Porcelain Veneers and Bonded Porcelain Restorations
Porcelain veneers have become
widely accepted as the benchmark of conservative cosmetic dentistry. They
have been used successfully to mask teeth which are discolored and poorly
shaped. Bonding ultra-thin shells of porcelain to teeth created many of
those Hollywood smiles that we envy.
Today, with the advancement in
adhesive technology, we can achieve truly tenacious bond strengths of
porcelain to tooth structure. As a result of this technology we are
capable of doing more with bonded porcelain than ever before. One such
application is the correction of mild to moderate crowding of the anterior
teeth or what we call Instant Orthodontics.
We call this instant orthodontics
because in as little as two weeks a patient can go from teeth that are
crowded to a perfect smile. Patients that decide to do instant
orthodontics usually have already explored the possibility of conventional
orthodontics and did not want to spend two to three years in braces to
align their teeth only to find that to correct the shape and color they
would have to do porcelain veneers.
Orthodontics vs Instant Orthodontics
One case in point, a patient
referred to me had gone through three years of orthodontics to align his
teeth. The orthodontist did the best that he could, but the patient was
still not satisfied with his smile.
He tried bleaching his teeth,
still not white enough! Something was missing. Clinical exam revealed worn
edges of the teeth and what we call a reverse smile line. In other
words, the edges of his upper teeth did not follow his lower lip line.
Instead the edges arched down in a frown.
Porcelain Veneer Technology
We created a whole new smile for him
with porcelain veneers and bonded porcelain onlays on his back teeth. The
patient was ecstatic! He then realized that all this could have been
accomplished without the discomfort of braces and waiting three
years.
Let's discuss the Instant Orthodontic
process
First, not everyone is a candidate. Teeth that are too
crowded can be difficult to optimally correct and a lot depends upon the
dentist's skill level. These are advanced bonding cases and they are not
for novices. So ask to see pictures of cases done by the
dentist.
Secondly, other options of correcting the crowding should
be discussed, namely conventional orthodontics. A referral to an
orthodontist for an evaluation would be a good idea.
Once it has
been determined that doing instant orthodontics with bonded porcelain is
the avenue of choice, diagnostic records are taken. Assuming that a
comprehensive exam has been performed, diagnostic photos and models are
made of the teeth.
The diagnostic photos can be digitally imaged to
give the patient an idea of what to expect. However, one must realize that
an imaged photo is only 2-dimensional and is a graphic artist's
interpretation of your future smile. In order to get a more realistic idea
of how to correct the crowding, a diagnostic wax-up is made.
The stone model of the patient's
teeth is shaped and built back to an ideal form with white wax. By using
the diagnostic wax-up we can tell how much tooth needs to be reshaped to
get that perfect smile.
The diagnostic wax-up also allows us to
fabricate temporary veneers and crowns for the patient to wear while the
ceramist fabricates their new teeth. With the temporaries in place, the
patient can visualize how they will look.
Additionally, it is at
this time that we can confirm the length and shape. If the patient is
pleased with the length and shape, an impression is taken of the temporary
veneers and an index is made so that the ceramist can more accurately
create what the patient is seeing. In other words, the more information we
give the ceramist, the more accurate the outcome.
Now that we have
our blueprint, we present the plan to the patient for approval. After the
patient approves the imaged photo and wax-up we schedule the preparation
appointment. At the preparation appointment we reshape the teeth to bring
them into alignment according to our wax-up so that the ceramist has the
necessary tooth reduction to build the teeth back to an ideal
shape.
Temporary veneers are placed and
the patient leaves the first appointment wearing a preview of their new
smile. At the next appointment, the temporary veneers are removed and the
permanent veneers are tried, fitted, and tenaciously bonded to the
teeth.
Then comes the best part. The patient is given a mirror, and
Voila!, watch their face light up as they view their new smile.