Although Porcelain Veneers are a particularly popular choice for improving a patient’s smile, there are dental patients for whom they are not my first choice.
Listed below are some of the reasons I might not choose to recommend porcelain veneers.
1. Needing to make the restored teeth many shades whiter than a pre-existing tooth. Porcelain veneers can look opaquely when they are employed over an extremely dark tooth. Porcelain veneers work best when they are bonded to predominately enamel and often dark teeth may require more than a minimal preparation to create a thickness of porcelain large enough to make a natural looking and much lighter restoration. If insufficient enamel will remain after this preparation, than a crown may be a safer and more predictable choice for masking these darkened teeth. Especially for patients with a need for optimal esthetic results.
2. Porcelain veneers are not as predictable, long term, for older patients who have experienced significant recession. These patients usually have exposed dentin at the cervical (Neck of the tooth) and bonding to cervical dentin can be weak. In my experience these cases can be more predictably restored using full bonded porcelain crowns. Full crowns preparations can provide more inherent retention for an esthetic porcelain veneer in these situations
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3. A patient with significant anterior wear with an edge to edge bite can be tricky to restore using porcelain veneers. These patients often desire a longer tooth. Lengthening teeth at the gingival can result in a margin in dentin or cementum which can be weak. Lengthening at the edge can also pose a risk, since these patients can be at greater risk for breakage of their veneer. Their pre-existing worn teeth edges demonstrate that they often place their anterior teeth in an edge to edge position. If these patients refuse to commit to religiously wearing a night guard , than I might not choose to restore their teeth with bonded porcelain veneers.
4. Often patients seeking cosmetic dentistry require restorations on six or more teeth. When multiple porcelain veneers are required and a patient has a limited budget, bonding with composite may provide more affordable option . Bonding, when carefully done can be highly esthetic and can be extremely durable in a patient with good hygiene. In dealing with worn edges bonding can be a good choice since it is easily and affordably repaired when it chips. Repairing a chip in a bonded restoration is usually less involved than replacing a broken porcelain veneer.
Although I have successfully restored patients with porcelain veneers for patients with all of the above situations, experience has taught me to be cautious when suggesting porcelain veneers for patients such as these. Patients undergoing esthetic dentistry have the expectation that the will; receive highly esthetic and durable restorations. Accordingly not all patients are ideal candidates for porcelain veneers.
