Porcelain veneers: An alternative to crowns.

What are porcelain veneers?
Porcelain veneers are ultra-thin shells of ceramic material, which are bonded to the front of teeth. This procedure requires little or no anesthesia, and can be the ideal choice for improving the appearance of the front teeth. Porcelain veneers are placed to mask discolorations, to brighten teeth, and to improve a smile. Highly resistant to permanent staining from coffee, tea, or even cigarette smoking, the wafer-thin porcelain veneers can achieve a tenacious bond to the tooth, resulting in an esthetically pleasing naturalness that is unsurpassed by other restorative options.

Why would you recommend a porcelain veneer?
Porcelain veneers are an excellent alternative to crowns in many situations. They provide a much more conservative approach to changing a tooth's color, size, or shape. Porcelain veneers can mask undesirable defects, such as teeth stained by tetracycline, by an injury, or as a result of a root-canal procedure, and are ideal for masking discolored fillings in front teeth. Patients with gaps between their front teeth or teeth that are chipped or worn may consider porcelain veneers.

Generally, veneers will last for many years, and the technique has shown remarkable longevity when properly performed.

What happens during the procedure?
Patients need three appointments for the entire procedure: diagnosis and treatment planning, preparation, and bonding.

Diagnosis and treatment planning: It's critical that you take an active role in the smile design. Spend time in the decision-making and planning of the smile. Understand the corrective limitations of the procedure. Have more than one consultation, if necessary, to feel comfortable that your dentist understands your objectives.

Preparation of teeth: This appointment will take from one to two hours. To prepare the teeth for the porcelain veneers, the teeth are lightly buffed to allow for the small added thickness of the veneer. Usually, about a half a millimeter of the tooth is removed, which may required a local anesthetic. At this appointment, a mold is taken of the teeth, which is sent to the laboratory for the fabrication of the veneers. This can take about one to two weeks. Because the teeth are buffed or reduced, they will look a little different until the next appointment when the veneers will be placed. If the teeth are too unsightly you, a temporary veneer can be placed, at an additional cost.

Bonding of veneers: This appointment will take about one to two hours. First, the dentist places the veneers with water or glycerine on the teeth to check their fit and get a sense of the shade or color. While the veneers are resting on your teeth, view the esthetic results, and pay particular attention to the color. At this point, the color of the veneers can still be adjusted with the shade of the cement to be used. The color cannot be altered after veneers are cemented. To apply the veneer, the tooth is cleansed with specific chemicals to achieve a bond. Once a special cement is sandwiched between the veneer and tooth, a visible light beam initiates the release of a catalyst to harden the cement.

How about maintenance?
For about a week or two, you will go through a period of adjustment as you get used to your "new" teeth that have been changed in size and shape. Brush and floss daily. After one or two weeks, you'll return for a follow-up appointment.

Have realistic expectations
Porcelain veneers are reasonable facsimiles of natural teeth, not perfect replacements. It's not uncommon to see slight variations in the color of porcelain veneers upon close inspection, as this occurs even in natural teeth. Nevertheless, this procedure can greatly enhance your smile, and can heighten inner satisfaction and self-esteem.

Sources:
Mark J. Friedman, DDS, professor of restorative dentistry at the University of Southern California, School of Dentistry, and in private practice in Encino, California; Cornelis H. Pameijer, DMD, PHD, professor of prosthodontics at the University of Connecticut School of Dental Medicine; Michael Weisenfeld, DDS, FAGD, Greenboro, North Carolina, Aetna Insurance dental consultant; "Porcelain Laminate Veneers: A Clinical Success?," Dental Update, May 1993; "The state of the art in porcelain laminate veneers," Esthetic Dental Update, October and December 1991; "Direct Composite or Bonded Porcelain: A Clinical Choice for Anterior Aesthetics," CDA Journal, April 1994.

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