Though porcelain veneers as we know them today have only been around since the ’80s, according to New York cosmetic dentist, Husam Almunajed, DDS, they’ve made a lasting impact on the burgeoning world of smile design. In fact, Austin, TX cosmetic dentist Elizabeth Lowery, DDS estimates that now as many as 90 percent of her patients end up asking her about veneers—a treatment option that wasn’t so standard not so long ago. “Even 20 years ago, porcelain veneers mainly only made an appearance in the mouths of Hollywood elite,” she says. “But, new innovations and technology have ensured that veneers are more widespread now.
The Bonding Breakthrough
Although porcelain veneers became available 30 years ago, Atlanta cosmetic dentist Ronald Goldstein, DDS says the very first veneers are to be credited to dentist-to-the-stars Dr. Charles Pincus, who hollowed out porcelain to thin shells and cemented them over teeth in 1927. The main modern-day discovery: alternate bonding techniques that allowed for stronger, more realistic-looking materials, says Washington, D.C. cosmetic dentist Michael Katsaros, DDS. “Adhesives became more tech-savvy. Companies looked into microbiological compatibility because enamel wasn’t a natural fuse to the tooth. They figured out how to use the microscopic surface of the tooth and better adhesives to blend the porcelain onto the surface, essentially reinforcing the tooth, protecting it and giving it a nicer appearance.” Ceramist Jason Kim— an expert responsible for modeling and shaping the porcelain teeth before the dentist applies them— notes that the new bonding is so advanced, it’s near-supernatural. “Data shows that the chemical bonding of the veneer to the enamel is stronger than the natural enamel bonded to the dentin of the natural tooth.”
The Enamel Save
“In the past, you had to sacrifice beauty for strength, making old veneers more opaque or chalky looking,” says Dr. Lowery. “With newer materials, veneers are stronger, so you can get both.” Cupertino, CA cosmetic dentist Khalil Saghezchi, DDS agrees: “In the past, we would have had to shave down the majority of the patient’s tooth in order to achieve a full-smile makeover. Now, we have a much more conservative approach, where, in many cases, we hardly need to prep the tooth or shave anything down—except sometimes to create a little space between the teeth. It is incredible how thin the porcelain veneers have become.”
New materials mean new ways to create life-like, natural teeth, says Kim. “Natural tooth coloring is not just about making the ceramic material and painting on top of it to create the color,” he notes. “Because the natural tooth is a light, reflective material, much of the color comes from the inside.” This is why a technique called “stacking”—where anywhere from 30 to 40 different colors of porcelain are painstakingly layered to create a translucent, natural gradation of color that mimics real enamel and prevents the opaque finish that dominated in the early years of veneers—is used. “Human teeth are a very light, reflective material—they’re not solid tooth,” says Kim. “Light travels into them and reflects, absorbs and illuminates differently because there’s an enamel layer and a dentin layer inside. However, they’re shaped so that the light reflects differently at different angles.”
Desiring a brand-new smile that appeared whiter and more symmetrical while still looking natural, this 36-year-old patient sought Dr. Lowery. Dr. Lowery placed traditional veneers and crowns along the upper teeth to create an aligned and brightened smile that followed the natural curve of this patient’s smile.
Many patients still believe that veneers take shape as the precisely square and perfectly opaque blocks they once were, Dr. Saghezchi says. “They think you can’t achieve a natural look with porcelain veneers, and everyone wants to be natural—that beautiful, but perfectly flawed look, in which the teeth, while white and smooth, are not perfectly straight all the way across. They have a natural shape to them and a transparency to the color.” Another misconception: New York cosmetic dentist Marc Lowenberg, DDS says most people are not fully educated as to what veneers are and often think that a great deal of tooth structure is removed in preparing the teeth for veneers. “This is true of caps or crowns, but veneers are very conservative, and less than 15 percent of the tooth structure is removed,” he explains. As far as major misunderstandings go, Dr. Almunajed also sees many patients who are concerned about what happens after the veneers are placed. “Once porcelain veneers are completed, you should be able to eat, chew and function comfortably,” he says. “The only thing I tell my patients is, ‘Don’t do anything with your veneers that you wouldn’t do with your natural teeth.’” This includes indulging in overly sugary foods or drinks that cause tooth decay, notes Dr. Lowery, who laments that patients often believe porcelain veneers are cavity-proof.
Smart Mouth: Here’s what the experts think is next for veneers in the 21st century and beyond.
One prediction in Dr. Katsaros’s crystal ball: the rise in popularity of “in-between” veneers, something he came across on YouTube. “The concept is called ‘Smile Lite,’ where doctors will use the same type of treatment design as veneers, but as less of a permanent solution,” he says. Similar to the temporaries placed before the final veneers, a silicone is filled in a mold to create veneers that are cheaper, but less customized. Without the stacked porcelain shades, these in-betweeners will appear more opaque and blocky, but can provide a cost-effective option for anyone looking for immediate smile improvement.
No-prep veneers are nothing new—the original porcelain variety was intended to require little-to-no preparation—but this option for smile makeovers can offer many benefits to anyone seeking minor tweaks. In fact, they’re so effective that Houston cosmetic dentist Guy M. Lewis, DDS sports no-prep veneers in his own smile and has performed the procedure on several family members. “No-prep veneers mean that we don’t drill or reduce the natural teeth—they fit right over them,” he says. “The biggest benefit is that there is no drilling, so the veneers are reversible—not that anyone I’ve seen has ever wanted to remove them.”
This 50-year-old patient wanted to replace her existing restorations to cover the tetracycline stains caused by antibiotic use and light exposure. To provide a more opaque but natural-looking smile, Dr. Sadati removed the patient’s old restorations and placed new veneers along her top teeth.