Veeners??? For me or not for me??..

madonna123

I am considering getting veeners on six of my front teeth.

I have always been very tooth proud. Reg check ups and cleans,
but due to pretty bad work through the health board dentist when I was young My teeth are a bit crooket.

I was given a retainer type of thing to wear when I was a kid, now my teeth are all over the place. They are all bunched up on top of each other, as if I have too many teeth for the size of my mouth, and one tooth which is next to a front tooth is slanted back. In pictures it lookes like the tooth is missing. :mad: I hate it.

I was considering veeners as this would give me a complete new front to my teeth creating a perfect smile, But I would like to be fully informed.

Do they break or chip easy? I was considering having them done abroad as Im not very trusting of Irish dentists.

Myself or any of my family who have had dental work done here have all been let down by our dentists. Id only trust them with the cleaning or whitening.

Any info for me? anyone had veeners or has an opinion\?

Orthoman

Hi Madonna,

Would avoid if possible and have fixed braces and retainers. Though the quick treatment for a result is obviously an attraction, remember you are then tied to a life of the porcelain smile. Though initally they may look good, as you get older the colour may look ridiculous and can only be changed by redoing the veneers. Extra care with brushing and your diet also needs to be considered.

With braces, at least you have your own teeth at the end.

Stay away from "6 month braces", poor value for money. As for the expense of treatment at home versus abroad, unfortunately this has a lot to do with our policy of the second highest minimum wage in Europe, higher material bills, higher VAT. etc., and yes I must admit the exorbitant fees of some dentists.
Chat with you friends for a recommendation. At least you know where the dentist is and have a come-back.

davo10

Orthoman, I agree with most of what you say. If veneers are of medium/poor quality and monochromatic they can look pretty poor after a few years. But if they have good anatomical shape and are of high quality with appropriate shading, they can look good for a lifetime.

Madonna, if your front teeth are heavily filled/discoloured/root treated then veneers may be indicated, if they are fine except for position, orthodontics is the best option. If you are getting veneers make sure you get high quality veneers, not the least expensive, remember you will have to look at these for many years. Typically a high quality veneer will cost €600-€1000 depending on where you have it done. A monochromatic veneer will cost about €300, there is a huge difference in quality and cost.

Ask for a diagnostic wax-up to be done prior to any drilling, this shows you what your teeth will look like when treatment is finished. also a matrix can be made from the wax up, temporary veneer material can then be placed over your teeth so you can see in a mirror what end result will be before any tooth reduction is done.

Orthoman

Hi Davo10,

Agree with what you say with regard to fillings and quality of veneers provided you are paying for quality and not just an inflated ego of the dentist.

Fillings aside, my main point was to avoid the "Simon Cowell" look.

Regards

Big_G

Veneers have their place in some treatment plans in my opinion. I like the patient to exhaust all orthodontic options first. Then I will do composite veneers because I prefer not to cut the teeth. If then the patient still isn't happy, we will consider porcelain veneers very carefully.

kkth0360

Hi Madonna,
You mention a tooth that's slanted back and appears in photos as though it's missing. When you close your teeth together, is this tooth tucked in behind your bottom teeth? If it is (this is called a crossbite), a veneer is probably not possible on that tooth.

As others have suggested, try and find a dentist you can feel comfortable with (personal recommendations from friends or family are often the best way to find a good dentist) and have an assessment to find out what treatment options might be suitable for you. Then once you have all the information you can decide between braces, veneers or a combination of both.

vishal

i am a sad to say it is possible to veneer a lateral that is in crossbite. my friend went to a lumineer lecture a while ago and the lecturer had done such a veneer.
my friend said to me it looked like a molar afterwards.

kkth0360

Really? Sounds monstrous!!
I suppose if the overbite was very minimal it might work, but I don't think I'd want one!
(Would like to see a picture though!)

Big_G

Guess your friend learned a good lesson: don't go to a lumineers lecture!

mawk

davo10 wrote: »

Orthoman, Typically a high quality veneer will cost €600-€1000 depending on where you have it done. A monochromatic veneer will cost about €300, there is a huge difference in quality and cost.

Sorry if this is a silly question, but I have quite bad stains on my eye teeth and have been considering veneers. when you say 600-1000e i presume this is per tooth?, having been through quite a few years of orthodontics my teeth are fairly straight but not very white.

