Designing New Smiles With Porcelain Veneers
This patient suffered from his small and timid looking teeth for decades. He eventually received a dental bonding by a general dentist which turned ugly within a few years. In addition, the the direct dental bonding procedure with composite materials never addressed the discrepancy of tooth size and maxillary arch width and length. The continues deterioration of the dental bonding contributed to the dingy appearance of his upper incisors. His gummy smile had been entirely ignored. We therefore decided to provide a gum lift at several of his upper front teeth and to place porcelain veneers (see lower image).
The combination of the recontouring and lift of the gum line with the placement of porcelain veneers contributed to the following outcomes:
- Removal of most of the pink visible during patient's smile.
- Refinement of the position of the gingival zeniths adjacent to the necks of the teeth to change the apparent location of the dental axes of the upper anterior teeth.
- Refinement of the scalloping of the gum line to create proper dental emergence profiles.
- Longevity of aesthetic appearance and surface glossiness of porcelain restorations.
Natural smiles come in many different forms and shapes. One common smile problem is characterized by small teeth with one to several small spaces, also called diastemas, between neighboring teeth. The cause for this condition is a discrepancy between the length of the maxillary arch and the sum of the widths of the maxillary teeth.
While orthodontic alignment is the traditional treatment for closing the interdental spaces, it does not address the relatively small size and dinkiness of the natural teeth. With the ever improving quality of porcelain materials and longevity of bonded ceramic restorations, laminate veneers have become a valuable treatment modality.
Orthodontic treatment always requires the retention of an established aligned dentition with fixed or removable dental retainers that need to be worn for many years. This creates various challenges, such as interference with oral hygiene and speech, as well as simply being uncomfortable and inconvenient. Certain dental conditions that are characterized by small teeth and interdental spacing can be treated by placement of porcelain veneers alone. The advantage of this option is long-term aesthetics and and the maintenance of the glossy surfaces of the porcelain as opposed to dental composites, which dull over time. In addition, fixed or removable retainers are unnecessary.
Hence, once the laminates are bonded to the teeth, the recipient can relax and enjoy his or her new smile without having to be constantly bothered by maintenance issues and the deterioration of composite restorations.
While laminate veneers are frequently requested for smile-enhancement procedures, especially for small teeth and the closure of diastemas, a cosmetic dentist needs to thoroughly understand natural tooth anatomy, oral function, and engineering principles that will lead to long-lasting and natural-looking dental restorations. The treatment logistics should include a systematic step-by-step approach which allows the new smile design to be tested and approved by the patient. The most important step when custom designing a smile is the placement of temporary dental veneers.. Experience and a good understanding of the principles of dental adhesive technology are indispensable for the delivery of porcelain restorations that remain in place many years to come.
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References:
Sękowska A et al. The size of anterior teeth in patients with gaps in the upper dental arch. Folia Morphol (Warsz). 2015;74(4):493-6
Duarte S Jr et al. The importance of width/length ratios of maxillary anterior permanent teeth in esthetic rehabilitation. European J Esthetic Dentistry. 2008 Autumn;3(3):224-34.
Raj V. Esthetic paradigms in the interdisciplinary management of maxillary anterior dentition-a review. J Esthetic Restorative Dentistry. 2013 Oct;25(5):295-304.
Frese C et al. The assessment of dentofacial esthetics in restorative dentistry: a review of the literature. J American Dental Assoc. 2012 May;143(5):461-6.