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The opinions and photographs within this web page are not ours. Authors have been credited for the
individual posts where they are. - Photos courtesy of Winfried - www.rxroots.com
Advice on Veneers
From: Kevin Cook
Subject: Advice on veneers
Date: 2001-03-21 07:24:08 PST

I am giving some consideration to getting several veneers, both for cosmetic
and medical reasons.  My dentist basically has me sold on them, but I would
like to do some research on my own before getting started to ensure that
this will be a worthwhile investment.  Can anyone recommend some websites or
internet resources to help me learn more about them?  I am particularly
interested in unbiased medical opinion as well as consumer opinion.

This is as good a place as you're likely to find on the internet.  Anything
specific you'd like to know?
They're not a panacea, but done in appropriate instances they work very
nicely and patients are usually very happy.
What medical reasons do you have for getting them?

Steve
Mark & Steven Bornfeld DDS

How old are you and why are they being recommended?

I'm 34. I have a great deal of bonding covering a long history of decay,
most of which is on the front surfaces of my teeth and are quite noticeable.
Long story short, my teeth are pretty darned ugly, and I want to improve my
smile.  The recommendation is that the veneers will protect my teeth from
further decay, and will be worth the expense as a better long term
alternative to bonding.

Steve,

"Medical reasons" may not have been the best choice of words - let me
explain.  Essentially, I have a mouth full of composite.  Every tooth, top
and bottom, has at least one filling, many have several.  The majority of
the decay has been on the outer (front facing) surface, primarily at or near
the gum line, and many of the fillings are quite large.  In some cases, so
much tooth structure has been lost that my dentist has recommended  some
crowns (probably two or three teeth in various locations).  A few others are
on their way to the same recommendation.  I am told that porcelain veneers
are a better long term solution for the teeth that do not require crowns as
they will protect my teeth from further decay and eliminate the need for
periodically replacing my existing fillings (and some of the older ones do
need replacement).  As much as the state of my teeth may sound like I am
pretty negligent when it comes to dental hygiene, trust me, that's not the
case!  I anticipate that what I believe to be a genetic proclivity to tooth
decay will continue until all the enamel is gone!  So by medical reasons, I
really meant that there is a basis other than just cosmetic reasons for
considering this, in that veneers may help to preserve what is left of my
teeth.

OK, so there is some vanity basis!  Of course I don't need veneers for all
my teeth, but if I am getting a few caps, and potentially some veneers for a
few teeth whose future without them may be questionable, then this may be
the best opportunity to voluntarily cover up some of the more noticeable
teeth that are speckled with discolored bonding and really improve my smile.
I just endured braces for almost two years, so I am committed to making
improvements!

I am not exactly wealthy, and veneers are certainly not cheap, so I need to
be comfortable that this large expense is the right thing for me.  I like my
dentist a lot, and I don't doubt that his recommendations are what he
believes to be the best thing to do.  I just have some reservations about
this, and want to make an educated decision because there is no going back
once I've done it.  Here are my concerns, and the questions that I hoped to
answer by finding some sort of forum with feedback from others who have
gotten veneers:

-Are they secure enough that I can eat corn on the cob and bite into apples,
and basically just not worry about them coming off?

-How likely are they to last ten years at a minimum, perhaps 20, or
potentially a lifetime (I'm 34)?

-Could there really be a long term savings over doing bonding (and replacing
it periodically) as an alternative?

-Are they as comfortable as natural teeth?

Thanks in advance for your insight and advice!

Kevin Cook

Teeth that are susceptible to decay may be  better served with crowns.

Veneers are indeed restorations in the reparative sense, not just a cosmetic
procedure.  What Joel said is true; that for patients with uncontrolled decay,
crowns sometimes are a better choice, since there is less tooth structure, and
esp. less restorative margin exposed to the oral environment.  But porcelain is
hard, pretty, and resists stain.  It does not have great shear or flextural
strength.  This means that chewing on pens, pencils and chicken bones is out.
One could say the same for porcelain/metal or all ceramic crowns.  I would give
the edge on esthetics to porcelain laminate veneers or all ceramic crowns.  The
appearance of porcelain/metal crowns is usually quite acceptable though.  The
edge on strength goes to the porcelain metal crown.  Of course, more tooth
structure must be removed in order to prepare a tooth for a crown than for a
veneer.  Frequently any of the above options may be quite acceptable.  The
selection is a judgement call, based on the factors I mentioned above.

Steve

Hi Joel,

You wrote:

<< Teeth that are susceptible to decay may be  better served with crowns.>>

Although we may agree on this point, the bottom line is teeth that are
susceptible to decay may be better served by improved home care.