I did have them bleached when i was stateside and it helped, but not enough and not on the heavy stains.

also, i have read about faux veneers of the composite filing material being used as a cheaper option, are these any use? as i presume i would need at least 12 teeeth veneered to match each other and 12k is a lot to spend..:(

btkm8unsl0w5r4

Veneers can look perfect if done carefully. I always get a waxup and do my reduction according to this. I use only felspathic veneers (sometimes empress on rehabs) and make sure they are as thin as possible. I usually try to prebleach before preparation.

The problem with veneer is longevity. They will last about 7-10 years after which they will need replacement. Orthodontics is more conservative.

madonna123

Thanks for all the information. If I was to have the brace and straighten my teeth to remove my crossbite and overlapping the its going to cost €5000 here. Thats a crazy amount of money. abroad is a massive amount cheaper but Id imagine I would have to return often to have check ups.

Big_G

As has been discussed on other threads, that really isn't a massive amount of money if you spread it over the 2 years average treatment time for an orthodontic case. That's less than €50 a week. It's less than a car payment plan and will last you a lifetime.

hoganj

Hello madonna,
As I understand it veneers are not designed to straighten teeth, thats what braces etc are for. I had crooked front teeth as a child so when I was in my mid teens my parents sent me to a private orthodontist for 'train tracks'. They lasted about 4 years and by the end of it my teeth were perfect. They cost a lot but I think that is the only real way to do it. They other options seem (to me anyway) like throwing money away. Train tracks push and pull your teeth so most angles are covered. Yes they look weird for a few years but believe me its worth it.

As for dentist in general, Irish dentists are no different from other countries. If you don't like one dentist then go to another one.

georgieporgy

mawk wrote: »

Sorry if this is a silly question, but I have quite bad stains on my eye teeth and have been considering veneers. when you say 600-1000e i presume this is per tooth?, having been through quite a few years of orthodontics my teeth are fairly straight but not very white.

I did have them bleached when i was stateside and it helped, but not enough and not on the heavy stains.

also, i have read about faux veneers of the composite filing material being used as a cheaper option, are these any use? as i presume i would need at least 12 teeeth veneered to match each other and 12k is a lot to spend..:(

Do a bit of research on DEEP BLEACHING mawk. If you do a google you will find lots of info with before and after pics. See if any of the 'before' pics look like your problem.
I haven't found any stain I couldn't eliminate with deep bleaching (unless it's decay you are talking about).

I personally don't like composite veneers because they can look very dull after a few years. I've got some and I hate them. I think I'm going to have to pay Fitzgme a visit. No- wait! maybe i'll try budapest first and have a free holiday also:D

Orthoman

Hi Madonna123,
You mentioned veneers for 6 teeth. Other posts mention 600 to 1000 per veneer, 5k for ortho is in between and does not have to be redone, provided you have your retainers.
Ortho fees have come down a lot recently as there are more of them around, so if you do some shopping on the internet, and avoid the "6 month brace" brigade, you will get it for cheaper. Factor in travel every 6-8 weeks for appointments though. And go to a specialist, their fees are the same.

Good luck:)

mawk

georgieporgy wrote: »

Do a bit of research on DEEP BLEACHING mawk. If you do a google you will find lots of info with before and after pics. See if any of the 'before' pics look like your problem.
I haven't found any stain I couldn't eliminate with deep bleaching (unless it's decay you are talking about).

I personally don't like composite veneers because they can look very dull after a few years. I've got some and I hate them. I think I'm going to have to pay Fitzgme a visit. No- wait! maybe i'll try budapest first and have a free holiday also:D

I have looked at this too, not convinced about its efficacy in my case due to the stains being of tetacycline in origin.

budapest you say...?

BryanL

Mawk, Deep Bleaching, is very different from run of the mill whitening, there's higher costs but for the most part you can be sure of getting to B1 shade which is the whitest natural shade.
With tetracycline staining it just takes a little bit longer. Without bleaching and just placing veneers, you need to either make the veneers very thick or opaque in colour to mask the underlying staining.
Bleaching would always be the first thing for you to do.
Madonna 123, it's a bit harsh to ask for irish opinions but say you wouldn't trust us with anything except cleaning?
If you wanted the "ideal" treatment it would be full Orthodontics first and then veneers if they are still needed. Straightening teeth with just veneers can mean removing a lot of tooth structure, which increases the risk of that tooth needing root canal treatment later.
Bryan
ps. Vishal, a lumineer lecture? that made me laugh:D:D:D

Big_G

georgieporgy wrote: »

Do a bit of research on DEEP BLEACHING mawk. If you do a google you will find lots of info with before and after pics. See if any of the 'before' pics look like your problem.
I haven't found any stain I couldn't eliminate with deep bleaching (unless it's decay you are talking about).

