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In dentistry, a veneer is a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth, or to protect a damaged tooth surface. There are two main types of material used to fabricate a veneer, composite and dental porcelain. A composite veneer may be directly placed (built-up in the mouth), or indirectly fabricated by a dental technician in a dental laboratory, and later bonded to the tooth, typically using a resin cement such as Panavia. In contrast, a porcelain veneer may only be indirectly fabricated.

• 1 History
• 2 Usage
• 3 Indications
• 4 Alternatives
• 5 See also
• 6 References

[edit] History

Veneers were invented by a California dentist named Charles Pincus [1]. At the time, they fell off in a very short time as they were held on by denture adhesive. They were, however, useful for temporarily changing the appearance of actors’ teeth.

Research started in 1982 by Simonsen and Calamia [2] revealed that porcelain could be etched with hydrofluoric acid, and bond strengths could be achieved between composite resins and porcelain that were predicted to be able to hold porcelain veneers on to the surface of a tooth permanently. This was confirmed by Calamia [3] in an article describing a technique for fabrication, and placement of Etched Bonded Porcelain Veneers using a refractory model technique and Horn [4] describing a platinum foil technique for veneer fabrication. Additional articles have proven the long-term reliability of this technique. [5][6][7][8][9][10][11][12][13]

Today, with improved cements and bonding agents, they typically last 10-30 years. They may have to be replaced in this time. The cost of veneers can vary depending on the experience and location of the dentist. In the US, costs range anywhere from $1000 a tooth upwards to $2500 a tooth as of 2009. Porcelain veneers are said to be somewhat more durable and less likely to stain than veneers made of composite.[citation needed][14],

[edit] Usage

When using veneers, the teeth’s appearance can be changed with minimal tooth preparation (e.g. drilling). Many veneer procedures can be done with the use of little or no local anesthetic. Traditionally, a reduction of approximately 0.5 mm is required for a porcelain veneer. Composite veneers are becoming more popular as they are easy to repair, whereas porcelain veneers have potential to fracture. It can be very difficult to match the shade of an individual veneer to the remaining teeth, hence placing several veneers is common.

There are some veneers which do not require any drilling in order to remove tooth structure. Instead, these veneers are constructed to be placed on top of teeth. As a result, treatment is less invasive and may be less time-consuming. One such popular option is Lumineers, a very thin piece of porcelain that is placed on top of the existing tooth structure that would allow alteration of the tooth color and shape.[15] However, it is important to keep in mind that such option is not for everyone. Since little to none tooth structure is removed in the preparation of Lumineers, some cases will result in bulky teeth.

Veneers may be used cosmetically to resurface teeth such as to make them appear straighter and possess a more aesthetically pleasing alignment. This may be a quick way to improve the appearance of malposed teeth without need to use orthodontics. However, the amount of malposition of teeth may be such that veneers alone may not be enough to correct them. Instead, orthodontics would need to be used, or orthodontics combined with veneers. The dentist who places veneers must be careful since veneers could increase the thickness of the front face of the teeth. If the teeth are too thick on the face they may appear to stand out and push out the lips. The effect may be enough to give the patient a full or donkey appearance when the lips are closed. Veneers must also be created such that the patient bites into them with minimal force. Otherwise, they may chip off. Patients whose lower jaw protrudes out farther than their upper jaw (known as a class III bite) may not benefit from veneers because the teeth of the lower jaw may bite into the teeth of the upper jaw such as to dislodge the veneers.

In recent years, it has become possible to fabricate porcelain veneers in the dental practice utilizing technologies and techniques associated with CAD/CAM Dentistry. [16][17][18] In a typical multiple anterior unit case, the patients salient front teeth are bonded with composite a day or two before the procedure to ensure that the shape, form, phonetics (speech) and occlusion (bite) are appropriate. Upon returning, the practitioner queries the patient as to their satisfaction. Once consent is given and appropriate type and shade of solid porcelain blocks are acquired, the practitioner then proceeds to correlate, or copy this bonded situation utilizing an imaging camera into the computer software. The teeth are then prepared. After preparation, the imaging camera is again utilized to image the prepared teeth and draw the data into the computer software. The software then superimposes the pre-operative situation with the prepared situation and measures are taken to complete all of the veneer restorations. These ‘virtual veneers’ are then sent to a milling unit which uses diamonds to carve the porcelain veneers out of the appropriately shaded porcelain blocks. After trying each of the veneers in, the practitioner then proceeds to apply stains and glazes to the veneers to accomplish whatever cosmetic/aesthetic outcome the patient is after. The customized veneers are then placed in an oven under heat and pressure to both strengthen and permanently integrate the colors into the restorations. A short time later, the veneers are acid etched, silanated and bonded in place using typical resin bonding techniques used with all porcelain veneer placement. Though technically difficult to perform, some practitioners are able to generate these high quality porcelain veneers that are customized on-site the same day, eliminating the need and inconveniences associated with temporization.

