Dental veneers are used to improve the aesthetics usually of the upper front teeth. A veneer can be made from plastic composite resin or ceramic. The composite resin veneers are usually cheaper and of a lesser aesthetic result. The ceramic veneers are more expensive, long-term, and have superior aesthetics. The procedure involves placing a layer of material over the front of one or more teeth. This material changes the colour and shape of the teeth. Veneers can be carried out on a single-tooth or more commonly can be used over the 6 upper front teeth which give the appearance of changing a complete smile. In some cases with people who have a very broad or large smile, it is necessary to cover up to 8 or even 10 of the upper front teeth. Veneering material can be placed over the teeth without preparing them however this is not common. Achieving beautiful aesthetics of teeth includes not just the colour but also the shape. To achieve excellent anaesthetics, both of these aspects are required to be perfect. Out of these two, the shape is arguably the most important. If the veneering material is added to the tooth without removing some of the tooth structure, the teeth will have the final appearance of looking too large and unusual. Ceramic veneers are longer lasting and most aesthetic. The secret to the success is that the bite or occlusion is still maintained on normal healthy teeth. The biting or chewing forces are maintained through the teeth and the veneering material simply covers the outside of the teeth. Veneers may not be suitable for people who are very heavy tooth grinders with severely worn out teeth. These people may be more suited to plastic composite resin buildups on their teeth which will slowly wear over approximately 7 – 10 years. These restorations can then be replaced on regular basis at approximately 7 – 10 years intervals.
Examination and Consultation
An examination or consultation for dental veneers would usually start with assessing the expectations someone was wanting to achieve with this particular treatment. We would encourage someone to show us images of other people’s teeth so that we could get an idea of what they are trying to achieve. Following this, we would carry out an examination of the existing teeth. Again this would include an assessment of the surrounding gums, bones, jaw muscles and bite. From this, we would be able to decide an approximate long-term lifespan of the remaining teeth. The suitability for ceramic or resin veneers would be assessed.
Finally, we discuss the advantages and disadvantages of each option. We have accumulated images of many cases over the last 20 years. A previous similar case would be used to give as close as possible to an idea of the final result. This is a most important aspect of the consultation in that somebody’s expectations need to be managed to match the final results.
Usually, a thin layer of enamel is removed from the front of the teeth to be the veneered. This tooth removal is carried out to the gum line of the teeth so that it is not possible to see the join between the ceramic veneer and the tooth. This is most important if the veneer is to be placed to correct a darkly discoloured tooth.
Crown and bridge dental impressions are then taken of the teeth which are sent to the dental laboratory. Temporary veneers are then constructed and bonded to the prepared teeth. We usually take a considerable amount of time to provide temporaries veneers in a similar shape to the final veneers.
Placement of the bridge
Placement of the veneers is normally carried out over two appointments on one day. It takes approximately 3 or 4 weeks to construct the ceramic veneers following the preparation and impressions. On the day of placement, the temporary veneers are removed. The new veneers are fitted to the teeth. They need to be adjusted individually and in relation to each other. There are normally 6 veneers carried out as a standard treatment to improve the smile aesthetics. Once the veneers are fitted to the teeth, they are reshaped to provide the most aesthetic contours.
Following this, a further consultation is carried out with the prosthodontist and ceramic technicians. Any changes, additions, and the final colours are decided upon. The second appointment is approximately 2 hours later to allow time for any additions to the veneers and the final colours to be placed. At the second appointment on the same day, these veneers are rechecked on the teeth and the colours are reassessed. If the colours and shapes appear to be perfect, the veneers are then cemented individually to the teeth. This further appointment will take approximately 2 hours. Normally, for weeks following this, a review appointment is scheduled to check for any leftover cement as well as rechecking the bite to ensure that the veneers are not damaged in the long term.
Care following tooth preparation is very similar to the instructions given following tooth preparation for crowns and bridges. Mild to moderate discomfort is common. This is usually addressed with the use of Panadol or Nurofen. The temporary veneers are quite thin and prone to fracture. Care will need to be taken during the temporary stage to protect these restorations. It is not uncommon for them to chip or fracture, we see people immediately if this occurs. In addition to this, the temporary veneers do leak somewhat. There can be increased sensitivity to cold although this is usually mild. Unfortunately, the temporary veneer stage is less than perfect. Other techniques for manufacturing temporary veneers are available however they all have their shortcomings.
After veneer placement
Veneer placement is a longer appointment. It is not uncommon to be fatigued or tired following this. Usually the jaw muscles will be fatigued from staying open for quite some time. Removal of the cement, which is used to attach the veneers, is quite important. The gums surrounding the teeth can be affected by this. Due to the excellent blood supply in the mouth, these effects will heal rapidly usually within 24 hours. The gums will grow around the new veneers and the aesthetics will subsequently improve over several days following placement. Ceramic veneers are excellent restorations with amazing aesthetic results. Interestingly they improve in the days following placement due to these changes in the gums.