I personally don't like composite veneers because they can look very dull after a few years. I've got some and I hate them. I think I'm going to have to pay Fitzgme a visit. No- wait! maybe i'll try budapest first and have a free holiday also:D

I use a material that supposedly dulls very little over time. Composite dulling is due to both particle shape and size. Losing irregularly shaped or large particles from the surface of the composite causes dulling over time. I use a composite that is supposed to maintain surface lustre due to proper nano-particles (not aggregates) and spherical particle shape.

It seems to maintain polish, but I have only had opportunity to observe it over two years. It certainly polishes like nothing I have ever seen, apart from porcelain.

It's called tokuyama estelite sigma. I quite like it for simple (non shade layered) veneers. It's also good for demonstration build ups.

Alternatively, we'll all go to Fitzgeme. But only for feldspathic veneers. Those empress veneers look like fridge doors.:D

davo10

Big G, were you a disciple of Martin Kelleher in Kings College in London?, he is a big advocate of the composite build up rather than ceramic restoration. I have seen both after 5 and 10 years and there is no comparison. A top class ceramic veneer/crown made by a quality lab has no equal (I like emax veneers by the way) and only place lava/procera crowns on anterior teeth unless bite indicates bonded prosthesis. Composite does dull after a couple of years and is more sensitive to social habits eg smoking, red wine etc than ceramic. Also I don't know about you but i find that the odd time I use composite to do a veneer-type restoration, the incisal edge tends to fracture easily or I have to make it quite thick, which detracts from aesthetics. Lastly it is difficult to mask tooth discolouration with composite whereas a ceramic veneer with correct shade of underlying cement can look fantastic.

Big_G

I follw the work of Lorenzo Vanini. I work for P. Crotty. I don't disagree about all of the points that you have made about porcelain vs. composite. However, with composite, I rarely have to cut teeth. It is a reversible procedure, and, the patient willing, is an excellent diagnostic tool for the planning of porcelain. Plus, composite is more easily repaired than porcelain. I'm not saying porcelain can't be repaired, just that composite is easier.

I will say that all of the things you talk about can be managed with composites. Blocking colour, chipping, etc can all be managed. Granted, its a hell of a lot easier when you cut the tooth and get the lab to do it for you, and yes they will last longer, but I (in my extremely limited experience ) worry about committing the patient to a lifetime of irreversible dentistry.

P. Crotty is a massive advocate of the composite build up. If the patient is unhappy with aesthetics, he'll move on to porcelain. Composites do take a bit of maintenance, but you have the confidence that underneath is a good tooth with plenty of enamel and the limited flexure that comes along with that.

Just my two cents. And yes, nothing looks quite as good as a well made porcelain veneer.

Big_G

By the way, with regard to zirconia, John Kanca is having some success with bonding at the moment. The key seems to be sandblasting with 50 micron particles.

Also, I don't know if you've read Pascal Magne or seen any of Inaki Gamborena's work, but they will only use pressed ceramics or procera veneers when dealing with extremely dark tooth substrate. Magne advocates feldspathic porcelain to achieve the 'biomimetic' standard in veneers. Vanini claims to achieve biomimetics with composite, and some of his work would seem to back this up, but like you say, surface lustre and maintenance are issues with composites.

Emax veneers seem to be a favourite of the prosthodontists. My dad is a lab tech and I grew up watching him make feldspathic veneers and they just look amazing. I just don't think you can achieve the same type of depth of colour and translucency with pressed ceramics.

Interesting discussion.

davo10

Big G, the issue i have with procera veneers is that the substructure only comes in 2 shades so in veneers it is difficult to mask substructure without over contouring ceramic. Lava comes in a variety of shades so can be used where tooth is discoloured.
After prep I photograph stump and take its shade, the lab makes veneer/ crown then makes new plaster stump with appropriate shade overlay, they then use different shade try in pastes to determine the correct permanent cement shade. When I recieve crown/veneer I also get ideal cement shade on a note for optimal aesthetics, they are never wrong.

Big_G

Agreed. Lava is nice in this regard. When it comes to veneers, I like the idea of the Castelnuevo prep (2mm incisal butt, .5mm facial reduction, contact points intact) for reduced flexure and minimal tooth reduction. I know this makes the lab's job more difficult, and I think it might preclude one from using ceramics also.

