Porcelain Veneers

updated September 6, 2017

Porcelain veneers are thin shells of medical-grade ceramic that are attached to the front surfaces of teeth for an immediate smile transformation. Individually crafted for each patient, these cosmetic enhancements are made from advanced material that closely resembles the appearance of natural dental enamel. Dentists can use veneers for an impressive number of cosmetic corrections, ranging from teeth whitening to orthodontic adjustments. Thanks to their lifelike appearance and wide array of functions, porcelain veneers rank among the most trusted and popular procedures in cosmetic dentistry.

History

Although veneers have become especially popular in the past couple of decades, they originated nearly one hundred years ago during the early days of the film industry. In the late 1920s, Dr. Charles Pincus, a famed Hollywood dentist, conceived of veneers as a way to enhance actors' and actresses' smiles on the screen. He would temporarily apply false fronts to the stars' teeth, giving them the stunning smiles that quickly became a trademark of Hollywood beauty. However, he lacked the technology to permanently affix the porcelain. In the late 1960s, Dr. Michael Bunocore ushered in the modern era of adhesive dentistry; by lightly etching teeth with a mild acidic solution, he created a stronger bonding surface for dental sealants and restorations. In 1982, J.R. Calamia and R.J. Simonsen applied Dr. Bunocore's techniques to the application of porcelain veneers. Suddenly, everyone had access to the stunning Hollywood smiles of days past.

Veneers Today

Over the past 30 years, developing dental technology has made veneers more lifelike and convenient than ever before. New types of porcelain are stronger and reflect light similarly to natural dental enamel. Digital imaging systems enable many dentists to create same-day restorations that are a near-perfect match to the natural shape and color of patients' teeth. Additionally, other advanced dental treatments such as teeth whitening and dental crowns can be combined with veneers to provide patients with comprehensive cosmetic results and truly stunning smiles.

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Candidates

Patients who are considering porcelain veneers are typically looking to address multiple structural or cosmetic issues with their teeth, such as:

• Chips
• Cracks
• Gaps between teeth
• Minor misalignment
• Discoloration

In order to have porcelain veneers placed, patients should:

• Have good periodontal and overall oral health
• Be committed to proper oral care and hygiene
• Have specific cosmetic goals, which they can articulate to their dentists at their initial consultations, as well as realistic expectations
• Have a sufficient amount of healthy enamel, as dentists usually remove a thin layer of enamel before placing veneers

Signs That Veneers May Not Be the Right Choice

As stated above, patients must have healthy teeth and gums to qualify for dental veneers. Patients with conditions such as tooth decay, gum disease, and root canal infection typically do not qualify for veneers. However, after a dentist successfully treats these issues, patients are usually cleared for cosmetic enhancement. Those who are considering porcelain veneers should remember that the procedure is typically a permanent one. Because the dentist usually removes a layer of enamel before attaching the porcelain, patients will eventually need to replace their veneers or choose an alternative restoration to take their place. Therefore, no one should receive veneers unless they are certain about their decision. Some patients who habitually grind their teeth and clinch their jaw may be disqualified from receiving veneers. Although dental porcelain is quite strong and durable, the forces of bruxism can put incredible strain on veneers, causing them to break or come off entirely. In many cases, however, a dentist may be able to treat the underlying causes of bruxism, eventually enabling patients to receive veneers. Additionally, newly developed dental materials allow ceramists to create stronger restorations that may be suitable for such patients.

Determining Candidacy

The only way a patient can fully determine his or her candidacy for veneers is by scheduling an appointment with a skilled cosmetic dentist. After evaluating health history, current dental health, and the condition of a patient's enamel, a dentist can make an informed decision regarding a patient's suitability for this treatment. He or she can also recommend alternative treatments for non-qualifying patients.

