The article on Dental Portal provides an in-depth look at veneers – thin micro-prosthetics for front teeth. It describes various types of veneers: composite, porcelain, E-max ceramic, and zirconium, along with their advantages and disadvantages. You will learn about the manufacturing technologies, including direct and indirect methods, as well as the differences in materials. The article also touches on the history of veneers and offers advice on choosing the right type based on individual needs.
What are Veneers?
Veneers are ultra-thin micro-prostheses in the form of overlays, made from ceramic or composite materials. They cover the front part of the teeth to correct external enamel defects. Veneers provide a perfect shape and color to the dental arch.
Their Appearance
Veneers are thin plates that mimic the appearance of real teeth: they replicate the enamel structure and are available in various natural shades.
Types of Veneers – Pros and Cons
In aesthetic dentistry, orthodontic plates are made using various methods from four types of materials.
Manufacturing Methods
- Direct (therapeutic) include composite plates. They are made directly in the patient's mouth in one visit.
- Indirect involve making plates from patient's impressions in a dental laboratory. This category includes all micro-prostheses except composite.
By Material
Composite veneers are made from standard filling material that hardens under exposure to light. They are created in two ways: directly and indirectly. The indirect method is used to restore the appearance of several teeth or an entire row of teeth. This process is similar to the production of ceramic veneers but uses the same material as the direct method. Indirectly made composite veneers are more expensive and durable than those made directly.
Advantages:
- Can be placed in one day (direct method).
- Easily replaceable.
- Good appearance.
- Relatively inexpensive.
Disadvantages:
- Short lifespan (3-4 years).
- Require regular polishing to maintain color and shine (every 3-4 months).
- The edges of the plates wear down.
- Prone to chipping.
- Can change color over time due to food dyes.
Porcelain Veneers. Porcelain or feldspathic ceramics were the first materials used for making veneers. They create cost-effective and aesthetic overlays with a color and transparency similar to natural enamel but are less durable than E-max. They are less expensive than zirconium and E-max ceramic veneers.
The manufacturing of feldspathic ceramic plates is done in three ways:
- Layered Application. Ceramic mass is applied layer by layer on a refractory base, with each layer fired at 900°C. Such plates are prone to chipping.
- Casting/Injection Pressing. Micro-prostheses are modeled from wax, then fired and a frame is formed for pressing porcelain. Finished plates are colored. Pressed plates are more robust than layered ones.
- CAD/CAM Milling. Plates are made from ceramic blocks. The dentist takes an optical impression, creates a 3D model in the CEREC program, and sends it to the milling machine. The plate is made in 10 minutes, then colored and glazed. Such micro-prostheses are more robust than layered and pressed porcelain.
Advantages:
- Natural appearance.
- Less expensive than indirect alternatives.
Disadvantages:
- Less durable compared to ceramics and zirconium.
E-max ceramic veneers, made from E-max glass-ceramic (lithium disilicate), surpass conventional ceramics in strength and appearance. They perfectly mimic the color and shape of real teeth.
There are two types of E-max glass-ceramics:
- E-max Press (pressed): Created from a wax model onto which E-max ceramic layers are applied and then pressed. This method allows for the production of strong overlays up to 0.4 mm thick, minimally affecting the enamel. Benefits include semi-transparency and a wide range of shades.
- E-max CAD (milled): Produced by milling a glass-ceramic block using CAD/CAM technology, based on a 3D model. Also used for making zirconium veneers. E-max CAD (~360 MPa) is slightly less strong than E-max Press (~400 MPa). E-max CAD also offers fewer color options than Press. Thin veneers (0.3-0.4 mm) are not made from E-max CAD/CAM. This material is expensive due to the use of high-tech equipment.
Advantages:
- Lifespan of over 15 years.
- Snug fit without gaps.
- No frequent polishing required.
- Resistant to plaque (non-porous surface).
- Color stability.
- Natural appearance.
Disadvantages:
- High cost.
Zirconia Veneers. They are as strong as metal but more flexible and do not damage the enamel of opposing teeth. Zirconia withstands all types of stress. In terms of color, shine, and translucency, they perfectly mimic real tooth enamel. Zirconia veneers fit better to the teeth than porcelain, composite, or ceramic veneers.
Two Types of Zirconia Veneers:
- Traditional: Made from standard, affordable zirconia blocks with a white, opaque color. They serve as the foundation of micro-prostheses. For aesthetics, they are coated with ceramic layers. This makes the prostheses more durable, allows for changes in color and translucency. However, they are thicker (0.8 mm) and require more tooth enamel removal. The ceramic coating can chip off. Lifespan over 10 years.
