Using Cosmetic Veneers To Improve Crooked & Discoloured Teeth
Would it be better to have a veneer or a crown on this tooth?
Veneers or laminates are tooth-coloured materials which can be either porcelain, ceramic or composite material. They are “cemented” to the front surface of teeth to improve their cosmetic appearance.
My patients often ask me the question “Would it be better to have a veneer or a crown on this tooth?” I thought therefore that it would be useful to let you know some of the considerations in making the decision.
During my time in dentistry there has been a gradual move towards “minimal dentistry. Philosophically I do and always have agreed with this approach and base my practise on it. Veneers fit well into this minimalist concept where the principal objective is to minimise the amount of tooth removal. Veneers best provide aesthetic improvement for fundamentally sound teeth. Crowns by contrast have a much wider application but do require considerably more tooth removal.
There are two main factors that contribute to the limitations of veneers which are inextricably linked to the minimal tooth removal. Firstly they are very thin – about the size and thickness of a false fingernail. This thinness gives them a very natural appearance when a good underlying tooth colour can shine through, but makes it difficult to predictably mask out underlying discolouration.
The second limitation is that being purely ceramic they are in themselves fragile and obtain their strength from the bonding process to the tooth. Any weakness or failure of the bonding, either to tooth or veneer, can result in fracture or loss of the veneer.
Taking these factors into consideration, use should be restricted to situations where the bite is “light” and they are principally bonded to enamel as the bond to dentine is much weaker and less predictable. Many authorities consider it mandatory to wear a night guard to protect them in all situations.
How are Veneers different to Crowns?
Crowns by contrast are much thicker and so can mask out underlying discolouration and are inherently strong in themselves (you can pretty much jump up and down on them). They can, and frequently are, used to reinforce weakened back teeth and can be used to predictably restore “heavy” bites, needing night guards only in extreme cases. The trade-off for this is that rather more tooth must be removed. In my hands I find they provide better long term predictability.
There is one final major point of difference between veneers and crowns that patients enquire about. This is where they meet the tooth – “the margin” in our jargon. Veneers gradually blend in to the tooth at the margin so that this is hardly visible. With crowns there is a sudden transition, which is noticeable. To overcome this in aesthetically critical areas we hide the margin just below the gum line. When done carefully in a well looked after mouth, these stay hidden for very many years. However the potential need for replacement due to exposure of the margins in the long term should be borne in mind.
Indeed the need for bearing in mind the long term maintenance and possible need for replacement of both types of restoration is a very important consideration. In situations where the aesthetics are very important this may mean that if one restoration fails it may require others to also be replaced if a perfect match is to be achieved.
I hope this brief overview will give you a basis to help you decide between the two types of restoration should the choice arise. We will of course answer any further questions you may have at the time this consideration forms part of your treatment plan.