Anterior Composite restorations versus Veneers?

Diastema
composite addition to close diastema

Dentists often plan smile makeovers with porcelain veneers on a routine basis. For a number of situations Veneers are the right choice, especially when teeth need to be lengthened or need a large amount of changes in their shape and position or color. Still for most of my patients I prefer to treatment plan tooth bleaching followed by minor bonding procedures to optimize smiles. Minor orthodontic movement employing tray aligners can play a part as well. Most of my patients esthetic needs do not require full anterior veneer restorations and if I can employ some small changes using composite and if needed, tray aligners,  the result can be both highly natural and cosmetic. Also, when I employ bonding I retain control of my patients esthetic choices and can leave a patients smile with their own unique character, since they can retain subtle idiosyncrasies that are unique to their own tooth arrangement.

Most ceramicists fabricating veneers employ a more idealized type of set up with all teeth in an ideal arrangement that looks good but sometimes is so uniform that it can look naturally perfect. Also due to the needs of the porcelain, sometimes these ideal setups are more prominent (slightly more facial at the incisal edges) than the patient's original teeth. The good news is that many patients find this prominence attractive and it is the look that they want. Many of our screen icons have had their teeth restored in this manner and having "movies star" teeth may seem desirable. That being said, I really prefer a more understated result, where the incisal edges are slightly more lingually placed and when I am fabricating veneers for my patients this need is communicated to my laboratories and often even after I get my finished veneers for my patients, I end up recontouring a portion of the labial surface and then polishing it afterwards with Brasseler polishing wheels.

Another reason I prefer composite, is I am often able to make my changes with more minimal preparation, since composite can be applied in thin applications and still look great. It does require some additional efforts  of a dentist, since color matching and carving skills are a must. Both porcelain and composite can chip or crack, but composite repairs using composite are simpler and usually more esthetic than composite repairs of chipped porcelain. Also composite can be often employed in an "additive manner", so that  minimal tooth preparation is required and composite can often be just added to existing tooth structure to achieve a more esthetic tooth.

Of course there are times when I employ treatment plan involving the use of porcelain veneers. Some patients don't like the shapes and color of their teeth and really need the type of full makeover that veneers can predictably achieve. Also some patients want  more monochromatic teeth. Natural teeth are usually not monochromatic and may have different zones of color and translucency that the patient may want to change. While composite certainly can be used to veneer teeth, it is not a material that I feel offers the most predictable results( in my hands) and if a patients needs 6-8 veneers I will choose porcelain veneers or crowns to accomplish their makeover

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2020/01/anterior-composite-restorations-versus.html - http://lspindelnycdds.blogspot.com/

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