Cost

The cost of porcelain veneers varies from patient to patient, although costs typically hover around several hundred dollars per tooth. Besides the number of veneers a patient chooses to have placed, there are several issues that can impact the full cost of veneers placement. These factors include:

• Type of veneers: Veneers can be made from several types of dental porcelain. The newest, most realistic and durable materials typically cost more than older products. In addition, there are advanced placement procedures which can impact the cost of veneers. For example, no-prep veneers or CEREC® fabricated veneers often carry a higher price tag.
• Geographic location: As with most aspects of living, the cost of dental treatment varies across the country. If patients receive veneers in a major metropolitan area on the east or west coast, they will typically cost more than veneers in a less populated location in the middle of the country.
• Experience of the dentist: Normally, highly qualified cosmetic dentists charge more to place veneers than their less experienced colleagues.

Veneers as a Dental Investment

Although veneers typically cost more than other cosmetic treatments, most patients who receive these enhancements consider them to be a very worthwhile investment. Because veneers have so many applications, by choosing this single treatment, patients can enjoy the benefits of teeth whitening, orthodontic treatment, and dental crowns, all at once. In addition, veneers offer incredibly lifelike results. After placement, many patients feel more confident than they have felt in years.

Payment

Because veneers are considered a cosmetic procedure, insurance typically does not cover this treatment. However, there are some occasions when a health care plan will cover at least part of the cost. For example, if a patient has had a filling or a similar restorative procedure, insurance may provide some coverage, as it falls under the label of "post-procedural care." A patient will be more likely to receive help from an insurance company if his or her dentist submits a preauthorization, along with photographs, x-rays, and a narrative, explaining how veneers will improve dental health and quality of life. A patient may also qualify for insurance coverage if he or she wants to replace an old, deteriorating veneer.

Financing Options

Even when a patient is unable to obtain insurance coverage, there are a number of medical financing companies such as Compassionate Finance®, which exist specifically to make medical and dental care affordable for a wider range of patients. These companies offer several repayment options, including fixed-interest plans. Most dentists also accept all major credit cards, and many offer in-house repayment schedules to qualified individuals. Patients should discuss their financing options at their initial consultation.

How to Choose a Dentist

When placed by a qualified and experienced cosmetic dentist, veneers have a stunningly natural look. To better ensure a satisfactory outcome, patients should be highly selective in choosing their dentist. Although many dentists offer veneers, the best results are more likely to come from those who have an extensive background in cosmetic dentistry in general and veneers in particular.

The best results are more likely to come from those who have an extensive background in cosmetic dentistry in general and veneers in particular

Training and Accreditations

Looking at professional affiliations is one of the most reliable ways to choose a qualified cosmetic dentist. The American Academy of Cosmetic Dentistry® (AACD) offers several levels of membership, starting at the lowest level with General Members. Dentists with this title do not have to be accredited and must simply express an interest in continuing education in cosmetic dentistry. An Accredited Member has passed the entire accreditation process, including a written and oral exam. An Accredited Fellow has achieved the highest level of membership, having demonstrated cosmetic excellence and ability in clinical practice. Patients should also look for dentists who are members of the American Dental Association.

Approach to Cosmetic Dentistry

Patients are more likely to be satisfied with their treatment when they choose a practitioner who takes an artistic approach to dentistry. Most dentists will have galleries of their past cosmetic work, and potential patients should take a close look at these pictures. They should ask themselves, "Do these results look natural? Is this what I want my smile to look like after treatment?" A dentist's clinical technology can also impact their work. For example, digital x-rays and intraoral cameras can give more accurate images than older imaging systems. Additionally, because there are several advanced types of veneers, interested patients should ask about specific procedures, such as no-prep veneers or CEREC® (Chairside Economical Restoration of Esthetic Ceramics) fabrication.

Interaction with Patients

While clinical excellence and artistic integrity are perhaps the most important factors in choosing a cosmetic dentist, a dental practitioner should also have a good chairside manner. Veneers are completely personalized restorations that have an enormous impact on a patient's smile and self-confidence. Therefore, it is important to choose a dentist who truly welcomes patient input and makes them an active participant in their treatment. Individuals should never choose a dentist with whom they feel ill at ease.

The Ceramist

Unless a dentist creates his or her own veneers using CEREC® technology, dental patients should also ask practitioners about the ceramist or dental lab that they work with. Ultimately, the cosmetic results will depend on top-quality fabrication. Whenever possible, patients should select dentists who work with top-rated craftspeople.

