To veneer or not, the dentist's dilemma?

Porcelain crowns and veneers 19 year post op


 Most patients seeking a better smile seek guidance from their dentists on how to improve their smile. Most are already familiar with porcelain veneers since they have friends or family who have chosen this route. The esthetic results are often determined by the lab and the dentists mission is to prepare and impression their teeth properly. Usually the lab provides a cosmetic wax up done over the patients study model. This wax up can be used to dress rehearse the case prior to tooth preparation and can be used to fabricate good looking temporization as well. At least some of the esthetic decisions are determined with the help of the lab. 

Patients seeking a treatment plan by a dentist about cosmetic dentistry would probably do best if they find a dentist equally familiar  with doing both esthetic restorations with composite as well as performing makeovers using veneers. Often the resulting veneers look good, but somewhat "fake", since the restorations tend to be more monochromatic that natural teeth and have somewhat stylized carvings. Digital designing can sometimes improve the appearance of the carvings since digital lab designers can sometimes use a digital library of  good looking natural teeth to help design and mill their restorations, but this is not possible if the veneers have an outer layer of feldspathic porcelain. Feldpathic porcelain is usually the most esthetic ceramic material, but it is usually shaped and carved by a ceramicist in an "analogue" manner. This makes the appearance dependent on the skill of the ceramicist involved. 

Many patients could benefit from good looking direct composite restorations, especially if they are more or less happy with their teeth but have small areas that need repairing or need small additions. When these are done properly the resulting restorations can greatly enhance smiles with minimal or no preparation of the patient's teeth. The results often do not alter the overall shape and character of a patients smile, just enhance it. Their friends may not even know what was done. They will only observe that their friend's smile is looking good! In my mind, this is the best that esthetic dentistry can offer, since the patient doesn't lose the look of their smile, but just enhances it. 

Another advantage of direct bonded composite restorations vs porcelain veneers , is that they are easier and less expensive to replace or repair. Since nothing lasts forever, this most likely will eventually become necessary, regardless of which type of restoration is chosen. 

There are many instances when porcelain veneers are the correct choice for a smile makeover. Adding overall length, changing the color of a smile without bleaching or when extensive additions are needed, porcelain veneers or even full crowns may be the best choice  Obviously, for those contemplating a smile makeover, their best option is to visit a cosmetic dentist versed in all types of esthetic procedures so that they can be fully informed about what option is best to improve their particular smile. 




from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2021/08/to-veneer-or-not-dentists-dilemma.html - http://lspindelnycdds.blogspot.com/

Comments

Post a Comment

Popular posts from this blog

Help! My Child is Terrified of the Dentist

Image
If you’re the parent of a young child, you know their brains are similar to sponges that soak up everything around them—especially in their first five years, which neuroscientists say is when they’ll do the most learning and developing in their entire life. At this formative time, your child may amaze you with what they notice: your facial expressions, the different tones of your voice, and your habits. If your habits include regular dental visits and an excellent oral hygiene routine, they’ll notice and want to emulate you. If you happen to feel anxious about your dental visits, or you groan when you’ve got to floss and brush, they may synchronize and feel your dread. This could lead to dental fears that stick with them for years—potentially a lifetime! Kids Can Be Courageous If you’re feeling guilty right now, go ahead and put that away as it won’t serve you or your little one. Everyone has some room for improvement, and Coastal Pediatric Dentistry® is here to help show you an
Read more

Going for the Gold?

Image
On the left is the older allow, on the right the new one that my lab has chosen to use The cost of a penny weight of pure gold is currently $79.53. The cost of a penny weight of pure palladium is $130.6. It used to be that palladium was added instead of gold to the precious metals often used for pfms, but now laboratories are finding that palladium is no longer affordable. The lab that I am using has just changed the formulation of the metal it's using to one that has more gold than palladium. I really do not mind, but metals with more gold are softer and often easier for a dentist to accidentally polish off delicate margins. It is important when polishing "higher gold" formulations to exert less hand pressure when performing the final polishing of the crown's margins. Other wise there should be no problem with this change. Traditionally labs have chosen alloys with higher gold percentages for optimal esthetics, since alloys with higher concentrations of
Read more

Tongue Ties: What Parents Need to Know

Image
For a long time, people just didn’t seem to know much about tongue ties. In the early years of my practice, few of my patients had ever heard of a tongue tie. When I pointed out that they or their children might be tongue tied, I was often the very first practitioner who’d mentioned it to them. When I told them that a tongue tie might actually be the root cause of their oral myofunctional issues, or even their sleep apnea , I’m sure that some of them thought I was crazy. But in the last few years, things have changed so much! Initially, there was a small increase in the number of patients who were contacting me specifically about tongue ties. Dentists and orthodontists also began reaching out more frequently to discuss the application of myofunctional therapy exercises to tongue tie treatment. But in the last year or so, that little bit of interest has become a surge of awareness. Tongue ties and their effects on health and craniofacial development are finally becoming mainstream.
Read more