[edit] Indications

Veneers are an important tool for the cosmetic dentist. A dentist may use one veneer to restore a single tooth that may have been fractured or discolored, or multiple teeth to create a “Hollywood” type of makeover. Many people have small teeth resulting in spaces that may not be easily closed by orthodontics. Some people have worn away the edges of their teeth resulting in a prematurely aged appearance, while others may have malpositioned teeth that appear crooked. Multiple veneers can close these spaces, lengthen teeth that have been shortened by wear, provide a uniform color, shape, and symmetry, and make the teeth appear straight.

[edit] Alternatives

In the past, the only way to correct dental imperfections was to cover the tooth with a crown. Today, in most cases there are several alternatives: crown, composite resin bonding or porcelain veneer or even cosmetic contouring or orthodontics

Non-permanent dental veneers are available. These dental veneers are molded to existing teeth and are removable and reusable and are made from a flexible resin material. Do it yourself at home kits are also available for the impression-taking process. Actual veneers are made in the lab and sent to the wearer through the mail.

[edit] See also

• Cosmetic dentistry
• Crown (dentistry)
• Dental restoration
• CAD/CAM Dentistry

[edit] References

1. ^ Pincus CL.”Building mouth personality” A paper presented at: California State Dental Association;1937:San Jose, California
2. ^ Simonsen R.J. and Calamia John R. “Tensile Bond Strengths of Etched Porcelain”, Journal of Dental Research, Vol. 62, March 1983, Abstract #1099.
3. ^ Calamia John R. “Etched Porcelain Facial Veneers: A New Treatment Modality Based on Scientific and Clinical Evidence”, New York Journal of Dentistry, Vol. 53, #6, Sept./Oct. 1983, pp.255-259.
4. ^ Horn HR. “A new lamination, porcelain bonded to enamel”. NY St Dent J 1983;49(6):401-403
5. ^ Calamia John R. and Simonsen R.J. “Effect of Coupling Agents on Bond Strength of Etched Porcelain”, Journal of Dental Research, Vol. 63, March 1984, Abstract #79.
6. ^ Calamia John R. “Etched Porcelain Veneers: The Current State of the Art”, Quintessence International,Vol. 16 #1, January 1985.
7. ^ Quinn F Mc Connell RJ “Porcelain Laminates: A review”, Br Dental J. 1986:161(2):61-65
8. ^ Calamia John R. “Clinical evaluation of etched porcelain veneers” Am J Dent 1989:2:9-15
9. ^ Nathanson D, Strassler HE. Clinical evaluation of etched porcelain veneers over a period of 18 to 42 months J Esthet Dent 1989:1(1):21-28
10. ^ Strassler HE, Weiner S “Long-term clinical evaluation of etched porcelain veneers” J Dental Res 77 (Special Issue A):233 Abstract 1017,1998
11. ^ Friedman, MJ “A 15-year review of porcelain veneer failure- a clinicians’ observations. Compend Contin Educ Dent. 1998:19 (6):625-636.
12. ^ Calamia John R. “Etched Porcelain Laminate Restorations: A 20-year Retrospective- Part 1″ AACD Monograph Vol II 2005:137-145 Montage Media Publishing
13. ^ Barghi, N , Overton JD “Preserving Principles of Successful Porcelain Veneers” Contempory Esthetics 2007:11(1)48-51
14. ^ Calamia John R.,Calamia Christine S. Porcelain Laminate Veneers: Reasons for 25 Years of Success, Successful Esthetic and Cosmetic Dentistry for the Modern Dental Practice, Dental Clinics of North America. April 2007 Vol 51 No. 2 Calamia, Wolff, Simonsen Saunders/Elsevier, Inc., Veneers by Calamia, Enamelique.com [1]
15. ^ Lumineers versus Veneers <http://www.nydentalspecialists.com/lumineers.php>
16. ^ Meeting patient demand with computer-generated veneers. <http://www.ncbi.nlm.nih.gov/pubmed/12073478?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=5>
17. ^ Anterior direct-ceramic restorations using computer-aided technology. <http://www.ncbi.nlm.nih.gov/pubmed/10752429?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=8>
18. ^ Reproducing natural color effects on milled ceramic restorations. <http://www.ncbi.nlm.nih.gov/pubmed/11351485?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=7>

Prosthodontology Fixed Prosthodontic Restorations Removable Prosthodontic Restorations Prosthodontic considerations Maxillofacial Prosthodontics Other specialties
See also

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