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The Initial Consultation

Before undergoing any dental procedure, patients should have a thorough consultation with their dentist. However, because veneers placement is so highly personalized, for this treatment, the initial consultation takes on special importance. At the first appointment, a dentist analyzes a patient's oral health to ensure that he or she is a good candidate for veneers. This first visit typically includes x-rays, photographs, and dental impressions. The patient explains his or her cosmetic goals so that the dentist can determine whether veneers are the optimal treatment to achieve those objectives.

Mock-Up

Before a patient makes the final decision to receive porcelain veneers, the dentist creates a mock-up, displaying what the patient's smile will look like following treatment. Dentists use varying methods to create these models. Some dentists use old fashioned impressions to create wax-ups, while other dentists use state-of-the-art technology to create advanced three-dimensional computer images. Neither method is better than the other; the important thing is that a dentist works with care and precision to create an accurate and beautifully rendered representation.

Types of Porcelain Veneers

Veneers can actually be made from several types of ceramic, including:

• Pressed ceramic: Veneers made from this kind of ceramic are quite strong, but they are typically thicker than other types of veneers.
• Stacked ceramic: Stacked ceramic veneers allow ceramists to create veneers that are more precisely customized for each patient.
• Lithium disilicate: This new type of dental porcelain is so strong that even severe bruxers may be candidates for veneers made from this material. Lithium disilicate veneers can only be created with CAD/CAM technology.

Veneers Brands

There are also a number of trusted veneers manufacturers. Some of the most popular brands include:

• daVinci^TM: daVinici is one of the most trusted veneers brands in the country, leading the industry for over 30 years. daVinci veneers are highly stain resistant and come with a "Limited Lifetime Guarantee"¹
• IPS Empress®: Empress Veneers come in 12 shades for maximum personalization. Worldwide, over 25 million restorations have been made from Empress porcelain.²
• IPS e.max®: e.max veneers are made from advanced lithium disilicate. According to worldwide clinical studies, they have an astonishing 99% success rate.³

Each of these brands offers its own advantages, and many outstanding dentists favor different brands. If patients feel very strongly about enhancing their smile with a particular brand or type of porcelain, they should discuss it at their initial consultations.

Traditional vs. No-Prep Veneers

The most notable distinction among different types of veneers is the difference between traditional and no-prep veneers. To place traditional veneers, a dentist removes a thin layer of enamel from a patient's teeth. No-prep or minimal-prep veneers, on the other hand, are much thinner, meaning that a dentist must remove little enamel, if any. Many dentists can fabricate and place no-prep veneers in a single day. While no-prep veneers are more convenient and affect less of the tooth structure, not all patients are candidates for these restorations. In some cases, they can look bulky, so patients with proportionately large teeth may not benefit from no-prep veneers. Additionally, because the porcelain is thinner and thus more transparent, they may not be the best option for patients who want to close gaps between their teeth. Ultimately, patients should only make their final choice with the help of their cosmetic dentist.

Preparing the Teeth

When patients select traditional veneers, the preparation process is extremely important. Proper groundwork helps to ensure a natural look and a strong bond between the teeth and the porcelain.

The Removal of Enamel

First, the dentist removes a fine layer of enamel from the front of the teeth to be treated. The exact amount of enamel depends on the patient's individual needs and the type of veneers being placed. However, in most cases, the dentist typically removes about .5 mm to .7 mm of dental material from the front of the teeth. In many cases, the amount is so small that no anesthetic is required.

Dental Impressions

When this first step is complete, the dentist takes impressions of the teeth. Traditionally, he or she will do this by placing soft putty into a tray. As the tray rests in the mouth, it hardens around the teeth. Then the dentist sends these impressions to an off-site dental lab. If a dentist uses advanced CEREC® technology, he or she takes a detailed sequence of pictures, which feeds into a chairside computer. Dental software generates a three-dimensional picture of a patient's mouth, and an in-office milling system fabricates veneers using these highly precise images.

Temporary Veneers

If a dentist works with an off-site lab, it typically takes one to two weeks before the veneers are delivered to the office. In these cases, the dentist may provide patients with a set of temporary veneers. Sometimes, patients are troubled by the appearance of their smile following the enamel removal. More often, dentists place temporary veneers to protect the underlying dentin and prevent sensitivity. Usually they determine whether temporary veneers are necessary based on the amount of enamel removed.

