Q: Isn’t it necessary to grind down the teeth a lot in order to place veneers?

A: Not really. Although in a case where the teeth are very crowded it is necessary to remove a small amount of the enamel, in order to close spaces veneers cover the facial aspect of the teeth so I can change the shape and position. Porcelain veneers are a little like false fingernails for your teeth. They do not involve as much tooth reduction as fitting a crown, nor do they cover the whole tooth.

Q: But if Ms. S’s teeth are too forward, how do you correct the alignment with veneers?

A: That’s when porcelain veneers work best; when I can do cosmetic repositioning as an alternative to orthodontics. When I prepare the teeth to receive the veneers, I remove some of the enamel so there is enough room for the porcelain. To close the space I take away from the distal surface (away from the midline-the center of the face) and add to the mesial surface (towards the midline). On the laterals I add to the mesial surface, closing the space and making wider, more naturally shaped laterals to match the centrals.

Q: Ms. S chose to close her diastema. Do you feel that you influenced her decision?

A: One of the keys to establishing a relationship with a patient is determining how they feel when they smile, what they like or don’t like about their teeth. I believe in showing my patients all of their options, and we always spend some time reviewing photos of similar cases to figure out what the goal is. I think Ms. S felt self-conscious more because the teeth were forward, and because she had discoloration in the enamel (which we removed with bleaching), than because she had a diastema. But she responded most positively to photos where we had closed the spaces. I knew she wanted her smile to look natural, so we did a digital simulation on the computer showing how Ms. S’s smile would appear with the spaces completely closed, and partially closed. She liked the after-image without the diastema better. I think she looks much younger in her after-photo because her teeth are evenly positioned and the shade is lighter, and I know she is happy with the result.

Q: What is the main difference between this patient and Ms. S? A: Although this case also involves a diastema, the two patients have very different smiles. Ms. O has a peg shaped lateral incisor on the right side that does not match the opposing lateral on the left side. She also has very uneven incisal edges on the four front teeth that draw attention to the fairly wide diastema. Otherwise, the alignment and position of Ms. O’s teeth is normal. Consequently, Ms. O’s veneers are more to improve shape and shade than to correct positioning, and the choice over how much space to leave between the centrals is more personal and elective.

A: Yes, she was absolutely sure she wanted to keep the space, although we did lesson it by about a millimeter. Ms. O said her husband was enthusiastic about her having cosmetic dentistry, but he loved her smile and didn’t want her to make it any less unique. I believe she made the right decision, particularly because retaining the diastema made it look completely natural; her teeth look great but no one would guess she had any dental work done at all!

Q: How long do veneers like these last? Do they require replacement over time?

A: In most cases the expected lifespan of porcelain veneers and crowns is 10-20 years, although they frequently last much longer. The great thing about porcelain is its immutability-it doesn’t stain or discolor, and the bonding agent that secures it to the tooth makes it very strong and not easily subject to fracture. I always tell patients that they shouldn’t chew on pencils, or open potato chip bags with their teeth (and patients without porcelain work shouldn’t do this either), but otherwise there are no food restrictions. It is also important that the patient maintain the health of the tissue, and regular prophylaxis’ are essential so that the gums do not recede.

Q: How is this patient’s veneer case different from the others?

A: There are several aspects of Ms. C’s smile that can be improved: the shade, the shape and position of the teeth, and the area at the gumline. In order to improve the shade we did the Britesmile light activated bleaching technique to remove the yellow stains in the enamel.

Q: There’s a big improvement just from the bleaching. Is bleaching harmful to the teeth? A: No, bleaching is not at all harmful to tooth structure. Teeth whitening techniques have been performed for the past 15 years, and extensive studies have determined that there are no harmful side effects. Although teeth enamel seems very hard, it actually has microscopic pores that are prone to discoloration over time from age, smoking, and the staining substances that we eat and drink. Bleaching simply removes the stains in the surface of the enamel.

Q: How long did this whole process take?

A: Ms. C’s bleaching and veneers were completed over three appointments about a week apart. Today, teeth whitening can be completed in a single office visit with light activated bleaching in about an hour. For 24 hours after the technique patients must refrain from eating or drinking anything that would stain a white t-shirt. Most veneer cases require only two appointments; one to prepare the teeth, take impressions, and place temporary bonding so that the teeth look nice and you will be comfortable chewing, and the second to permanently place the veneers.

Q: Her smile looks completely different. How did the veneers change the shape of her teeth?

A: The biggest change comes from the tissue recontouring I did at the gumline. If you look at the before photo, you can see that not only was the right lateral protruding forward, but all of her teeth appear very square. Her gumline is straight across the top of the teeth, rather than following the natural arch of the teeth at the tissue. Also, when you smile your teeth should curve naturally, following the lower lip line with the front teeth longest and the laterals slightly shorter. Teeth should also be wider at the incisal edge and taper at the gumline. I was able to improve Ms. C’s "smile line" and the shape of her teeth by recontouring the tissue and changing the shape of her teeth with porcelain veneers.