Porcelain Veneers and Crowns

Dental or porcelain veneers are made out of ceramic (porcelain) and they’re one of cosmetic dentistry’s most powerful tools in creating beautiful smiles.  They are also called porcelain laminate veneers or just laminates.  Porcelain is very well tolerated by the body and is one of the most biocompatible dental materials available to dentists.  It takes great communication between the cosmetic dentist and the dental lab to ensure the proper material selection to best balance beauty, function and strength.  They can be as thin as a contact lens and are bonded onto your natural teeth.  Veneers cover the front and sometimes the sides of the tooth and crowns cover all surfaces of the visible part of the tooth.  There are several different types of porcelain with varying esthetic properties and strengths.  Some common materials used for dental veneers and crowns are feldspathic porcelain, and lithium disilicate (Emax).  Zirconia is another type of glass ceramic that is improving cosmetically and is the strongest ceramic type for dental restorations.  There is another type of veneer type called minimal prep veneers or more commonly Lumineers.  These can be great for certain cases and have advantages and disadvantages like all restoration types.  Dr. Tony Kim can help you with your dental veneer needs whether it’s fixing a single discolored tooth or a complete smile makeover.

This client came in with quite a few dental problems and some sub par cosmetic dental work.  Some new porcelain restorations have dramatically changed the smile and now she can smile with confidence.

This patient had small lateral incisors (peg laterals) and wanted veneers to make the teeth more proportional to her smile.  You can see that the color match can be done to mimic the adjacent teeth.  She now enjoys the smile she always wanted.

Porcelain (Ceramic) Veneers and Crowns can fix teeth that are:

1. Discolored – Porcelain veneers from a trained cosmetic dentist and a high quality lab can fix stained teeth that are discolored externally and internally.
   1. Coffee, tea, and red wine can discolor teeth over time.  Teeth whitening can be limited in effectiveness of whitening depending on the severity of staining.
   2. Some people have permanent discoloration of their teeth.  This could be from certain sicknesses or heavy antibiotic use when the teeth are developing.  Certain genetic conditions can also lead to discolored or damaged teeth.
   3. Teeth that have had root canals can darken over time.  This can be a very difficult condition to improve but there are special techniques that can be used.  Internal bleaching can be done by a general dentist and endodontists and this may help whiten teeth that have darkened from trauma.
   4. Old fillings that have been leaking for some time can stain a tooth from within.  Sometimes just replacing the filling can brighten the tooth but other times the damage under the filling can lead to infection and root canals.
2. Worn Down – Ceramic crowns and veneers can help rejuvenate teeth that have been worn over time.
   1. Poorly functioning bites can accelerate wear and flattening.  If teeth are rubbing each other in harmful ways, just imagine how many times this happens every meal of every day multiplied by years and decades of use.
   2. Clenching and grinding can severely damage teeth over time.  Most people who do clench and grind don’t even know that they’re doing it at night.  However, we can see certain patterns and conditions that occur from chronic clenching and grinding.  In severe cases, the teeth can wear down completely flat to the gumline.  Flattened teeth make us look older and make the smile less attractive.
3. Cracked/Chipped – Sometimes ceramic bonding can address these issues but for moderate and severe cases porcelain veneers is a great way to fix the damage and cosmetic issues of cracks and broken teeth.
   1. Can also come from poorly functioning bites.  Teeth that constantly hit each other in poor function will weaken them over time.
   2. Accidents or trauma to face.  Sport injuries, car accidents, and falling down on accident are common ways teeth break.
   3. Clenching and grinding will lead to more breakage over time.  Chips and cracks will appear more frequently if the bite dysfunction is not addressed.  As mentioned before, clenching and grinding really weaken teeth.
4. Have Spaces – This is a great situation for minimal prep porcelain veneers such as the Lumineers.  We can fix problems due to:
   1. Genetics.  if your mom and/or dad had gaps between their teeth there is a good chance you will too.  There are also genetic syndromes that will cause improper formation and sizing of teeth.
   2. Broken teeth.  If a front tooth has some of it’s side chip off, it can lead to a gap where the tooth broke.
   3. Teeth move slowly over time.  And if a tooth is lost prematurely, teeth can move around even more.
5. Are Crowded – Smile makeovers with porcelain veneers can fix cosmetic problems if you do not want orthodontics or if braces will not be enough to give you the smile your looking for.
   1. Teeth shift over time.  Crowing often occurs in the front lower teeth as time passes on.
   2. Lost retainers after previous orthodontics.  It’s a very common problem of having teeth relapse after braces.  That’s why is so important to always wear your retainer after braces are taken off.
6. Have previous fillings that are breaking down – Larger old fillings which have to be replaced are better protected with porcelain veneers or crowns.  Larger fillings are much more prone to breakage and then potential loss of teeth.
   1. White fillings that have discolored over time.  They can appear yellow or brown as stains and leakage increase.
   2. Silver/mercury fillings which have permanently stained teeth.  Over time leakage between these amalgams and the tooth can leads to dark grey and black stains in the teeth.