Fabricating the Veneers

The veneers fabrication process varies slightly, depending on the specific type of porcelain used, but for the most part, the procedure remains largely the same. Using the impressions sent by the dentist, a ceramist creates a working model. Inside this replica, he or she builds up multiple layers of porcelain, using intense heat or pressure to increase the strength of the material. All layers of porcelain may be the same shade, or the ceramist may hand-paint each layer for the most lifelike appearance possible.

Single-Visit Fabrication

When a dentist uses CEREC® technology to fabricate dental veneers, the process is much quicker. After analyzing the computer images and making any necessary adjustments, the dentist sends the images to a milling system. Much like a 3-D printer, the machine creates customized veneers from a single block of porcelain in a matter of minutes. The dentist selects the shade of porcelain that most closely matches a patient's teeth. He or she can further personalize the restorations by painting or polishing the material.

Placing the Veneers

When the veneers are complete, the dentist double checks their shape and appearance. In particular, he or she makes certain that the porcelain does not affect the patient's bite or cause any alignment issues. If necessary, he or she can trim down and reshape the porcelain. The dentist also checks the color of the veneers against the natural shade of the patient's smile. Although veneers are already made of custom-matched porcelain, the dentist can often fine-tune their appearance by selecting the right shade of bonding material. During this assessment process, patients should work closely with their dental practitioners to ensure their desired outcome.

Etching the Tooth

Immediately before placing veneers, the dentist applies an acid gel to the teeth. The gel dissolves some of the minerals on the surface of the teeth, creating a rough surface on the microscopic level. Then he or she coats the teeth in a bonding agent, and the solution adheres inside the tiny fissures on their surface. This process creates a strong base for the porcelain veneers.

Cementing the Veneers

Finally, the dentist spreads dental cement on the back of the veneers and affixes the porcelain on the front of the teeth. As stated above, the color of cement is specifically chosen to coordinate with the veneers and match the natural color of a patient's smile. After applying a gentle force to set the porcelain in place, the dentist uses a curing light to harden the cement. The light stimulates a chemical reaction in the bonding agent, causing the cement to set in a matter of minutes.

Combining Porcelain Veneers with Other Treatments

While you can certainly have just one or two porcelain veneers placed on your teeth and call it a day, you can also combine veneers with other cosmetic treatments as part of a more comprehensive smile makeover plan.

You can also combine veneers with other cosmetic treatments as part of a more comprehensive smile makeover plan

Teeth Whitening

Although veneers are often used to cover up dental stains, they are typically considered a solution for intrinsic tetracycline stains. When patients use veneers to cover up one or two intrinsically stained teeth, their other teeth may appear discolored in comparison. By selecting professional teeth whitening, they can harmonize the color of their smiles. Professional teeth whitening can be performed at home or in the office, and a cosmetic dentist will help patients select the right option for their budget and lifestyle.

Gum Reshaping

Gum reshaping, also known as gum recontouring, is one of the procedures most commonly combined with veneers. Together, the two procedures are an excellent solution for a "gummy smile," characterized by disproportionately small teeth and large gums. Typically, a cosmetic dentist plans both procedures together to ensure a beautiful, well-proportioned smile. Gum reshaping can be performed using manual instruments or a surgical laser. The latter method is becoming increasingly popular, thanks to its minimal discomfort and recovery time. After carefully planning the new shape of a patient's gum line, a cosmetic dentist carefully remove excess tissue and smoothes ragged edges for a smoothly contoured appearance.

Restorative Treatment

Veneers are an excellent way to restore teeth with minor structural damage. However, the thin porcelain is not strong enough to restore severely damaged teeth. If a patient has a large crack, a broken tooth, or extensive dental decay, a crown may be the best way to repair these injuries. Missing teeth can be replaced with dental implants or bridges. When combined with restorative treatment, veneers can help to reinstate a patient's smile and dental functionality.

