When to recommend veneers

Porcelain veneers are like the Rolls Royce of restorations. They provide the highest-quality solution available in terms of beauty, function, and longevity for conservative anterior indirect restorations.

Feb 1st, 2006

Porcelain veneers are like the Rolls Royce of restorations. They provide the highest-quality solution available in terms of beauty, function, and longevity for conservative anterior indirect restorations.

While I frequently recommend porcelain veneers to my patients, they may not always be the most appropriate treatment. Each case is unique, and other options may work better within the broader context of a patient’s interests and concerns. A practitioner’s ethical duty is to thoroughly understand the alternatives, and to explain their virtues and limitations to a patient. My recommendations are guided by what I would choose for my mouth, if I were in a patient’s situation. People appreciate and trust an open, unbiased approach that is based on their best interests rather than on my bottom line.

Alternatives to porcelain

Dentists can accomplish almost everything esthetically and functionally with veneers that they could with alternative cosmetic solutions. Usually, veneers work much better. So the real question becomes: When do you recommend veneers, and when do you recommend other options? Let’s consider the pros and cons of the alternatives.

Bleaching- Many patients easily can be disappointed with the results of bleaching. To avoid this, dentists should warn patients about its limitations. First, bleach only affects color. This is just one aspect to consider when assessing the overall beauty of a smile. A true smile makeover changes the shape, length, and contour of the teeth to create the best smile possible. Only restorations can achieve this result.

Second, bleaching only lightens teeth to a certain level. This varies according to age, enamel, and other factors. Patients frequently are dissatisfied, especially if their natural color has darkened over time, which it inevitably does. When teeth can’t be bleached to the desired color, patients must opt for porcelain or composite resin.

Third, bleaching is reversible, and touch-ups are required. The frequency of touch-ups depends on many variables, especially personal habits that stain enamel. Porcelain veneers retain their color and do not stain. Despite its limitations, bleaching is an inexpensive, viable option for someone who wants to focus solely on a brighter smile.

Orthodontics - Orthodontics is another option if the primary goal is to straighten teeth. Patients who also want to brighten their smiles must either supplement with bleaching or whiten with veneers. Braces are generally less expensive than porcelain for similar structural results; however, the treatment is less convenient since it requires many visits over a period of time. Of course, sometimes teeth are too crooked for a restorative solution. Even when restorations will work, if the teeth are relatively “virgin” and any discoloration can be addressed with bleach, orthodontics becomes a favorable and practical option.

Composite resin- Porcelain-like results can be obtained with composite resin, although they are more prone to maintenance issues. Dentists sometimes must remove tooth structure, but they do not need to remove as much as they do with ceramic. Since composite resin is a cheaper material, and does not require a lab (no lab fees), practitioners can charge less and the treatment requires only one visit. On the negative side, unlike porcelain, plastic dulls over time and needs repolishing. Also, it can be scratched and stained more easily, and is weaker and more likely to break. Porcelain lasts longer - 10 to 15 years as opposed to about five for plastic. Finally, although dentists can create beauty with composite resin, they need advanced expertise. This requires training and practice. Unless practitioners have the expertise, they should be careful about the results they promise. Porcelain restorations are crafted by laboratory ceramicists who have been trained and have extensive experience creating veneers.

These alternatives to veneers are options I present when the situation calls for it. A patient’s budget and personal choice are other factors in these decisions. Since you rarely see an adult with “virgin” or “near virgin” teeth, most patients want to address both the color and contour of their teeth. Several factors - discoloration, fillings, fractures and chips, a paucity of enamel, aging, and discolored teeth - happen over time. So, in most cases, the best and most long-term solution for addressing these issues is porcelain (veneer) restorations.

Dr. Christopher Pescatore lectures worldwide on topics such as state-of-the-art esthetic procedures, techniques, and materials. He holds a U.S. patent for a nonmetallic post system to restore endodontically treated teeth. He is the former clinical co-director and current featured speaker at the Las Vegas Institute for Advanced Dental Studies. He has a full-time practice in Danville, Calif., dedicated exclusively to esthetic dentistry, and also serves as Clinical Director of MicroDental Laboratories. Contact him at (925) 362-9330, or at chrisdmd@aol.com.

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