Porcelain veneers, dental veneers, lumineers, or porcelain laminates.
Different terms for the best veneers possible.
Different terms for the best veneers possible.
Cosmetic dentist of San Francisco, Dr. Jorg-Peter Rabanus, explains how they are designed and what they can do for every possible dental condition.
Dental veneers are fabricated of biocompatible materials, such as porcelains, composite acrylics, or combinations of different porcelains or ceramics.
'Porcelain laminate' is an older term for 'porcelain veneer.' The term 'laminate' comes from the latin word 'lamina' which means 'thin plate' or 'scale.' Lamination is a uniting of superposed layers of a protective material by an adhesive or other means.
The best veneers are fabricated in the dental laboratory by specific cutback and layering techniques. The term 'veneer' comes from the german word 'furnier.' Originally, it was a thin sheet of wood adapted for adherence to a smooth surface. Porcelain veneers have principally the same protective and aesthetic function as wood veneers. They are thin layers of high quality materials that are bonded to a smooth understructure. Veneers are the most common procedures offered by cosmetic dentists. They have many applications, such as
- strengthening of weeakened enamel,
- restoration of eroded and worn enamel,
- veneering with a whiter layer of porcelain to mask heavily stained teeth, and
- creating more youthful attributes, by incorporating incisal translucency, harmonic line angles, and the proportions of young teeth.
We will constantly update the information about porcelain materials and the technology that are used for these purposes.
Porcelain veneers are a rapid, aesthetic, and safe way to correct unattractive front teeth. They correct heavy dental stains, teeth that are crooked, disproportionate, relatively small (with spaces), and structurally damaged. As mentioned above, they are shells of ceramic/porcelain material that can be chemically bonded to tooth structure. Dental veneers are the most popular treatment modality for comprehensive smile makeovers.
One of the most significant breakthroughs in dentistry has been the development of new adhesion techniques and materials (see also this review of cosmetic dental porcelains) that enable the dentist to successfully adhere organic tissues and inorganic materials to each other.
The bonding between a porcelain veneer and the natural tooth surface is very strong if done correctly. It can be so great that an accidental trauma of a veneered tooth may cause a fracture within the tooth structure and not at the interface of porcelain veneer to prepared tooth surface.
Bonded to tooth structure, certain porcelain veneer materials display similar physical properties as natural enamel. In addition, with the advance of ceramic technology, natural layers and youthful translucencies of vital teeth can be perfectly mimicked.
For further information, go to page "Materials and Methods" in the section "Technical Specifications."
Smile makeovers with porcelain veneers often involve just one diagnostic and two treatment visits. The first visit is for diagnosis and dental impressions that are used to create a diagnostic wax-up on study models. During the second visit, the information obtained with the model analysis and the diagnostic wax-up will be used to prepare the teeth. Master impressions of the prepared teeth will be taken. Temporary acrylic veneers are created with acrylic-filled matrices that are molds of the diagnostic wax-up. Hence, the temporary veneers look exactly like the diagnostic wax-up, allowing the patient and the cosmetic dentist to evaluate their appearance and comfort in the patient's mouth. The processing at the dental laboratory usually takes two weeks. The final porcelain veneers are permanently bonded at the last office visit.
The old porcelain restorations have the following unnatural characteristics:
- Monochromatic color scheme: boring and unnatural
- Sharp incisal line angles with small embrasures leading to an aged appearance
- Lack of incisal translucency with a lack of playfulness
- Extreme central dominance of the upper central incisors, giving the smile a "nerdy" appearance
- Lack of progression of the axial line angles of the upper anterior teeth from mesial to distal
- Lack of Golden Proportion. While it is not a stringent requirement for a beautiful smile, it is an excellent point of reference around which a smile can be tested
- Unnatural surface characteristics as can be visualized by the way light is reflected from the labial surface of the upper incisors
The patient was hoping to get more youthful teeth. She wanted to be able to confidently smile again. she is a human person who naturally smiles a lot, and the old dental restorations had prevented her to show he true personality.
State-of-the-art principles of smile design resulted in natural and youthful porcelain veneers. This smile makeover addressed all the aesthetic shortcomings listed above and consequently changed her life.
Some dentists place dental veneers that consist of resin composite. However, the long-term prognosis of porcelain veneers is much better.
Dental porcelains and ceramics are superior to metals with respect to corrosion, galvanism, and biocompatibility. Emergence profiles are less likely to be over-contoured, as is often the result with metal-ceramic restorations in an effort to mask metal sub-structure.
The conclusions of many studies are that porcelain surfaces accumulate much less dental plaque compared to resin composites, gold alloys, and amalgams. In addition, the plaque formed on ceramic surfaces is of healthier composition. Hence, while looking very natural, as shown in very conservative cases as shown on a separate page that shows a case where healthy and refreshed-looking teeth are created without changing their general "personality."