Smile Makeovers

Although veneers can completely enhance a person's smile, for the most comprehensive results, patients often choose to undergo smile makeovers, combining two or more cosmetic procedures. This treatment is completely customized based a patient's individual needs and goals. When patients come in for their initial veneers consultation, they should mention their interest in a smile makeover so the dentist can create a single treatment plan that includes all procedures.

Results

Following their second appointment, patients who choose veneers leave the office with a completely enhanced smile. In the case of no-prep veneers, many people enjoy a one-day transformation.

Recovery

After receiving porcelain veneers, there is no recovery time. Unless patients have opted for dental sedation, they will be able to drive themselves home from the office, and they can immediately go about their daily routine, including physical activity. Following the enamel removal, patients may temporarily experience some mild discomfort. For about a week, they may want to avoid very hot or cold foods, as well as extremely chewy, hard, or crunchy food. When this initial sensitivity wears off, however, patients should be able to return to their normal dietary habits.

Durability

On average, veneers last about 10 years, and as dental porcelain becomes stronger and more durable, their lifespan may increase significantly over the next several years. Of course, veneers, like natural teeth, are still susceptible to damage. If a veneer breaks or comes off, patients should carefully store any missing pieces and bring them to the office as soon as possible for repair and/or reattachment. When this is not possible, there are several alternative options, including dental crowns or cosmetic bonding. Fortunately, patients typically do not experience any discomfort if their veneer breaks or comes off.

Caring for Porcelain Veneers

After the placement of porcelain veneers, patients should commit themselves to good oral hygiene regiments, regular visits to the dentist, and generally healthy lifestyles. This helps to ensure the longevity of the veneers, not to mention good oral health.

Preventing Decay

With proper care, veneers are much more likely to reach the 20 year mark. Along with making regular visits to a general dentist, routine brushing and flossing is the most important thing that patients can do to protect the longevity of their veneers. Although the porcelain itself is not subject to decay, when the underlying tooth structure is damaged by cavities, this can damage the veneer. In many cases, after the cavity is repaired, the tooth is no longer able to support a new veneer.

Protecting Gum Health

Good oral care is also important because it helps prevent gum disease and receding gums, which can compromise the appearance of veneers. Because the porcelain ends at the gum line, if the tissue recedes, the edge of the veneer will become visible, and the entire restoration may need to be replaced. Patients should be diligent about frequent brushing and flossing, but they should also be careful to avoid overly vigorous brushing, as this can also compromise periodontal health.

Avoiding Excessive Force

Habits such as nail biting, chewing ice, and using teeth to open packages are already harmful to teeth, leading to cracks, chips, and dental erosion. Although porcelain is quite strong, it is not quite as tough as natural teeth, so these habits are even more detrimental to patients with veneers. Those with bruxism should also seek treatment before getting veneers or as soon as the condition develops. Although lithium disilicate veneers have proven to be durable even for habitual teeth grinders, treating this condition can further extend their lifespan and protect against related health conditions.

Maintaining the Color of Veneers

Because porcelain is not porous, dental veneers are highly stain resistant. However, the dental cement that holds them in place is still subject to discoloration. When this becomes stained, the edge of a veneer can appear yellowed and unnatural. To protect the color of their smile, dental patients should avoid stain-producing substances such as coffee, tea, wine, berries, soy sauce, and tomato sauce. Smoking is perhaps the most notorious culprit for dental staining.

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Aesthetic Benefits

Few cosmetic dental treatments offer the comprehensive results and aesthetic benefits that veneers can provide. In a single treatment, veneers can correct surface flaws such as chips and cracks. As mentioned above, they can also conceal dark tetracycline stains, which cannot be treated with traditional teeth whitening procedures. Veneers can also change the shape of teeth, often making these enhancements an ideal solution for patients with proportionately small, worn, irregularly shaped, or pointed teeth.

Veneers and Light Reflection

Natural dental enamel is translucent. Light shines through this layer and bounces off the underlying dentin, giving smiles their healthy sheen. Dental porcelain is also semi-translucent, meaning that light reflects off of the restorations just as it does off of dental enamel. Thanks to the highly customized fabrication process described above and the way light interacts with the restorations, porcelain veneers are virtually indistinguishable from enamel. Patients can enjoy a thoroughly enhanced but completely natural smile.