- «Multi-layer»: Made from colored monolithic blocks of pure zirconium (e.g., Katana, Prettau). They accurately replicate the color and translucency of real teeth. These veneers are thin (0.4 mm), similar to Emax ceramic plates. Sometimes they are applied without prior enamel reduction. Lifespan of about 20 years.
Advantages:
- Excellent, long-lasting aesthetics.
- Color stability.
- Close fit to the teeth (minimal risk of caries under prostheses).
- Withstand any chewing stress.
Disadvantages:
- High cost.
The history of the first veneers begins in aesthetic dentistry, where they have been used for several decades. Their emergence is linked to the cinema of the 1930s. As the quality of film images improved, the physical flaws of actors became more apparent. California dentist Charles Pincus suggested to the actors the use of porcelain plates, which were fixed to the teeth with a special powder. This led to the creation of the term 'Hollywood smile'.
Originally, veneers did not gain widespread popularity due to the low quality of the porcelain and weak adhesion to the enamel. However, by the 1980s, they began to be used as permanent restorative solutions.
Where Are They Placed?
Veneers can be placed on any tooth, depending on how many teeth are visible when smiling. For some, veneers on the six front teeth – incisors and canines – are sufficient. Others need veneers for ten teeth – incisors, canines, and premolars.
Placing veneers on molars is not advisable, as even the strongest ceramic veneers cannot withstand constant chewing pressure.
For a better aesthetic result, it is recommended to place veneers on the teeth of both jaws. Otherwise, one row of teeth will look unnatural compared to the other.
How Veneers Are Placed on The Teeth
The process of veneer placement takes up to two weeks and includes several steps:
- Diagnosis and Shade Selection: The dentist assesses the condition of the teeth and oral cavity, removes deposits, treats caries. This prevents inflammation under the veneers. Then, the dentist and patient choose the color of the veneers.
- Preparation of the Teeth: Space is created for the veneers on the teeth. Thin zirconium and ceramic veneers (Emax) require minimal removal of tooth enamel (0.3-0.5 mm).
- Impression Taking: Scanning of the oral cavity to create a 3D model.
- Manufacturing of the Veneers: Depending on the material, different methods are used. If enamel was removed, the dentist temporarily places plastic caps on the teeth.
- Fitting and Fixation: After the fitting, if the patient is satisfied, the dentist proceeds with the placement of the veneers. He treats the surface of the veneers and teeth with acid for better adhesion, then glues the veneers with a special adhesive.
Indications for Restoration
Restoration is recommended for patients with:
Placing veneers on molars is not advisable, as even the strongest ceramic veneers cannot withstand constant chewing pressure.
- Chips and cracks in the enamel caused by wear;
- Wedge-shaped defects in teeth;
- The need to replace old veneers.
- Discoloration of the enamel due to medications;
- Wide gaps between teeth (diastemas, gaps, tremas).
Yes, they do. The frequency of replacement depends on the type of veneer material and the quality of care. For example, composite veneers need to be replaced more often, approximately every 4 years. Ceramic and zirconium veneers, on the other hand, can last up to 20-25 years.
Contraindications — Who Should Not Get Veneers
The placement of veneers is not recommended in the following cases:
- Gum inflammation.
- Presence of cavities.
- Wearing braces or other orthodontic appliances.
- Bruxism (teeth grinding).
- Absence of side teeth, which can lead to excessive load on the front teeth and breakage of the veneers.
- Severe tooth misalignment or bite issues.
These are relative contraindications that can be corrected. The dentist can perform treatment and then place veneers. However, the application of thin veneers is not possible in the case of absolute contraindications:
- High mobility of teeth.
- Significant destruction of most teeth.
- Large fillings.
Placing Veneers on Teeth – Advantages and Disadvantages
Why patients choose veneers:
- They restore the appearance of the dental row.
- They last between 3 and 25 years, depending on the material used.
- They allow changing the enamel color to the desired shade.
- They conceal chips, cracks, and wide gaps between teeth.
- They protect teeth from bacterial accumulation.
- They prevent food from getting stuck and reduce the risk of infections and cavities, as it's difficult for bacteria to adhere to the surface of the veneers. However, oral hygiene remains important, as veneers only cover the front part of the tooth.
- They align the teeth.
- They strengthen the teeth, as they are made from very hard materials.
Disadvantages of Veneers:
- Often, a part of the tooth tissue needs to be removed for the placement of veneers. This is painless but irreversible. After this, veneers must be worn permanently.
