“Porcelain veneers” or “dental laminates” are thin, custom created shells or jackets designed to cover the fronts of teeth. These bonded restorations offer a durable and predictable way of creating or restoring beauty to a smile and/or can be used to re-establish function and strength. These thin sheets of ceramic are becoming a very popular treatment choice for cosmetic dentists, prosthodontists and a growing number of general dentists. Veneers only cover the parts of the tooth that have been damaged or injured or that require modification of shape or color and they can be a far more conservative alternative to dental crowns. The more skilled the dental practitioner is, often less tooth structure is removed.
Uses of Porcelain Veneers:
- Close spaces or gaps, fill diastemas, close “black triangles”
- Restore decay, replace worn enamel, erosion, attrition
- Change tooth shapes – length, width
- Improve symmetry and orientation, re-shape crooked or misaligned teeth
- Repair fractures and chips
- Change chroma and value (brightness)
- Cover blemishes, stains or discolorations
- Create uniformity of surface morphology
- Changing occlusion
Characteristics of Dental Laminate Veneers
Laminates were developed originally as a way to save tooth structure while still improving the appearance of teeth. These restorations can be as thin as 0.2mm which means that only a small amount or no tooth reduction is needed. When more structure is retained each time a tooth is fixed, the tooth will be stronger and will be able to be restored again in the future. Because of the translucency of ceramics, these restorations can be made to blend in very nicely with the natural tooth
at the margin. This eliminates the dreaded “black line” commonly found on poorly done or very old porcelain-on-metal-crowns. These restorations are bonded into place and the margins are far less likely to leak or fail. There are several ceramic systems today that can match the light transmitting properties of natural enamel which will allow our veneers to be invisible and as Dr. Fondriest says, “believably natural”.
Porcelain Veneers Procedure and Process
There are three phases to a veneering procedure:
- Evaluation and planning between doctor and patient: After you share your goals and expectations with us, we will take photographs and models and possibly radiographs to plan out how many steps it will take to achieve the desired outcome. Sometimes other specialists (e.g. orthodontists, periodontists) will be brought in to help if you want perfect symmetry with your smile of if there are problems with the supporting structures of your teeth.
- Preparation of the mouth and impressions: Once the plan is settled and the exact length, shape, surface texture, shade, and position of every tooth has been determined, the doctor and his laboratory technician partner will decide if any tooth structure needs to be removed. Many veneer cases don’t require any or only small amounts of tooth reduction. If more aggressive changes in shape or position are desired or there are many defects with the teeth, then more drilling will be needed and temporaries will be created to give you a nice interim smile. Impressions of the teeth and supporting structures are taken and sent to the laboratory with photographs, measurements of the face, bite, and jaw movements, etc. A detailed prescription written by the doctor is prepared and a complete summary of what your dreams, desires, and expectations are also included so the ceramic artist knows exactly what you want.
- Delivery and bonding: In this last stage of the procedure, the dentist will ensure the proper fit and appearance and then bond the custom porcelainsheaths 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 are veneers made?
- Milling: The laminate can be cad / cam milled from a large block of pre-sintered porcelain. This method requires the least amount of expertise from the lab and is the simplest and cheapest type o
f veneer. These can even be fabricated in the dentist’s office without 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 unidimensional color wise butit can have superficial stains painted on.
- Hand stacking: A technician will mix water, binder, and 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 to be covered. Each layer is artfully chosen to closely represent the colorful layers found in a natural tooth. This technique will require the lab artist to fire or sinter (fusing the ceramic particles together in an oven at a high temperature to transform it into a dense glasslike state) the porcelain several times to gain full contour. This technique is done only by ultra high end labs and can deliver a beautiful result.
- The lost wax technique: Creating a wax version of the veneer and then investing (covering / submerging) it in a plaster-like investment. The wax is melted out of the investment with high temperatures and then ceramic material is pressed (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 specifically to add desired optical characteristics and to allow for very close shade matches with the proximal natural teeth.
What do porcelain veneers or laminate veneers cost?
Prices range greatly depending on pre-operative symmetry of tissue, tooth alignment, lip mobility and amount of display (amount of the teeth that are exposed visually in the smile), bite relationship, amount of change requested in shape, length, brightness, etc. Prices also vary based on quality level of the ceramist. Many patients do not realize that dentists, cosmetic dentists, and prosthodontists don’t actually make the porcelain veneers themselves. They contract with a specific type of laboratory technician called a ceramist to create the veneers for you. The training of the ceramist and appearance and quality level of the veneers that they create will vary greatly. The ceramist will charge the dentist directly anywhere from $25 to $1000 for a single veneer depending on the ceramist’s skill level and the time he/she spends making it. T
he restorative dentist then adds this lab fee to the overall cost of veneers quoted to you the patient. The cost to the patient ranges greatly from as low as $750/veneer to $3000/veneer. It is common to have 6-12 veneers done at a time.
What Role Does Translucency Play in the Look of a Veneer?
Natural teeth are very translucent, which is why top-rated dentists make it their goal to create porcelain veneers that maintain as much of that translucent look as possible. There are many porcelain choices that serve well for different treatment agendas. Most of the porcelain choice decisions are made soley by the dentist. The dentist also picks the laboratory technician to create the restorations. Most patients have no idea of how variable the cost is of the restorations that are created for them. As with every profession, there is a bell shaped curve of talent and outcome quality. The higher end dentists are using the finest laboratories using the most life-like porcelain in the most artistic ways.
Are veneers strong?
- Porcelain can be bonded to teeth just like bonded composite (tooth colored) fillings. The bond can be very strong if all of the steps are followed and there is no contamination during the bonding procedure.
- Generally yes they are very strong, but like many things in life, it depends. If the dentist has been conservative with the tooth preparation and the majority of the tooth still has enamel on it, then the veneer is incredibly strong and in fact it will strengthen thetooth. If the tooth has been heavily reduced and there is no enamel left, a veneer is not a good option. Without enamel, the bond will be weaker and the longevity of the restoration will be suspect, especially 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.
How long does the process take?
- It depends on what type and what quality level of veneers you are getting. The average dental office can deliver your veneers the same day or within two weeks. If you are looking for the very high quality, then it takes more time. There is an old saying “It is possible to be really good or excellent at a few things but, being excellent at everything is unlikely”! This applies to dentists also. There are few dentists that are also excellent at doing ceramics. Typically, to get the better work, a prosthodontist or dentist who is an expert in esthetics, will employ a highly trained ceramist to make the veneers. The very best lab artists are much in demand and often will take 6-14 weeks after the impression appointment to return the finished veneers to the dentist to bond into your mouth.
Will porcelain veneers stain or get darker over time?
Quality porcelain is 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 instead of at the surface so as the surface eventually wears, there is no loss of the original shading. Cheaper products made from monolithic blocks of porcelain (most of the same day veneers that are milled in office) 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.
The upper front 6 incisors are “feldspathic restorations”. These laminates were employed to brighten the smile and to modify the shapes of the teeth of this woman from Libertyville.