Ceramic veneers are minimally invasive adhesive restorations achieving excellent esthetics. Thanks to very conservative preparations limited to enamel or even with no preparation at all leaving the dental surface exactly as it is (“no-prep” technique), it is possible to make porcelain veneers with an average thickness of about 0.5 mm.
Such restorations do not interfere with the health of periodontal tissues since the preparation is kept slightly away from the gingival margin; nonetheless, ceramic veneers offer excellent esthetics and natural appearance, due to the absence of metal frameworks and the use of all-ceramic translucent materials.
Dental veneers allow to correct shape and volume anomalies (e.g. closure of interdental black spaces and diastemas, reshaping of peg-shaped teeth, etc.), pigmentations and discolorations (e.g. nicotine and coffee spots, yellowish composite restoration, etc.), dental malpositions and congenital enamel defects (e.g. fluorosis, amelogenesis imperfect, etc.). Consequently, the correct fabrication of porcelain veneers can give fullness and harmony to the smile. Porcelain veneers can be also used to restore correct occlusal functions, lengthening fractured or worn incisal margins, particularly after enamel aging
Nowadays, modern material technologies allow to use different kinds of ceramic to produce porcelain veneers, from the traditional, highly translucent feldspathic veneers, to the most innovative ceramics based on lithium disilicate, characterized by high mechanical resistance.
The optimal mechanical properties and the high fracture resistance of lithium disilicate allow to fabricate ceramic veneers even in biomechanically risky situations, just like in patients wearing bite planes or with worn dentition.
Both feldspathic and lithium disilicate veneers, cemented with extremely reliable adhesive techniques and dedicated luting agentsg, guarantee excellent biological integration, optimal esthetic results and high biomimetics, restoring the optical and mechanical characteristics of natural teeth.
QUESTIONS & ANSWERS ABOUT DENTAL VENEERS
Are all the dental veneers you use made of ceramic?
Yes, although they change considerably in terms of “kind”: feldspathic ceramics, lithium disilicate, etc.
Do you use particular technologies and materials? What are their names?
We use state-of-the-art technologies (intraoperative stereomicroscope, sonic and ultrasonic handpieces, etc.), high reliability materials (high strength ceramics, enamel-dentin adhesive systems of the latest generation, dedicated cements) and production technologies certified by dental laboratories whom we collaborate with.
Is it necessary to drill my teeth?
No, it is not necessary; it depends on the kind of defect you have. If you have to increase the volume of your teeth or if you have to close spaces (diastemas), it is possible to use some techniques (no-prep ones) that do not require teeth preparation. However, to obtain optimal results, it is not possible to do so in all cases. The success, both esthetical and functional, is based on the creation of a very thin space to incorporate the ceramic veneer (0.4-0.6 mm) on the dental surface without creating over-contours, namely rough edges or protruding areas, especially at the gingival margin, so as to avoid gum inflammations, pigmentations and other problems.
Established that veneers are very resistant, how can I prevent them to lose retention?
To limit the risk of decementation (reported in literature in a percentage of about 1-2%), it is necessary to correctly prepare the tooth, leaving the maximum quantity of enamel possible, using reliable cements (specific resin cements dedicated to veneers) and paying attention during mastication, avoiding to tear hard foods and modifying bad habits, such as eating nails, biting pens, etc. In case the teeth have been considerably lenghtened for functional or esthetic reasons, it is compulsory for the patient to wear a bite to be used during night.
At the beginning veneers are not visibile, but does the effect last? How can I keep this effect over time without having to return to the dentist?
The risk for veneers to be seen can be related to 2 factors: “fake” esthetics (big “movie” teeth, too white and too uniform ceramic, total absence of asymmetry) and marginal pigmentation over time. To avoid this, it is necessary to study carefully the case with the application of previsualizing veneers without preparing teeth, using the so called “mock-up technique”, that allows the patient to see what the final result will be before preparing the teeth and correcting esthetics before starting the treatment. Moreover, pigmentations can be made less evident placing preparation margins in not visible areas, so preparing teeth strategically. As to the esthetic performances of ceramics, the color does not change ever; differently, the color of natural teeth and/or roots or composite restorations could become darker over time. In order to limit pigmentations as much as possible, it is important that patients limit the intake of pigments (e.g. nicotina, carotene, etc.). Obviously, recall follow-up appointments are paramount to guarantee a long lasting natural appearance as ell as a proper function of dental veneers.
What are the advantages and disadvantages compared to other (and which ones) treatments?
The main advantage is undoubtedly the minimal invasiveness compared to other traditional restorations, just like crowns necessitating the preparation of the whole tooth, while veneers preparations interest only the external part for less than 1 mm. Absolute disadvantages do not exist but only relative contraindications, namely those conditions that do not allow to fabricate veneers at all, just like excessively broken teeth, too wide interdental spaces, absence of pontic teeth, etc. Obviously, each case has to be planned individually by means of a multidisciplinary approach.
Could you describe the patients whom you apply dental veneers to?
Most of all, patients require dental veneers for esthetic reasons, like dental anomalies or malpositions, space closure (e.g. diastemas), discolorations, pigmentations and enamel defects (e.g. amelogenesis imperfecta, fluorosis). A few patients are treated with veneers as finishing of the orthodontic therapy, when residual spaces affect esthetics even after the orthodontic treatment; so, veneers are used without moving teeth and avoiding to interfere with a correct occlusion. Many other patients ask for dental veneers because of tooth wear, caused by aging, friction or parafunctions, particularly when teeth are no longer visible during speech or smile, making patients look like “older”. A limited category deals with patients who do not want to drill their teeth and who, therefore, do not accept the idea of prosthetic crowns.
What do these patients have in common?
Essentially, they all have high demands for esthetic: steady and white teeth, a perfect and harmonious smile. Furthermore, the idea that this therapy is very minimally invasive and very conservative drilling just a minimum amount of tooth tissues is the main reason that leads patients to choose this kind of treatment. Statistically, dental veneers are required most of all by 18- to 45-year old women, even though in the last few years this trend is changing.
What are the differences with the other patients of the dental office?
They are patients with high esthetic sensitivity, careful attention to details and that often have very clear ideas on the shape and color they desire as final result. Moreover, dental veneers are required by patients that want to complete an esthetic treatment. Usually, the treatment is much faster than traditional prosthetic crowns and it does not require the time needed for a correct orthodontic treatment.
What does it scare or worry these patients?
The main fear of these patients is the idea of drilling their teeth: the patient often requires dental veneers because he/she knows they will “preserve” a very high amount of the original tooth. Then there is the fear of breaking or losing them while eating. These eventualities are absolutely negligible if the patient follows some little advices and changes some bad habits.
Clinical Case 1: Feldspathic ceramic veneers on maxillary anterior teeth.[tab icon=”” title=”Clinical Case 1″]Case of a 26-year old female patient with fractured incisal margins on the maxillary central incisors.
The patient referred she had already restored the central incisors twice by means of composite materials but both restorations had broken; furthermore, the patient was not satisfied with the esthetic result of composites. Consequently, 2 feldspathic ceramic veneers were made.
Such kind of adhesive restoration allows to restore both esthetic and function with a conservative approach and minimally invasive preparations with an average thickness of about 0.6. The use of these materials guarantees predictable and long-lasting results as well as valuable esthetic effects that are not affected by discoloration, just like composite restorations.Read the full article