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Porcelain Veneers

If you're unhappy at all with your smile, the chances are that porcelain veneers can give you the beautiful smile you want. But you have to understand that this procedure is just as much art as it is dentistry, and asking your family dentist to do this would be tantamount to asking your local painting contractor to create a mural for you. Knowing how to work with teeth is one thing. Knowing how to use dentistry to create a beautiful smile is something entirely different.

What Is a Porcelain Veneer?

The word "veneer" implies that this is something thin, and that is exactly what it is. You can see a photograph of one above. It's typically around half a millimeter thick (about the thickness of a fingernail), and it is bonded over your natural tooth. It is porcelain because porcelain can be baked with a durable glaze on it that resists staining even better than natural teeth. It is harder than enamel, and if placed correctly will last for many years. The color and translucency can be manipulated to look exactly like a natural tooth, so much so that even an expert cosmetic dentist, looking at your teeth from the front, should not be able to tell whether or not your teeth are natural or porcelain.

To be done properly, the teeth receiving the veneers should be prepared slightly beforehand. That way the margin between the veneer and the tooth can be made almost imperceptible.

In this electron microscope view, you can appreciate the importance of doing them this way. If the porcelain were on top of the enamel, it would be harder to achieve a seamless margin in the transition from the porcelain to the tooth. There would be a ridge that would tend to attract stain and plaque.
 

 

P = porcelain, C = composite bonding agent,
E = enamel, D = dentin
Image courtesy of sciencedirect.com

The Art of a Porcelain Veneer Makeover

The most important ingredient in a smile makeover with porcelain veneers (also called laminates) is the dentist doing the work. I have heard and seen many horror stories during my years as a cosmetic dentist. An estimated 30% of all cosmetic dentistry done in the United States involves re-doing poor quality cosmetic dentistry. Added to that, there is a lot of poor quality work that should be re-done, but the patient simply can't afford it. Don't let the next sad story be yours. My estimate is that from 98% to 99% of dentists aren't artistic enough or trained well enough to do a beautiful smile makeover, and this includes a lot of dentists who promote themselves as cosmetic dentists.

Here is an "after" photograph sent to me by a dentist who promoted himself as a cosmetic dentist:

While this is much better than the average work that we see, it is not what I would call a beautiful smile. The teeth are at least natural in color, are straight, and are reasonably pleasing. But they are overly bulky. The dentist, who is much better than average in cosmetic dentistry, chose to do this case with a no-preparation technique and used the Lumineers brand of porcelain, regarded by many cosmetic dentists as inferior.

Here is another case that was published by Dr. Ira Koeppel, a dentist recommended by the mynewsmile.com website. This person came to his office with these six porcelain veneers done by another dentist:

This is a truly sad case. The veneers are too white, opaque, overcontoured, and give the appearance of buck teeth.

Here is another case. In this photograph, the two front teeth are done:

Because of poor margin placement, there is stain showing between the front teeth. There is also some darkness at the gumline of the tooth on our right, which could be the result of one of several procedural errors.

By contrast, here is a case that I did in the 1990s:


Before

After
 
 

The point I like to make to people contemplating a smile makeover is this. Why spend any money at all if the result is going to be just mediocre? Save your money and wait until you can afford to have a beautiful smile. I have gotten a number of e-mails from patients who had these placed and felt like their own natural teeth looked better than the resulting smile makeover. What a shame, to waste thousands of dollars that way!

To find a dentist capable of doing a beautiful smile makeover, I recommend consulting the website www.mynewsmile.com. There I list dentists that I have personally screened for artistic and clinical ability.