Cosmetic dentistry without veneers is akin to a bird without wings. For years veneers have been the mainstay not only of cosmetic dentistry, but also of general restorative dentistry. They give people beautiful smile and at the same time restoring the structure of moderately broken down teeth.
Dental Veneers are custom made shell-like material bonded on the facing of the front teeth. Its main advantage over crowns is its minimal preparation, a much more conservative treatment in preserving tooth structure as opposed to crowns. There are two main types of materials used, composite and porcelain. Porcelain is the gold standard, it gives the best quality of finish in terms of aesthetics and durability.
Below is an example of a ‘standard' porcelain veneers case.
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Before treatment, the patient noted that the teeth ‘look tired’, and closer examination shows the teeth are stained from years of drinking coffee/tea/wine, the old fillings are discoloured and they are wearing down with multiple chips. After ten porcelain veneers were placed, the transformation can be quite remarkable. Many patients who have been too embarrassed to talk in public by covering their mouth with their hand, cannot help but smiling the whole day with their new veneers.
A standard case above means the original teeth are straight, no crowding present, mild to moderate wear of the teeth, well-positioned gum margins, absence of gum disease and last but not least, a wide upper arch form.
First things first
An OPG (panoramic xray) is essential before treatment commences. The X-ray will detect if any of the teeth to be veneered has any form of pathology such as infections and periodontal disease. This is to be followed by clinical examination of the gums and teeth. If the gums bleed, a trip to the hygienist or for more advanced cases, treatment by a periodontist is essential.
Infected teeth will require root canal treatment before any veneers are placed.
What about orthodontic (braces) treatment?
During clinical examination, the dentist will make an assessment if veneers are suitable. Depending on the severity of each case, the examples below may need orthodontic treatment before the placement of the veneers, to give the optimum result.
Gaps Between Teeth
Prominent gaps as shown by the (before) photo below requires braces before the placement of veneers. Without braces, closing the gaps with veneers will result in most unaesthetic large teeth.
The (after) photo below shows veneered teeth with ideal size and shape, after the gaps were orthodontically closed before the veneers treatment.
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Crowded Teeth
Moderate to severe crowding as shown in the (before photo) below requires orthodontic treatment to align the teeth. If veneer treatment is carried out without orthodontic treatment, the rotated teeth will need to be heavily ground down to accomodate the veneers, weakening the teeth in the process, and in some cases exposing the nerve.
The (after) photo below shows veneered teeth that were minimally prepared, after the crowding was orthodontically treated before the placement of the veneers.
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Narrow Arch Form
A narrow upper jaw is the most difficult cosmetic case to manage. Due to the underdeveloped jaw, there is usually not enough room for the teeth, causing crowding. Additionally, the back teeth tend to be almost invisible, when viewed from the front, the best veneers in the world will only give partial improvement of a person’s smile.
The (after) photo below shows a significant improvement of the jaw when orthodontically treated by way of expansion.
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Worn Down Teeth
Severely worn down teeth cannot be successfully treated with veneers. In cases shown by the (before) photo below, the patient has been grinding their teeth, resulting in much shorter worn down teeth. The bite is grossly over-closed due to the wear. Veneers on these teeth will not last, they will simply break as the thin material will not be able to withstand the strong biting forces of the chewing muscles.
The bite will need to be opened by building up the back teeth, therefore creating more space to lengthen the teeth at the front. In this case crowns will be more suitable as they are stronger structurally.
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TMJ Pain
There is an increasing number of patients with pain and headaches associated with the TMJ joints. A potential contributing factor to the chronic pain is the presence of malocclusion (bad bite). The signs to look out for are deep bite, pronounced overset (distance between the front upper teeth and the front lower teeth in the horizontal plane), receded jaw, worn down teeth, missing teeth, misalignment between the upper midline and the lower midlines and crowded teeth among other things.
The patient below had chronic pain for years, when the bite was corrected, the pain was reduced significantly.
It is wise to resolve any pain issues before considering veneers.
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Gum Lifts (Gingivectomy)
Uneven gum margins or a gummy smile, where there is an excess of gum showing when smiling can be markedly improved with gum lifts utilising a laser. This is well illustrated in the same patient above. The laser ‘carved’ out the excess gum tissue, resulting in longer teeth and shorter gums giving a much more pleasing smile.
Summary
Veneers have been the mainstay of cosmetic dentistry for many years, they have given millions of people plenty to smile about. However, preliminary records and assessment by a qualified dentist are essential to minimise complications and dissatisfaction of veneers treatment.