This patient had considered porcelain veneers for a long time. He had received numerous consultations with cosmetic dentists prior to his meeting with Dr. Peter Rabanus. He didn't like the spaces, his small teeth, the shade, and the irregular gumline and tooth size. He decided to obtain a smile design with selective gum lifts and dental laminates.
Note the differences in tooth size when his pre-operative photographic pictures were taken during his first consultation. The progression of the angulation of the central axes of the anterior teeth appears irregular as well. The left lateral incisor was shorter than the right lateral incisor. After placement of the porcelain veneers, the relative proportions of the neighboring teeth were more harmonic. The smile line became more aligned with the inside border of the lower lip.
The design of several porcelain veneers for an entire smile makeover is often based on provisional acrylic restorations, which are also called "temporaries." They are placed on the prepared teeth to determine the new morphological characteristics of each tooth and the overall appearance of the veneer group. The patient has time to test wear the temporaries to verify their aesthetics and their harmony of function within the oral cavity. This includes speech, lip closure path of the lower lip against the newly developed incisal edges of the upper incisors, their smile line, the guidance of the mandible by the newly developed inclines and dental surface anatomy during all oral functions.
Find more new smiles with natural porcelain veneers.
More new smiles with dental veneers.
A quick word about porcelain veneer technology:
More and more people want whiter teeth. The cosmetic dentist needs to know how to keep porcelain veneers natural despite their bleached shades. This is done with anatomic layering with porcelains of different optical characteristics.
The exact pathway of achieving the optimum result is determined by the original condition of the teeth, such as:
- tooth position
- crowding or spacing
- dental misalignments
- degree of discolorations
- gum line
- prior dentistry (unfortunately this often dictates the design of new porcelain restorations)
The optical characteristics of porcelain veneers are:
The more existing tooth characteristics need to be mask the thicker the porcelain layer needs to be. In addition, pressable ceramics need a little bit more space than feldspathic porcelains. They require a minimum reduction of 0.8 mm for pressing ingots and additional 0.3 to 0.4 mm for enamel layering techniques, while conventional feldspathic porcelains require only a 0.5 mm reduction at the gingival half and 0.75 mm at the incisal half. Porcelain veneers that are fabricated out of pressable porcelains require an over-the-edge preparation to stabilize the wax-up and the veneers on the stone models throughout the fabrication process.
The tooth preparation for a porcelain veneer is always dictated by what the veneers needs to compensate for. Diagnostic wax-ups and smile designs using long-term provisionals are used for this. Based on the optimum position and dimensions of a porcelain veneers, which is indicated by preparation guides that are fabricated on the diagnostic wax-up of the patient's models, the cosmetic dentist determines how much tooth structure needs to be removed. Since cosmetic dentistry does not use opaque porcelains that would make a tooth look very artful, the shade of the underlying tooth structure needs to be considered. A porcelain veneer needs a minimum thickness of 0.2 to 0.3 mm for each shade change. This means that a change by three shades would require a minimum thickness of 0.9 mm in an ideal scenario. In addition, porcelain veneers of 0.3 mm thickness have been shown to crack easily.
In short, the thickness of a porcelain veneers is determined by the amount of desired shade change and the final tooth position, which is dictated by functional and aesthetic parameters.
When patients have extremely dark teeth, it is necessary to prepare the teeth through the enamel into the dentin layer. This is no problem if the cosmetic dentist understands the state of the art of dentin-bonding technology. Unfortunately, this is the point at which many dentists try to simplify or use a cheaper product. This is one of the most important steps of the entire delivery process of porcelain veneers and should not be cut short. The dentin-bonding technology is covered elsewhere on this website.
When teeth are prepared into dentin due to their dark shade, a dentin porcelain is used so that it restores the shape of the original dentin layer and creates a more favorable color. This is also recommended for the matching one tooth to existing natural and lighter neighboring teeth, because the control of dentin color improves the accuracy of the match, which often depends on perfect matches in deeper layers of the teeth.
Dr. Rabanus emphasizes the development of incisal characterizations and 3-dimensional effects. Youthful teeth have a high degree of incisal translucency and display dentinal developmental lobes. They often coincide with incisal irregularities, such as notches, which are especially cute in female patients. Lateral incisors that have these incisal notches look sexy, playful, and youthful. It is a desirable effect for female patients, but some male patients have opted for this choice in porcelain veneers as well. Hence, Dr. Rabanus and his dental laboratory have developed well-defined communications regarding the desired outcomes of anatomic layerings for each individual patient.
It is understood that the above design details of porcelain veneers are easier understood with illustrations. Since this website is always a work in progress, Dr. Rabanus will eventually add those illustration, some of which can already be found on other pages about smile design within this website.