Porcelain Veneers – are they the only way forward to enhance smiles ?


Forward thinking is essential to keep ahead in cosmetic treatments. In plastic surgery, liposuction and implants (breast and bum) which are some of the most common cosmetic procedures, have now been replaced by far less invasive treatments such as the zenora laser and stem cell injections. These newer procedures do not scar, have no post-operative pain and require no incisions.

Non invasive treatments are taking over. I thought I will explain this is some detail for those who might be interested. For many years patients have assumed that cosmetically enhanced smiles require porcelain veneers, tooth whitening or a bit of both. These treatments all have their place in dentistry but their popularity is often misunderstood.

All dental cosmetic treatments should start with a careful analysis of the concerns that the patients have..

– Is there a problem with the colour of the teeth/tooth ?

– Is there a problem with the position of the teeth/tooth ?

– Is there any wear or tooth tissue loss through trauma ?

You might be surprised to learn that porcelain veneers are not really indicated as the first-choice treatment for that latter two problems.

Veneers really started off their existence with the view to masking discolouration of teeth. Their rise to fame was brought about by certain TV programs where it was claimed that it was possible to change anybody’s life by subjecting them to multiple cosmetic procedures. Veneers have been overprescribed due to a boost in demand because of public perception. Those days are over !

It is possible, at present, to non-invasively treat many of the concerns patients have (regarding the appearance of teeth) without picking up a drill or an injection. We have highly polishable composite  materials (white fillings) with shades to match both dentine and enamel that can directly be added to the tooth surface, contoured by the dentist and completed  within very short appointment times. These treatments have high cosmetic value, carry no risks, create hardly any discomfort, remove no tooth tissue and are reversible. They can also be adjusted on future appointments (reshaped, added to etc.)  The finish is only up to the skill of your dentist.

We are able to improve the colour, shape and close gaps using these materials. The contouring procedures are carried out (in the best of practices) with fine gold tipped instruments and fine brushes. Unlike veneers, where they had to be sent away to a laboratory, and you had to wait 2 weeks to have them fitted – here the results are immediate.

So what are we saying ? Porcelain veneers are out ? NO. They still have a place in dentistry. It is just a limited one. They carry a risk of fracture and decementation. They are very difficult to adjust once cemented and they are expensive ! Above all, they are made by a laboratory technician. Some of who are very good at what they do. But they never get to see our patient. Only the dentist has had the privilege to assess the fine details such as symmetry and lip line with the patient. It follows that not all details of pre-operative assessment can be written on a lab sheet. There are too many variables for the dentist to mention and only a stone model for the technician to work on.

Finally, the right kind of dentist would want to take responsibility for his/her work. Like any job, we want to feel we did well. That responsibility is slightly diluted when the actual veneer/crown is made elsewhere by someone else. The most demanding cases carry the highest benefits for dentists, both professionally and emotionally. The personal touch is in the communication, understanding and chair-side adjustments. There is also that little something when we see the patient smile for the first time when they look in the mirror after treatment and we know they like it. And we hear a small voice in the back of our mind saying ‘I did that’.

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