Advantages over Other Procedures

In addition to the comprehensive nature of veneers, this treatment offers a number of advantages over similar alternatives:

• Veneers are stain resistant and last for years at a time. When patients choose teeth whitening treatment, they often receive less dramatic results and must undergo touchup treatments approximately twice a year.
• Veneers look more lifelike than similar enhancements. Cosmetic dental bonding can correct similar flaws, but the material is opaque, meaning it does not reflect light the way porcelain does.
• Veneers are stronger than composite resin.
• Although veneers typically cost more than bonding or teeth whitening, they usually have a smaller price tag than dental crowns.

Increased Confidence and Happiness

One of the biggest advantages of porcelain veneers is the effect they can have on a patient's self-assurance and emotional wellness. When patients feel good about the appearance of their teeth, they are more likely to smile. In turn, this can increase their mood, social life, and even professional success. Multiple studies have proven that smiling directly impacts emotion; a landmark study conducted by Dr. Robert Zajonc in 1989 found that even a forced smile could actually make people feel happier. Zajonc theorized that the when people activate the muscles needed for smiling, it actually raises the temperature of blood travelling to the brain. In turn, these higher temperatures stimulate the parts of the brain that control emotion.⁴ Not only are veneers a great investment in a patient's appearance, they could also be an investment in their overall wellbeing.

Oral Health Benefits

The primary benefits of veneers are cosmetic; however, there are several ways that they can boost overall dental health. First, they can lend some strength to damaged teeth. Patients should note, however, that veneers cannot restore a severely damaged or weakened tooth. In these cases, a dental crown will provide better protection for a patient's oral health.

Encouraging Oral Hygiene

Veneers can also promote good dental hygiene. When patients have a beautifully enhanced, natural smile, they are more likely to practice outstanding care and maintenance. At their initial consultation or at any time during the placement process, patients should ask their dentist about the best way to care for their veneers and protect the underlying teeth.

Health Advantages over Other Dental Procedures

Although veneers typically require some enamel removal, this procedure leaves the majority of the tooth structure intact. In contrast, to place a crown, a dentist must reshape the entire tooth, removing a significant amount of dental material. For patients looking for a more conservative option with minimal tooth modification, veneers may be the ideal alternative.

Instant Orthodontics

For cases of minor misalignment and bite problems, porcelain veneers can serve as a sort of "instant" orthodontics, dramatically improving the appearance and function of the teeth without requiring the months or even years needed with traditional orthodontics.

Repairs for Gapped Teeth

Diastema, or gapped teeth, can occur for a number of reasons, including genetics, gum disease, an incorrect swallowing reflex and irregularly sized teeth. Many patients assume that the only way to correct gaps in their smile is to undergo several years of orthodontic treatment. While this may have been true in the past, today veneers offer an immediate solution. By creating veneers that are slightly larger than the underlying teeth, a cosmetic dentist can close in this space with porcelain restorations.

Enhancing Crooked Teeth

Patients with only slightly misaligned teeth or with a single severely crooked tooth are understandably reluctant to wear braces for several years. Fortunately, veneers are an effective and fast alternative. By placing a new façade, a cosmetic dentist can mask irregularly rotated or positioned teeth. At the same time, the restorations can mask other flaws for instant orthodontics with additional cosmetic benefits.

Veneers and Severe Orthodontic Issues

Patients who are considering veneers for instant orthodontics should note that this treatment is not considered an effective option for severely crooked teeth or malocclusion. Because veneers do not actually correct the underlying tooth structure, patients with serious orthodontic issues should address these problems to prevent complications such as dental erosion or TMJ. Additionally, when patients who have malocclusion receive veneers, the restorations often have a very short lifetime; the porcelain faces constant pressure from the dental misalignment. In a relatively short time, this can lead to structural damage, or a veneer can come off entirely.

Risks

As with any medical treatment, there are some risks associated with the placement of porcelain veneers. For the most part, these risks are minor and quite rare.

