Porcelain Veneers

Feldspathic Veneers

This Winnetka patient had spaces or gaps in her smile. She wanted natural shading and surface textures so that no one could tell that she had her teeth done.  Click image to enlarge.

What are porcelain veneers?

Porcelain veneers or dental veneers are thin custom made shells or jackets designed to cover the front of a tooth. These bonded teeth covers 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. A porcelain veneer can be a far more conservative alternative to a dental crown.  The more skilled dentists tend to remove less tooth structure.

Uses of Veneers:

Characteristics of Porcelain Laminates

Laminates were originally developed as a way to save tooth structure while improving how the teeth look.  These teeth covers 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. The porcelain margin blends very nicely with the tooth. 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”.

The porcelain can be made thin enough to have a contact lens effect

Porcelain can be made so thin that it blends nicely with the natural tooth beneath it. This makes the margin invisible. A contact lens effect allows the margin to blend into the root.

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 xrays 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 with little drilling of tooth enamel. If aggressive changes in shape or position are desired drilling will be needed. Significant drilling will require temporary veneers 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 teeth covers are bonded to the front of your tooth. 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.

Veneering Teeth

This Indianapolis physician wanted a smile makeover. She really didn’t want us to drill on her real teeth. Her teeth had been dark due to using tetracycline as a teenager. Her local dentist said that he would have to do full crowns to cover the darkness. She did her research and came to us to be restored. We were able to be much more conservative with tooth reduction by doing low prep veneers. We chose a porcelain that was opaque enough to cover the stains but still beautiful. Click to enlarge.

 How are Veneers made?

  1. Milling: 

    They can be cad/cam milled from a large block of ceramic. No pretty surface porcelain is used to characterize them. 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.

  2. Hand stacking:

    A dental lab technician will mix water to the unfired ceramic powder to form a slurry.  The ceramist 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.

  3. The lost wax technique: 

    A full contour 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 is 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. This customizing is what allows us to match the shades of the natural teeth well.

What do porcelain veneers cost?

Prices can range greatly. Consider that you got quotes from 5 different dentists to do a smile makeover for you. The quote might be as little as $3500 and as high as $100,000! Patients don’t understand the variation in quality levels of different dentists. What quality niche is your dentist?There are also levels of perfection.  How perfect do you want your smile to look? a perfect smile is different for everyone.

A more conservative cosmetic dentist may be able to improve your smile with a little reshaping of your teeth and bleaching. While another dentist might do aggressive drilling down of 28 teeth. The best option is to fit the treatment to your personal goals. Get at least one other consultation other than your regular dentist.

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 higher end dentists use the finest ceramists. The training level of the ceramist determines the quality of the veneer restorations. The ceramist will charge the dentist directly anywhere from $25 to $1,200 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.

Are porcelain veneers strong?

Veneers before and after

Often night grinders have shortened or heavily worn teeth. There is an untrue belief (even by some dentists) that laminates can’t be done if you grind your teeth. Actually, porcelain veneers are an excellent choice for night grinders. Advances in ceramics have the newer porcelains matching the wear and fracture strength of natural enamel. If done properly, veneers are just as strong as Nature!

  • 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 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 veneer you are getting.  The average dental office can deliver your teeth covers 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 porcelain veneers stain or get darker over time?

Quality ceramic materials designed for laminates 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 teeth covers” have surface stains to make them blend better.  This type of porcelain laminate will eventually get brighter with regular hygiene and age as the superficial surface colors wear off.

Dr Fondriest is a Nationally recognized and highly sought after cosmetic dentist. He serves clients from throughout the United States