Benefit Cosmetic Review

In dentistry, a veneer is a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth, or to protect a damaged tooth surface. There are two main types of material used to fabricate a veneer, composite and dental porcelain. A composite veneer may be directly placed (built-up in the mouth), or indirectly fabricated by a dental technician in a dental laboratory, and later bonded to the tooth, typically using a resin cement such as Panavia. In contrast, a porcelain veneer may only be indirectly fabricated.

History

Veneers were invented by a California dentist named Charles Pincus . At the time, they fell off in a very short time as they were held on by denture adhesive. They were, however, useful for temporarily changing the appearance of actors' teeth.

Research started in 1982 by Simonsen and Calamia revealed that porcelain could be etched with hydrofluoric acid, and bond strengths could be achieved between composite resins and porcelain that were predicted to be able to hold porcelain veneers on to the surface of a tooth permanently. This was confirmed by Calamia in an article describing a technique for fabrication, and placement of Etched Bonded Porcelain Veneers using a refractory model technique and Horn describing a platinum foil technique for veneer fabrication. Additional articles have proven the long-term reliability of this technique.

Today, with improved cements and bonding agents, they typically last 10-30 years. They may have to be replaced in this time. The cost of veneers can vary depending on the experience and location of the dentist. Costs range anywhere from $1000 a tooth upwards to $2500 per tooth as of 2009. Porcelain veneers are said to be somewhat more durable and less likely to stain than veneers made of composite.

Usage

When using veneers, the teeth's appearance can be changed with minimal tooth preparation (e.g. drilling). Many veneer procedures can be done with the use of little or no local anesthetic. Traditionally, a reduction of approximately 0.5 mm is required for a porcelain veneer. Composite veneers are becoming more popular as they are easy to repair, whereas porcelain veneers have potential to fracture. It can be very difficult to match the shade of an individual veneer to the remaining teeth, hence placing several veneers is common.

There are some veneers which do not require any drilling in order to remove tooth structure. Instead, these veneers are constructed to be placed on top of teeth. As a result, treatment is less invasive and may be less time-consuming. On the other hand, since the teeth are not reduced in size the veneers may appear too large or bulky unless the material used is extremely thin. Therefore, the success for these veneers is best when limited to specific cases.

Veneers may be used cosmetically to resurface teeth such as to make them appear straighter and possess a more aesthetically pleasing alignment. This may be a quick way to improve the appearance of malposed teeth without need to use orthodontics. However, the amount of malposition of teeth may be such that veneers alone may not be enough to correct them. Instead, orthodontics would need to be used, or orthodontics combined with veneers. The dentist who places veneers must be careful since veneers could increase the thickness of the front face of the teeth. If the teeth are too thick on the face they may appear to stand out and push out the lips. The effect may be enough to give the patient a full or donkey appearance when the lips are closed. Veneers must also be created such that the patient bites into them with minimal force. Otherwise, they may chip off. Patients whose lower jaw protrudes out farther than their upper jaw (known as a class III bite) may not benefit from veneers because the teeth of the lower jaw may bite into the teeth of the upper jaw such as to dislodge the veneers.

Indications

Veneers are an important tool for the cosmetic dentist. A dentist may use one veneer to restore a single tooth that may have been fractured or discolored, or multiple teeth to create a "Hollywood" type of makeover. Many people have small teeth resulting in spaces that may not be easily closed by orthodontics. Some people have worn away the edges of their teeth resulting in a prematurely aged appearance, while others may have malpositioned teeth that appear crooked. Multiple veneers can close these spaces, lengthen teeth that have been shortened by wear, provide a uniform color, shape, and symmetry, and make the teeth appear straight.

Alternatives

In the past, the only way to correct dental imperfections was to cover the tooth with a crown. Today, in most cases there are several alternatives: crown, composite resin bonding or porcelain veneer or even cosmetic contouring or orthodontics

Non-permanent dental veneers are available. These dental veneers are molded to existing teeth and are removable and reusable and are made from a flexible resin material. Do it yourself at home kits are also available for the impression-taking process. Actual veneers are made in the lab and sent to the wearer through the mail.

One type of veneers, lumineers (styled LUMINEERS ), allows for easy removal due to the lack of modification required to the tooth to apply the veneer. Lumineers are made of a unique porcelain known as Cerinate.

See also

• Cosmetic dentistry
• Crown (dentistry)
• Dental restoration

References

1. ^ Pincus CL."Building mouth personality" A paper presented at: California State Dental Association;1937:San Jose, California
2. ^ Simonsen R.J. and Calamia John R. "Tensile Bond Strengths of Etched Porcelain", Journal of Dental Research, Vol. 62, March 1983, Abstract #1099.
3. ^ Calamia John R. "Etched Porcelain Facial Veneers: A New Treatment Modality Based on Scientific and Clinical Evidence", New York Journal of Dentistry, Vol. 53, #6, Sept./Oct. 1983, pp.255-259.
4. ^ Horn HR. "A new lamination, porcelain bonded to enamel". NY St Dent J 1983;49(6):401-403
5. ^ Calamia John R. and Simonsen R.J. "Effect of Coupling Agents on Bond Strength of Etched Porcelain", Journal of Dental Research, Vol. 63, March 1984, Abstract #79.
6. ^ Calamia John R. "Etched Porcelain Veneers: The Current State of the Art", Quintessence International,Vol. 16 #1, January 1985.
7. ^ Quinn F Mc Connell RJ "Porcelain Laminates: A review", Br Dental J. 1986:161(2):61-65
8. ^ Calamia John R. "Clinical evaluation of etched porcelain veneers" Am J Dent 1989:2:9-15
9. ^ Nathanson D, Strassler HE. Clinical evaluation of etched porcelain veneers over a period of 18 to 42 months J Esthet Dent 1989:1(1):21-28
10. ^ Strassler HE, Weiner S "Long-term clinical evaluation of etched porcelain veneers" J Dental Res 77 (Special Issue A):233 Abstract 1017,1998
11. ^ Friedman, MJ "A 15-year review of porcelain veneer failure- a clinicians’ observations. Compend Contin Educ Dent. 1998:19 (6):625-636.
12. ^ Calamia John R. "Etched Porcelain Laminate Restorations: A 20-year Retrospective- Part 1" AACD Monograph Vol II 2005:137-145 Montage Media Publishing
13. ^ Barghi, N , Overton JD "Preserving Principles of Successful Porcelain Veneers" Contempory Esthetics 2007:11(1)48-51

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