Tooth Sensitivity

Veneers are considered a very low-risk treatment. However, as with any medical or dental procedure, there is some chance of complications. Because this treatment often involves enamel removal, the biggest risk is that a patient will experience permanent tooth sensitivity, especially to hot or cold temperatures. Typically, if sensitivity lasts for more than 3 to 6 months after veneers placement, this indicates an underlying problem with the procedure. For example, the dental cement may be leaking or the nerve may have been exposed and infected during placement.

Dental Damage

There is also a slight risk that the underlying dentin may become damaged during the enamel removal process. Alternatively, a poorly fitting veneer could change the alignment of a patient's bite, leading to dental sensitivity, discomfort while eating, or, in more extreme cases, bruxism and jaw pain.

Future Replacement

Although veneers can last several decades, they must eventually be replaced, and the second placement process will involve another round of enamel removal. Those who already have some enamel erosion before their first treatment may not have enough material for a second placement. In these cases, they will require an alternative restoration such as cosmetic bonding or a dental crown. Patients should discuss their replacement options before receiving their first set of veneers. If they are not willing to consider alternative treatments in the future, they should not choose a procedure that will permanently alter their teeth.

Minimizing the Risks

As stated above, veneers are considered to be a very safe dental treatment, and there are several things that patients can do to further reduce their risks. First, they should be cautious when choosing their cosmetic dentist, following the guidelines listed above. By reading reviews from past patients, they can determine whether a particular dentist has a history of case complications. Second, if they are truly concerned about dental sensitivity or the permanent nature of veneers, patients may opt for no-prep veneers. Because they require little enamel removal, if any, the risk of sensitivity is lower. Patients should be aware, however, that some dentists believe no-prep veneers look less natural than traditional veneers.

Temporary Side Effects

While permanent sensitivity following veneers placement is uncommon, many patients do experience some mild temporary discomfort. Typically this sensitivity is most apparent during the first 1 to 3 weeks after veneers placement. Patients can control sensitivity by avoiding very hot and cold foods, especially in close succession. Patients should also try using desensitizing toothpaste for up 6 months after treatment.

Safety Data

In 2007, D.M. Layton and T. Walton conducted a seminal study on the durability and complication rates of veneers. Tracing the lifespan of 304 veneers placed by the same dentist in 100 dental patients, Layton and Walton found that approximately 96% of the veneers lasted 5 to 6 years, 93% lasted 10 to 11 years, 91% survived 12 to 13 years, and 73% lasted 15 to 16 years. Only 16 of the veneers failed. These failures were attributed to unsatisfactory aesthetic results, structural damage, loss of retention, and dental decay.⁵ A more recent study, published in the International Journal of Prosthodontics in 2012, traced the lifespan of 318 veneers placed in 84 patients between 1987 and 2009. The study concluded that 94.4% of the veneers survived 5 years, 93.5% lasted 10 years, and 82.93% lasted 20 years. Participants included 42 patients with bruxism and 23 smokers, indicating that veneers are a long-lasting option, even for these high-risk groups. ⁶ Neither of the studies reported any significant complications for the participants' overall dental or physical health.

Alternatives to Porcelain Veneers

If you or your dentist decides that porcelain veneers are not the right treatment for you for any reason, there are several other options that can rejuvenate and restore radiance to your smile.

Bonding

For patients with insufficient dental enamel or for those who are hesitant to permanently alter the structure of their teeth, dental bonding, often called composite veneers, may the optimal solution. A dentist applies dental composite to the front of a patient's teeth. This material is carefully selected to match the natural color of his or her smile. By carefully sculpting the material, the dentist can achieve many of the same results possible with veneers. Like veneers, bonding can correct severe stains, cracks, misaligned teeth, and gaps between teeth. Unlike veneers, however, composite resin is opaque and does not offer the natural sheen of porcelain.

Teeth Whitening

Patients who are looking to enhance the color of their smile may opt for teeth whitening. By chemically breaking down the bonds that hold dental stains together, both in-office and at-home treatment can lighten teeth by up to eight shades. However, this treatment is only suitable for extrinsic stains, such as those caused by food or smoking. Whitening treatment will not affect tetracycline stains or the discoloration caused by decay or an old dental filling.