- High cost. Composite veneers are more affordable but require regular polishing and replacement every 3-4 years. Ceramic and zirconia veneers are more expensive, but they last long and maintain their aesthetics for up to 25 years with proper care.
- Non-repairable. If a veneer cracks, it must be replaced. However, only the damaged veneer needs to be replaced.
Veneers affect the teeth as a part of the enamel is removed for their placement. After 20-25 years, the veneers need to be replaced to protect the root.
Another aspect – after the placement of veneers, increased tooth sensitivity may occur. This condition usually disappears within 1-2 weeks. To reduce discomfort, it is recommended to use toothpastes and gels for sensitive teeth.
How to Care for Veneers
To extend the life of your veneers and maintain your smile:
- Avoid putting heavy pressure on teeth with veneers. Do not bite into hard foods.
- Cut food into pieces and chew with your side teeth.
- Be cautious with fibrous foods to prevent them from getting stuck between your teeth.
- Avoid biting seeds. Clean them manually and chew with your back teeth.
- Limit consumption of teeth-staining foods (coffee, red wine, strong tea).
- Avoid drastic temperature changes in your mouth to prevent cracks or veneers from coming off.
- Brush your teeth in the morning before breakfast and in the evening before going to bed.
- Clean teeth with veneers using a soft brush and non-abrasive toothpaste. The other teeth can be cleaned with a medium-hard brush.
- Use a water flosser and mouth rinses.
- Be careful when using dental floss. Insert the floss into the widest gap between the teeth and remove it gently.
Veneers can be placed on all teeth except the molars, provided there are no contraindications. Crowns are used to replace any teeth, including premolars and molars. For placing veneers, only the front part of the tooth is ground down, whereas for a crown, the tooth is ground down all around.
How Much Do Veneers Cost?
The placement of veneers is a complex and expensive procedure that requires a high level of expertise from the dentist. The cost of veneers depends on several factors:
- The materials from which the veneers are made.
- The placement of temporary veneers during the fabrication of the permanent ones.
- The preparation for the placement of veneers.
- The prestige and level of the dental office.
- The presence of an in-house dental laboratory in the office, which can reduce the cost of the procedure.
Frequently Asked Questions
What are the alternatives to veneers?
For smile aesthetics restoration, overlays are also used: Lumineers, Ultraneers Lumineers – a patented technology made exclusively at Cerinate Laboratory (USA). Ultraneers – a Russian-developed alternative to Lumineers, made from IPS Emax ceramics.
What's the difference between veneers and Lumineers?
● Material (Lumineers are made from Cerinate ceramics);
● Strength (zirconia / Emax ceramic veneers are 3-4 times stronger than Lumineers);
● Thickness (Lumineers are about 0.3 mm).
Which veneers are better to choose?
We recommend choosing zirconia or Emax ceramic plates. They combine strength, durability, and aesthetics.
Which material is better – composite or E-max ceramics?
Definitely, E-max ceramic veneers are better. Yes, they are almost twice as expensive. But they are ideal in aesthetics, don't require regular polishing, and last almost four times longer. We don't use zirconia as they look unnatural (having a matte shade) and require more tooth reduction.
Is it true that teeth become sensitive after veneer placement?
Yes, in the first 7-14 days, there may be a painful reaction to various stimuli. Then the increased sensitivity subsides. During this period, it is recommended to use special toothpaste for sensitive teeth.
If veneers develop a pigmented plaque over time, can they be whitened?
This is a relevant question for smokers or frequent tea/coffee drinkers. In such cases, delicate professional cleaning is periodically performed.
Whitening won't help – the components of the whitening gel cannot penetrate the structure of the composite, ceramics, or zirconium dioxide.
Is it difficult to get used to veneers?
No. Teeth may feel slightly larger, but this does not interfere with chewing or speaking. Also, sensitivity may initially increase, but this passes within 1-3 days.
How to choose the shade of restoration?
Restoration shades are called Bleach. Most often, the Bleach 4 tone looks the most natural. The Bleach 1 tone appears too bright and unnaturally white. However, during the trial fitting, the mock-up may seem duller as it is made of plastic. The final ceramic construction will appear brighter.
Can veneers straighten teeth?
It's better to align teeth with orthodontic constructions, as it's less traumatic. To significantly change the shape of teeth with veneers, a substantial amount of enamel (down to the dentin) needs to be reduced.
Whitening or veneers, which is better?
The choice depends on the condition of the teeth. If the dental row is even, without defects, and the enamel is relatively light, there's no need for overlays; it's better to undergo whitening every 6-12 months.