Stan

Kevin:

Q: -Are they secure enough that I can eat corn on the cob and bite into
apples,and basically just not worry about them coming off?

A: Yes, they are secure, just do it slowly and carefully, do not abuse of
crowns nor normal teeth (I mean don't bite like a hungry teenager and don't
open beer bottles with your teeth)

Q: -How likely are they to last ten years at a minimum, perhaps 20, or
potentially a lifetime (I'm 34)?

A: If you brush and floss enough, and might use some clorhexidine mouth
rinse, or something like a Listerine (ask your dentist) to help you fight
the bacterial plaque, they are likely to last longer than a lifetime.
I agree with Dr. Bornfeld about metal-porcelain crowns having better
flextural strength, and about that more dental tissue must be removed for
the preparation, porcelain might crack in both kind of crowns, (but it would
be a repairable accident)

Q: -Could there really be a long term savings over doing bonding (and
replacing it periodically) as an alternative?

A: I would think so! remember the hole in a tooth gets BIGGER each time a
filling is changed, so if you continue doing it at some point you'll reach
the time when you do crowns or... crowns or...a removable prothesis after
extraction.

Q: -Are they as comfortable as natural teeth?
A: Yes they are!

Cheers  ,Dr. Gabriel Schugurensky

I don't disagree that this is really the best advice of all!  Honestly, I
really do the best that I believe I can.  I brush and floss constantly.  In
fact, having had braces recently, I am in the habit of carrying a brush and
paste wherever I go!  Still, despite a dental hygiene regimen more
aggressive than anyone I know, I still have new cavities waiting for me at
every six month checkup.

Just make sure you know the long term issues with all your options.  For
example, make sure you can afford all re-dos and touch-ups that may be needed
in the future.

Veneers are better than bonding, being porcelain instead of plastic, but they
won't protect cavity prone teeth from decay.

Full coverage crowns will do this.  But for optimum cosmetics you want ALL
porcelain crowns.  These are best available from a "CEREC" dentist.  Look that
up on a search engine.

One of the most difficult aspects of cosmetic dentistry and crowns, or veneers
is the effects of the temporary crowns you wear while you are waiting for the
lab to make the permanent ones.

CEREC eliminates this altogether.

You can have your treatment finished in one visit and have no temporaries or
impressions to worry about.  If you don't like one of the CEREC's the dentist
can make you another one on the spot. Check it out! - Larry Fincher DDS

One of the drawbacks to CEREC is the fact that they are monochromatic.  If
you're looking for the ulitmate in esthetics, this is a problem.  BTW, this is
also a problem with Emress, but it can be addressed by having the lab do a
cut-away technique and then add some other shaded porcelain where you want it.
CEREC doesn't allow for this.  Sometimes monochromatic will work, but how many
anterior teeth are truly monochromatic?

Nice hidden advert, doc.  There is not much evidence for this statement.
Cerec is good, but not there yet in fit. just my opinion.

Frank,

The full coverage Cerec crowns look great on premolars and molars right out
of the machine.  There is enough translucency and enough richness to the
color that they generally look better than PFM's.  To do cuspid to cuspid
really requires custom staining and glazing.  The variation of color in a
natural tooth is much greater here.  I am quite amazed at how good these
things can look as full crowns! - Stephen Mancuso,D.D.S.

Frank,

The fit is comparable to a laboratory porcelain margin.  You can still get a
better marginal adaptation with a gold margin.  But,,,,,,,,,,,,,,,, is it
significant??

Stephen Mancuso,D.D.S.
Troy, Michigan   USA
Toughest root canal

Retricted mouth opening

Deep decay

Upper second molar

Open sinus lift

Implant after extraction

Implant # 20

Implant # 30

Irreversible pulpitis

2 step necrotic case

Fracture

Lesion on MB

Endo perio case

Surgery or implant

Silver point removal

Series of cases

SS reamers and files

Single visit RCT

Ortho resorption

Apico retreatment

Apical perforation

Funky canine

Crown preparation

Two tough molars

Epiphany recall

To squirt or not

Core distal end

MTA miracles

Pain with LR

Instrument removal

3 canals upper Bi

Acute pain

Dental decay

Calcified chamber

Mandibular first molar

Ultrasonic activation

Fluorosis

TF and patency

Interim dressing

Huge lesion

Tough distal canal

Debris in pulp chamber

Access and success

Restricted mouth opening

Broken drill fragment

MB2 or lateral

Gutta percha cases

Another calcified

Big Perf

Canals and exit

Dam abuse

Amalgam replacement

Simple MTA case

MTA barrier

Restoration with simile

Immediate implant

Traumatic accident

Lesion on D root

Extract / Implant

Carious exposure