CHAPTER 1
WHY VENEERS?
MACIEJ ŻAROW
Why veneers?
Veneers start a risky game. They can improve the patient’s well-being and comfort, increase their chance of professional success and social standing. On the other hand, they can also – even irreversibly – change everyday life for the worse. Do we know the answers to all the questions that a patient might ask?
THE PATIENT’S POINT OF VIEW
Patients are interested in veneers because they are an attractive treatment; they improve their smile and well-being relatively quickly. They know that veneers have glamorized many famous people, such as actors, entrepreneurs, politicians, and celebrities. They hope that entering the world of veneers will change their daily life, give them social confidence, increase their chances of professional success, and raise their social position. Therefore, it is safe to say that veneers or esthetic treatment can sometimes work in the same way as good psychological therapy.
More than once, I have hosted in the dental clinic modest and almost non-smiling patients who, after veneer treatment, have completely changed their lifestyle; they smile widely, are more talkative, change their hairstyle to a new, more sophisticated cut, and alter their wardrobe for a more fashionable one often intended for young and confident people.
CLINICAL POINT OF VIEW
I write on purpose about veneer treatment, not about cosmetic change. After all, this type of therapy is, in most cases, a dental treatment. Despite all the aspects of our changing reality, the role of social media into our clinics, and the generational change in the business approach to running dental practices, we must not forget that we are dentists, and our primary goal is to treat. Veneers do not only change the shape and the color of the teeth, but they also have a therapeutic effect, which goes beyond the improvement of esthetics and the patient’s comfort. Their therapeutic meaning can be outlined in ten aspects1–10:
They improve the function of anterior guidance and lateral guidance,protecting molars and premolars from tooth wear
They improve the function of eating
They can have a positive effect on phonetics
With gentle preparation, they often strengthen tooth stiffness, which is compromised due to root canal treatment and structural loss
They are nearly non-invasive for the periodontium (with supra- or juxtagingival preparation and with an appropriate emergence profile)
They are less invasive than prosthetic crowns, where the preparation means a significant structural loss
They improve health conditions for the gingival papilla by creating carefully planned and stable contact points
They reduce plaque accumulation by covering the composite fillings
They protect thin and chipped incisal edges, thanks to their appropriate material strength
QUESTIONS THE PATIENT MAY ASK:
Do veneers require significant tooth damage?
We can plan and minimize the range of the tooth preparation. Using appropriate methods, it is possible to perform veneers with a preparation depth of 0.2–0.4 mm or less into the hard tissues (Fig 1-1). What is important is that we try to prepare the tooth so as not to remove the entire thickness of the enamel or expose the dentin (exposing the dentin may reduce the durability of the veneers).1,11–12
Fig 1-1
It is possible to perform veneers with reduced tooth preparation using appropriate methods. (The photograph shows tooth 22 before veneer cementation.)
How long do veneers last?
Under optimal conditions (a significant amount of enamel ensures good adhesion of the veneer to the tooth), we can expect durability up to 15 years and more (Fig 1-2).13–15 However, with age, physiological atrophy of the gums may progress and, after many years, the veneer–tooth transition can be visible. That is why professional oral hygiene and plaque control are important, contributing to slowing down the periodontal aging process.
Fig 1-2
Under optimal conditions, we can expect the durability of these restorations to be up to 15 years or even more. These veneers have been successfully functioning in the mouth for over 12 years.
Can veneers be placed over teeth with composite restorations?
Of course, veneers are recommended wherever it would be too difficult to perform direct composite restorations, especially in the case of multiple restorations. In such complex situations, it is much easier to improve the smile with the indirect veneers (Fig 1-3).16
Fig 1-3a
A patient presented to the dental office to improve the smile esthetics in the maxillary anterior sextant. The patient was unsatisfied with unesthetic tooth reconstructions.
Fig 1-3b
Six feldspathic porcelain veneers were performed.
Figs 1-3c to 1-3e
Patient’s smile in different shots after veneers cementation.
Fig 1-3f
The initial situation, before veneer treatment.
Fig 1-3g
Clinical situation after veneers cementation.
Is it true that veneers often fall off or break?
Veneers fall off due to incorrect indications (occlusal overload or structural compromise) or an error during the cementation procedure. If the teeth are overloaded, the risk of failure increases significantly. Sometimes, additional procedures should be performed in advance. Such procedures can include the functional risk assessment, removal of the premature occlusal contacts, and in certain cases, increasing the vertical dimension of occlusion (Fig 1-4).17,18 There are also clinical cases where the tooth may not have enough of its own healthy structures, and veneer adhesion to the tooth will not be predictable.3
Fig 1-4
(a) The anterior teeth of this patient might appear ideal for veneers. However, after a thorough overview of the medical history and physical examination, it was found that the patient actively wears her teeth (b to d). After deprogramming, it was found that the cause of the tooth wear can be the avoidance pattern of premature contacts. (e) These premature contacts are visible after deprogramming and obtaining the central relation (CR). Only appropriate preparation of the occlusal conditions will reduce the functional risk of the veneers.
What does it mean: altering the vertical dimension?
Altering the vertical dimension means increasing the clinical height of the posterior restorations that will provide the front teeth with more necessary space for chewing, swallowing, breathing, and talking. The principle is as follows: reconstruction of the teeth in the mandibular arch, in the maxillary arch, or reconstruction in both, which will relieve the front teeth (Fig 1-5).17,18
Fig 1-5a
The female patient shown in Fig 1-4 was qualified for altering the vertical dimension – initial situation.
Fig 1-5b
Tooth preparation for indirect restorations in the fourth quadrant.
Fig 1-5c
Indirect restorations after cementation in the fourth quadrant.
Fig 1-5d
Tooth preparation for indirect restorations in the third quadrant.
Fig 1-5e
Indirect restorations after cementation in the third quadrant.
Fig 1-5f
Anterior teeth isolated with a rubber dam, ready for direct composite restorations.
Fig 1-5g
“Palatal frames” of composite restorations were made with silicone index obtained for the diagnostic wax-up.
Fig 1-5h
Mamelons were created with the dentin composite resin layer.
Fig 1-5i
Situation after restoration with final enamel composite and initial characterization.
Fig 1-5j
Altering the vertical dimension of the occlusion provided appropriate space for the porcelain veneers.
Figs 1-5k and 1-5l
Patient’s smile from (k) the right and (l) the left semi-profile after veneers cementation.
Stay updated, free dental videos. Join our Telegram channel
VIDEdental - Online dental courses