Here’s a video on porcelain veneers:

Benefits of Porcelain Veneers and Crowns

1. Look beautiful and natural
   1. Color matched to existing teeth.  Utilizing shade guides and photography we can get very close matches to your other teeth.
   2. Using high quality labs with artistic talent.  Talented technicians can take the data from the dentist and then translate that into beautiful restorations that look realistic.  It takes longer making porcelain restorations with multiple layers for most beautiful results.
   3. Some people want Hollywood white smile makeovers but others want more natural colors with even some imperfections built in for more realism.  We listen to what you want and will test out the makeover with temporaries so you can see in your own mouth what the shade will look like.
2. More Confidence
   1. More confidence leads to better self esteem.  I see this happen all the time.  People gain confidence in social situations because they know their smiles are not distracting people.  In fact they may get compliments about their smile makeovers!
   2. Better self esteem can help career, personal relationships.  It doesn’t take a genius to figure out that more confidence can easily mean more success in life.
3. Strong and Durable
   1. Hi tech materials are much stronger now than before.  Ceramics like lithium disilicate and zirconia are much stronger than the traditional porcelains.  Dr. Kim is a highly trained cosmetic dentist who can help decide what materials will work best for your situation.
   2. Properly functioning bites can greatly increase longevity.  When teeth hit at proper angles and have something called canine protected function then teeth tend to have much less wear over the years.  When somebody gets a full smile makeover an improvement in bite is always part of the plan.  For smaller cases where most teeth are not prepared, Dr. Kim still tries to figure out ways to improve the bite to maximize long term strength.
4. Don’t Stain
   1. Ceramics don’t stain the way teeth do.  They can slowly change color over time but they are much more resistant to the normal things that can stain natural teeth.
5. Repair damage.
   1. Veneers are a conservative approach to repair broken and damaged teeth.  There are large sections of teeth that are left untouched versus crowns which require preparation of the entire tooth.  Sometimes though, porcelain crowns may be necessary versus veneers due to the additional damage that has to be repaired.
   2. Can repair wear/stain/damage and improve bite at same time.  For severely damaged mouths, sometimes a full smile makeover can address multiple issues at the same time.  However, it requires a dentist trained in advanced occlusion and cosmetic dental techniques.  Dr. Kim does have the proper training and experience for this type of difficult dentistry.

Check out the video on cosmetic crowns and bridges:

My Thoughts on Lumineers versus Traditional Veneers

If you’ve been looking for a cosmetic makeover you may have read about Lumineers.  They are a brand name of a ceramic veneer that is designed to be cemented onto your teeth without any preparation or very minimal preparation of the teeth.  This sounds like a fantastic idea and there are a few situations in which this can be a very nice option.  However, from my experience and from that of many other experienced cosmetic dentists, there are some serious drawbacks to this type of veneer.  Because the veneers are bonded on top of your normal teeth, oftentimes they appear bulky and look like they are bulging out of your smile.  As a conservative minded dentist I totally understand and agree with the principle of minimally invasive dentistry.  But I also want to accomplish the cosmetic goals my clients want and expect.  So I believe the best approach is to take the smallest amount of tooth away to get a great result.  Because with a cosmetic veneer case, a beautiful and natural looking smile is usually the top priority.  I believe people would prefer more natural looking teeth versus thick and more opaque looking teeth.  But again, there are instances where minimal prep veneers or Lumineers may be appropriate and I would encourage an interested person to come in for a consultation to see if they truly are a good candidate for a Lumineer versus a traditional veneer case.

Lab Quality and Experience of the Lab Technicians

We send our porcelain restorations to the highest quality dental labs.  They all use high power magnification when creating their work for maximum accuracy at the margin area, which is a weak link with porcelain veneers and crowns.  Because there is so much involved in cosmetic veneers, a master ceramist is a critical part of the team of creating beautiful and believable smiles.  Some veneers can be more translucent and in other cases need more opacity.  The shapes of the teeth have to match the face and the strength of the bite needs to be studied as well.  In terms of cosmetic dentistry, a mediocre labs work put next to a superior labs work will reveal significant differences.

There are inhouse ceramic crown making machines such as the CEREC or E4D but we feel that a ceramic artist at a high quality lab can create superior esthetic restorations.  Also, understand that when your teeth are prepared for a porcelain restoration, you will have an acrylic or resin temporary fabricated and then cemented on the tooth for a few weeks while the final restoration is created.  If you have any questions regarding porcelain veneers or would like to speak with Dr. Kim, contact us through the website for a complimentary consultation.