Index / Cosmetic
Porcelain veneers
A layer added,
not a tooth
replaced.
A veneer is a thin shell of ceramic bonded to the front of a tooth. Done properly, very little enamel is removed, the bond is to enamel rather than to dentin, and the tooth underneath is still a tooth.
Why people come here
- He teaches occlusion and full-mouth rehabilitation to other dentists
- Fellowships in three academies — FAGD, FACE and FICOI
- The complex cases other practices refer out
- A written, itemized plan before anything is scheduled
What it is
Thin is in — and he
wrote the article.
A veneer covers the front and the biting edge of a tooth. A crown covers all of it. That difference matters, because the strongest bond in dentistry is ceramic to enamel, and a conservative veneer preparation stays in enamel almost everywhere. A crown does not.
Dr. Nosti published Thin Is In in Dentaltown in March 2012 and Porcelain Veneers: From Case Selection to Cementation in March 2013, and teaches veneer preparation and cementation to other dentists. The argument in both is the same: the less tooth you remove, the better the bond, and the longer the result lasts.
Where teeth are crowded or tipped forward, the conservative route is often to move them with aligners first. It adds months and usually removes the need to cut into healthy tooth to make room for ceramic.
Materials
Not all ceramic is the same.
The material is chosen for the case, not for the price list. Each one trades beauty against strength differently.
Feldspathic porcelain
Built up by a technician in thin layers by hand. The most lifelike material available and the thinnest achievable, which makes it the most conservative. It is also the most technique-sensitive and the least forgiving of a heavy bite, so it is reserved for cases where the occlusion has been dealt with.
Lithium disilicate
Pressed or milled glass-ceramic — the workhorse of modern cosmetic dentistry. Strong enough for most front-tooth situations, beautiful when layered and stained properly, and predictable in a way that hand-built porcelain is not. Dr. Nosti is a key opinion leader for Ivoclar, whose lithium disilicate is the material most often meant when dentists discuss this category.
Zirconia
The strongest option, and the one to reach for when a tooth takes punishment or when there is dark underlying tooth to mask. Newer high-translucency formulations look far better than early zirconia did, but it is still a choice made for strength first.
Composite bonding
Done directly in the mouth in one visit, at a fraction of the cost, and reversible. It stains and chips sooner than ceramic and will need attention every few years. For a young patient, a small repair, or someone who wants to test a change before committing, that trade is often the right one.
The appointments
Four visits, two of them short.
Design and records
Examination, photographs, scans, shade, and the design of the finished teeth. Nothing is prepared at this visit.
Visit oneTrial and approval
You wear the proposed result, change what you want changed, and approve it.
Visit twoPreparation and provisionals
Minimal preparation, a final scan, and provisionals built to the approved design so you leave looking like the plan.
Visit threeBond and check
Try-in, shade confirmation, bonding under isolation, then the bite is adjusted and verified with T-Scan before you leave.
Visit fourCandidacy
Veneers are not for everybody.
Reasons to do something else first
Or instead
- Untreated gum disease, decay or an infected tooth
- A heavy, unmanaged clenching habit — ceramic bonded onto that will break
- Very little remaining enamel, where a crown bonds better than a veneer
- Teeth that need large movements; aligners first, or orthodontics alone
- A tooth already heavily filled or root-treated, which usually wants a crown or onlay
A good veneer case
Where this works well
- Worn, chipped or short front teeth, with the bite addressed
- Teeth that have darkened beyond what whitening will fix
- Small gaps and mild crowding where the teeth are otherwise sound
- Old veneers or bonding that has discolored at the margins
- Enamel still present over most of the preparation surface
- A patient willing to wear a night guard afterward if clenching is a factor
Questions
Veneers, answered.
How long do they last?
Published survival figures for bonded porcelain veneers are generally in the region of ninety percent at ten years, and good cases comfortably outlast that. The variables that actually decide it are the bond to enamel, the health of the gums, whether the bite was corrected, and whether a clencher wears a guard.
Veneers are not permanent in the sense of never needing attention. Expect them to be a long-term restoration that is eventually replaced, not a one-time event.
Is it painful?
Preparation is done under local anesthetic and is not painful. Some sensitivity to cold and pressure for a few days after preparation is normal and settles. Where preparation is minimal, many patients report very little afterward at all.
Can one veneer be matched to my other teeth?
A single veneer matched to natural neighbors is the single hardest thing in cosmetic dentistry, and it is honest to say so. It is done — with a custom shade appointment and sometimes the technician seeing you in person — but the result is harder to guarantee than a set of several.
Can they be removed?
Not in the sense of being peeled off and the tooth returning to how it was. Any enamel removed to make room for ceramic does not grow back, so a veneered tooth will always need something covering it. This is precisely why the preparation should be as small as the case allows, and why the design is settled first.
Will they stain?
The ceramic itself does not stain. The bonding margin at the gum line can pick up color over years, particularly in smokers and heavy coffee or red wine drinkers, and the natural teeth around the veneers will continue to change color while the ceramic does not. That is why shade is decided after any whitening, not before.
Keep reading
Next step
Start with an examination and a straight answer.
A consultation includes an examination, the records the case needs and a written, itemized plan. If what you are asking for is not the right treatment, Dr. Nosti will say so and tell you what is.