dentist. The dentist also picks the laboratory technician. The higher end dentists are using the finest laboratories using the most life-like porcelain in the most artistic ways.
Are Dental Veneers strong?
- Dental Veneers can be very strong, but like many things in life, it depends. If the dentist has a light touch with the drill then the veneer will be incredibly strong. In fact it will strengthen the tooth. If no enamel remains a veneer may not be a strong option. Perhaps a crown would be better. Without enamel the bond is weaker. The strength and longevity will be suspect. This is especially true with people who grind their teeth. Due to a low tensile strength of glass, it is possible for veneers to chip at the edges when overloaded. As stated earlier, porcelain is about 90% the strength of natural enamel.
- Porcelain can be bonded to teeth just like bonded composite (tooth colored) fillings. The bond is very strong if the dentist follows all of the steps. Important steps are commonly skipped if they take more time.
How long does a Veneer take?
- It depends on what type and what quality level of dental veneer you are getting. The average dental office can deliver your restorations the same day or within two weeks. Only mass production labs can return a case in two weeks. If it is done in one day, the dentist makes it him/herself. Few dentists are excellent at doing ceramics. There is an old saying, “It is possible to be great at a few things, but being excellent at everything is unlikely”! This applies to dentists trying to be technicians also.
- A dentist who is an expert in esthetics will work with an expert ceramist to make veneers. The highest quality labs take more time. The very best lab artists are much in demand. It can take 4-20 weeks after the impression appointment to return the finished restorations. The dentist then bonds them into your mouth.
Will a porcelain veneer stain or get darker over time?
Quality ceramic materials designed to cover teeth are very dense and highly polished. These porcelains rarely stain. They are also very color stable. Higher quality versions have most of the pigments/colorants buried within the body of glass. When the surface eventually wears, there is no loss of the original shading. Most of the milled in office “same day veneers” have surface stains to make them blend better. This type of veneer will eventually get brighter with age as the superficial surface colorants wear off.
Dr Fondriest is a Nationally recognized and highly sought after cosmetic dentist. He serves clients from throughout the United States