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What is a Veneer?
A veneer is a purely aesthetic restoration which covers the buccal surface (facing the outside of the mouth) of a tooth and which may be made of either composite or porcelain material. More than ever, veneers are the subject of great interest due to the considerable demand from patients who want teeth that are whiter, perfectly aligned and flawless in color, shape or position.
Why a Porcelain Veneer?
Not all situations are suitable for direct composite restorations and these cases should instead be treated with porcelain veneers. Porcelain veneers combine the principles of tissular economy and adhesion to dental tissues to a very high level of aesthetic integration. Consequently, if a tooth is considerably altered, the composite will not be able to entirely mask the defects and a porcelain veneer will be able to provide a perfect integration which is both aesthetic and functional from the point of view of color and shape. The excellent clinical performance (both aesthetic and mechanical) of the cemented porcelain veneers has made them the preferred choice in terms of stability and longevity. This dentistry practice is less invasive; it is often conservative in terms of pulpal vitality and more sparing of natural dental tissues. Moreover, by avoiding the use of metal alloys, it is not only biocompatible but the resemblance with natural teeth is a significant asset.
The Treatment Plan
Any aesthetic treatment must first and foremost be part of a global approach by respecting certain imperatives, including biomechanical, biological, functional and, of course, aesthetics. It is fundamental to establish a treatment plan which is adapted to the individual patient. The plan must take into account the following parameters: the etiology of the coloration, the location of the coloration on the tooth, the occlusion, the oral hygiene, the age of the patient, the gingival health and the position and alignment of the teeth. Apart from the foregoing, the plan must take into account the preservation of the existing tissues, the aesthetic expectations and the critical evaluation of all the alternative therapeutic solutions. The dentist must make a choice bearing in mind that the possibility of a clinical revision surgery is of paramount importance. He/she must envisage not only the present but the future as well, since definitive treatments do not exist in dentistry. This is the reason why the dentist must consider from the outset what the next intervention will be in the event that a problem occurs on one or several teeth (all porcelain crown or porcelain-fused-to-metal crown). Once those imperatives have been defined, the dilemma of choosing between the all-composite and the porcelain veneer no longer exists: the two materials are not in conflict and, quite the contrary, may be utilized in harmony in the same patient.
Indications
Multiple colored teeth (tetracycline)
General defects of the enamel (decalcification)
Closing of spaces between teeth
Malposition and/or rotation of the teeth
Abrasion of the incisal tips of the teeth
Failure of the composites
Advantages
Highly aesthetic results
Strength of the cemented porcelainResistance to stains
Resistance to wear
Maintenance of healthy gums
Contraindications
Lack of enamel ordental structure
Extreme wear of the teeth
Extreme dental crowding
Parafunctional buccal habits (e.g. bruxism)
A patient who wishes to have a reversible treatment
Disadvantages
High cost
Time-consuming (requires two appointments)
Preparation of the tooth
Fragility of the uncemented porcelain
Possibility of wear of the opposite teeth
The Surgical Procedure
The first appointment (preparation of the teeth, impression and temporary restorations):
Prior to proceeding with the preparation of the teeth, it may prove necessary to perform a cleaning or to change the old restorations. The dentist must also make the choice of color for the new veneer taking into account, if possible, the color of the natural tooth and the preferences of the patient. Following this comes the preparation of the tooth. Generally speaking, the removal of a 0.5 mm layer of dental substance is sufficient. An impression of the teeth is then taken, following which the dentist fabricates temporary restorations on the modified teeth. These transitional restorations are important and must be carefully conceived. Not only do they protect the tooth and the gum, but they also play an important role in providing a preview of the permanent restorations by allowing the dentist and the patient to assess the therapeutic and aesthetic elements of the project.
The second appointment (fitting of the porcelain veneers, final cementing, finishing):
After removing the temporary restorations, the dentist proceeds with the final fitting of the porcelain veneers in order to verify their adaptation and their color. If no modification is required, the veneers are cemented, using clear resin cement.
Short-Term Considerations (30 Days Following the Installation)
It is particularly important to use caution during the first 72 hours following the cementing of the veneer as the resin which binds the porcelain to the tooth continues to set during that time. The patient must follow a soft diet, avoid extreme temperature variations in the mouth and refrain from consuming any food or beverage susceptible of causing a discoloration or coloration of the teeth (wine, coffee, etc.).Following this three-day period, the patient resumes a normal diet, however, the patient must avoid crunching hard candies, biting into crusty bread or nibbling meat on bones. The patient must undertake normal regular dental hygiene care (toothbrush and dental floss). Two to four weeks following the installation, a follow-up appointment is required in order to verify the condition of the restorations and allow the patient to provide feedback. Minor adjustments may be made if necessary.
Long-Term Considerations
Oral hygiene must be optimal in order to avoid any accumulation of plaque at the veneer/tooth junction. Ideally, subsequent appointments must be made with the dentist every three to six months in order to ensure the longevity and aesthetics of the veneers. The life span of the veneers is estimated at five to ten years and, as is the case for any dental restoration, there is a potential for failure of the treatment.
Potential Failures
Fracture
It is possible for fissures to occur in the porcelain prior to or during the cementing. These fissures may become more pronounced and appear as cracks once the veneer is installed. It is also possible that a clean break of the porcelain may occur during the installation when the veneer is being cemented.
Failure of the cementing
Complete bonding failure of the veneer is a rare occurrence. If it does occur, the dentist must start over. In the event that this problem occurs more than once, it is suggested that the veneer be replaced with a porcelain crown. When only one piece of the porcelain is broken, the dentist may try to put the pieces back together or fill in the gap with resin compound.
Marginal Infiltration
It is possible that an infiltration of fluid from the oral cavity occurs at the periphery of the veneer at the porcelain/tooth junction, creating certain problems such as unsightly coloration, staining, repeated cementing failure.
Color
Generally speaking, the color of the veneer remains stable during the first three years after installation. It is possible that the color may deteriorate with the passage of time. The infiltration of liquids at the periphery of the veneer may cause the occurrence of stains. As well, the color of the resin cement between the porcelain and the tooth may be altered, thus affecting the appearance of the veneer.
Informed Consent
Your prognosis is: Good Average Unfavourable
Informed consent is the result of a discussion between the patient and the dentist. This document is remitted for information purposes and may be completed or clarified during the exchanges with your dentist. Some dentists may furnish satisfactory explanations without remitting this document to the patient.
Explanations
if you need further explanations, the dentist will write them here
Informed Consent at the Time of Manufacturing a Porcelain Facing
I understand the advantages and the disadvantages associated with a porcelain veneer. The entire surgical procedure has been explained to me as well as certain considerations relating to diet, hygiene and subsequent appointments which must be taken into account on both the short and long term. I also understand that failures of the treatment remain possible and that a porcelain veneer does not constitute an end in and of itself.I have discussed all of the foregoing with my dentist, he/she has answered all of my questions and I hereby provide my informed consent to the treatment.
Signature of the patient:
Date:
Signature of the dentist:
Date:
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