Dental Crowns

In some ways, dental crowns are very similar to veneers. Custom-made to match a patient's natural teeth, these tooth-shaped porcelain caps fit over a damaged tooth. However, unlike veneers, a crown extends all the way around a tooth, meaning the dentist must remove a significant amount of the dental structure. Crowns are an excellent option for patients who have considerable damage that affects the strength or structural integrity of a tooth. However, for patients who are simply seeking cosmetic enhancements, veneers are an effective, less invasive option.

Orthodontics

As stated above, those with severely crooked teeth or malocclusion may not be good candidates for veneers. Rather, they may want to consider more comprehensive orthodontic treatment. Thanks to modern dental advances, patients are not limited to traditional metal braces; they can also choose tooth-colored brackets, clear aligner trays, and accelerated treatment options.

Frequently Asked Questions

Does the placement procedure hurt?

The placement of porcelain veneers is typically a pain-free procedure. Dentists usually numb the tooth and the surrounding area before removing the dental enamel. In many cases, this amount of enamel is so small that patients do not even require anesthesia. Once the enamel is removed, patients may experience some sensitivity, particularly before the veneers are attached; once the porcelain is in place, this discomfort should disappear within a few weeks. The attachment of veneers involves no discomfort, although patients may need a few weeks to adjust to the feel of the veneers in their mouths.

How long does the placement procedure take?

Traditional veneers placement takes place over two visits. The length of time required for each of these visits will depend on how many veneers a patient chooses to have placed. Following enamel removal and dental impressions, it typically takes between 1 and 2 weeks for patients to receive their new veneers. When dentists use CEREC technology to fabricate veneers in the office, patients could enjoy a dramatically enhanced smile in just a few hours.

How do I know if veneers are right for me?

The only way to know if porcelain veneers are a viable option is through a complete evaluation and exam. A cosmetic dentist will examine a patient's dental history, as well as his or her current dental health and the condition of the dental enamel. The dentist will also explain other cosmetic treatments, so that the patient can make a fully informed decision about his or her dental care.

Do veneers look natural?

Veneers are among the most realistic dental enhancements available. Because they are custom-made for each patient, they will match the shape and color of the surrounding teeth. Additionally, because they are translucent, veneers interact with light just like natural dental enamel.

How many veneers should I get?

Veneers are intended to enhance the teeth that show when a patient smiles, so the number of veneers a patient needs partially depends on how wide their smile is. Some people only show six teeth when they grin, while others may display up to twelve teeth. Of course, a patient's specific cosmetic goals will also determine how many veneers he or she should receive. For example, if someone wants to treat a single chipped tooth, he may only require one veneer. On the other hand, if another patient wants to conceal widespread tetracycline stains, she could require as many as ten or twelve veneers. Patients will also need to consider their budget; because veneers are individually priced, the number of veneers is the biggest factor in determining the overall cost of treatment.

What happens if I only get veneers on my upper teeth?

Because veneers are custom-created to match the surrounding teeth, veneers can be an effective way to treat only the upper (or lower) teeth. However, many patients choose to have teeth whitening performed on the other dental arch for more comprehensive, uniform enhancement.

What should I do if a veneer breaks or comes off?

In the unlikely event that this happens, patients should gather any pieces and store them in safe place before calling their dentist. They should never try to glue the porcelain back in place, although, if they feel extremely self-conscious without the restoration, they can temporarily apply it with drug store adhesive. Many times, a dentist can reapply a broken or loosened veneer. In other cases, a dentist may need to replace the veneer or restore the tooth with another treatment such as a dental crown.

Can I get veneers if I have gum disease or dental decay?

Before receiving veneers, patients should have good dental and periodontal health. Although cavities or gum disease do not permanently disqualify patients from veneers, a dentist must treat these conditions before a patient undergoes any cosmetic enhancements. Veneers can be an excellent option for restoring a patient's smile after it is compromised by decay or a similar condition.

Is one type of veneers better than another kind?

Each type of veneers has its own advantages, and certain dentists prefer to work exclusively with particular brands or types of porcelain. Ultimately, the type of veneers patients choose will be based on their specific needs and the recommendations of their dentist.