Little things mean a lot: veneers, crowns, and the missing link in smile restoration

Nov. 1, 2010
"I don't like my smile." Sound familiar? It should.

by Rob Veis, DDS

For more on this topic, go to and search using the following key words: orthodontics, space maintenance, appliance therapy, crowns, veneers, Dr. Rob Veis.

"I don't like my smile." Sound familiar? It should. "Smile Engineering" is what we do. The question to be asked here is, "What's the best way to give someone back the smile they desire and deserve?" There are options.

If your patient doesn't like his or her smile, there are four potential ways to address the problem - crowns, veneers, orthodontics, and orthodontics plus cosmetics.

The options include no-prep veneers, normal veneers, simple minor-tooth-movement orthodontic appliances, braces, or the Inman Aligner (previously discussed in "Appliance Economics: Yes, We Can!" DE September 2009), ... as well as the "little things" - bleaching, bonding, and enamel recontouring.

The restorative option

When you're not given an orthodontic option, you have to go restorative. The restorative approach of placing a veneer or crown can (and often does) compromise the long-term health of the tooth - especially if it necessitates a root canal, post, and crown.

Consider this ... if a patient has crooked front teeth and has not been offered (or has decided not to go with) comprehensive orthodontics, you can prepare teeth to bring them back into the arch form. The catch?

In the process, you'll likely have to remove the majority of the enamel structure ... or end up deeply into the dentin (or in the pulp chamber), necessitating an intentional endodontic procedure in order to achieve the desired esthetic result.

At bare minimum, consider a combination of cosmetics and orthodontics. You could at least take the teeth in question, move them into a more ideal position (not perfect, but preferable), and by so doing, create an opportunity to remove a minimal amount of the actual tooth structure and do veneers.

What about simply aligning the teeth and performing a bleaching or bonding - without picking up the handpiece at all? Every time you pick up that handpiece to prepare a tooth for a restoration, you are performing surgery on an organ system.

Healthwise, it is always preferable to eliminate the need for a surgical experience. If you have the ability to align the teeth, you certainly can turn that alignment into a veneer instead of a root canal, post, and crown ... or turn a "no-ortho" case into a veneer ... or place a "no-prep" veneer over the tooth surface.

The missing link

Whether your veneer technique of choice is no-prep or normal ... whether you're doing a crown or a bridge, a bleach or a bond ... minor tooth movement (via orthodontics) is the missing link when it comes to enhancing cosmetic and prosthetic results - in other words, your patient's smile.

Why keep orthodontic minor tooth movement procedures in your treatment bag of tricks? Because if you don't, you run the risk of becoming what I have always termed an "enamel plasty-ist" - singlemindedly grinding the life out of patients' teeth to achieve cosmetic results that you could achieve with a far less invasive treatment plan.

You're not really offering your patients the best in care. Overprepped teeth lead to root canals, posts, and crowns. Teeth that are overcontoured to mask the effects of mal-alignment can lead to improper embrasure spaces, which lead to food impaction, which leads to periodontal disease.

The economics of smile

In this torturous job market, people need to present themselves in the best light possible. That means a good-looking smile. At the same time, they're hypersensitive to the prospect of being tortured further.

Many don't want to have their teeth ground down for crowns. They'll let you do a veneer, but you can't do that without the orthodontics, so you'll get paid for doing both. It may be a single tooth that's out of alignment that leads to six veneers (and/or bleaching, etc.), which you wouldn't be able to do without doing the orthodontics first.

The little things - for improving self-image, confidence and the presentation of self - mean a lot to potential patients. Meet that need. Offer them those little things that mean a lot and you'll always come up smiling.

Note: For a more detailed, comprehensive look at minor tooth movement, orthodontics/cosmetics, and the appropriate appliance therapy, consult "Principles of Appliance Therapy for Adults and Children" by Rob Veis, DDS, and John Christian, MBA, CDT, and be sure to visit

Dr. Rob Veis is CEO of the Appliance Therapy Group® (ATG). Reach him through or by calling (800) 423-3270.

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