BryanL

I did a nice veneer on a 6 year old last week. I did four sealants and then placed flowable over her upper A, shade bleach XL, no charge.
She was getting a bit of attention at school about it being discoloured, her smile when she saw her "white" tooth made my day.
Bryan

btkm8unsl0w5r4

davo10 wrote: »

Big G, the issue i have with procera veneers is that the substructure only comes in 2 shades so in veneers it is difficult to mask substructure without over contouring ceramic. Lava comes in a variety of shades so can be used where tooth is discoloured.
After prep I photograph stump and take its shade, the lab makes veneer/ crown then makes new plaster stump with appropriate shade overlay, they then use different shade try in pastes to determine the correct permanent cement shade. When I recieve crown/veneer I also get ideal cement shade on a note for optimal aesthetics, they are never wrong.

The big issue with non glass ceramics like Zirconia or alumina is that its not bondable, no matter what the lab or company tells you you cannot bond the veneer to the tooth. If you need strength in a veneer best think of a crown, veneers are enamel restorations on sound teeth.

E-max for crowns, use empress aesthetic for veneers. I find pressed veneers very monochromatic in general. Personally I always use felspathics, for very discoloured teeth I use PFM
For discoloured teeth I usually try to prebleach and go for extra preparation in certain areas, If the ammount of reduction is in dentine I go for a crown for blockout.

Big_G. I too favour leaving the contacts intact if possible (space closures the exception) I also like a butt joint however I have no set ammount or reduction, I let the wax up index decide that. Once there is 0.5mm facially I am happy. With the butt joint you have to be carefull that the POI lines up with the facial so there is no palatal cement gap.

BryanL

anyone have problems not cracking a 0.5mm veneer during placement?
The guy Magne use normal composite heated to cement his veneers?
Bryan

Big_G

Accolade PV is a good kit to have for veneers. Flowable works too for cementing veneers. I also find that using those little microbrush type things with the adhesive on the end handy for placing veneers. I think they're called stix or stick-its or something like that.

Kanca advocates his new 'super-silane' Interface which he claims possibly gets a covalent bond with porcelain. He says that in mechanical testing the substrate has failed before the bond, so the adhesive strength of the bond is greater than the cohesive strength of porcelain or tooth! I haven't used it yet but it sounds ideal for veneers if his claims are true. He also claims it negates the need for HF and that a simple 50 micron sandblast does the trick.

BryanL

what's his entire protocol though?
Magne, uses Hf etch then removes the white layer of surface dust by re-etching with normal etch and then washes the entire veneer in a ultrasonic bath, while heating his composite.:rolleyes:
The bond strenghts these guys can achieve in a lab are not the same as are achieved in the mouth, where it's not always enamel bonding.
Bryan

btkm8unsl0w5r4

I use Nexus cement in a dark room under orange light. Heating the cement does reduce the viscosity but can speed up the set even with LC only. My entire protocol is:

1. Try in veneers (un etched from lab). Using water soluable Nexus try in paste.
2. Wash veneers with ++ water. Etch with HF fro 20 sec per veneer. Wash +++++.
3. Veneers in a ultrasonic in pure alochol 10 mins.
4. Prep teeth. Pumice, cord, dam. Air abrade if any small restorations or dentine.
5. Dry veeners (alochol give perfectly dry surface.) apply silaine (from nexus kit). Cover veeners.
6. Etch teeth 20 seconds total etch. Wash and Dry.
7. Bond (from Nexus kit) do NOT cure.
8. Lights out, orange light on. Working fast now.....
9. Cement onto pad, and onto veneer. Fast onto tooth. Ensure complete seat. I use the wax tipped Pic-Stic. One or two veneers at a time.
10. Remove excess with microbrush. Cure while covering gingival margin with finger. Then press the gingival margin and cure totally. A little excess cement at the margin is a good thing.
11. Tidy with a scalpel and move onto next veeners. Re test that they still fit properly before sialination. A bit of cement can hold them up interproximally.

6 veeners = 1.5- 2 hours min. I have had too many mis cements, now I am a fussy sod.

MusRo

Hi Madonna,
The best advise I could give you is "DONT DO IT!!!!". I had a veneer added to a front tooth when I was in my late teens as my tooth had a toffee colored stain on it. Worst decision I ever made... The procedure involved shaving off a millimeter of my healthy front tooth and then a veneer like a false nail was glued to the tooth. The initial results were fab but while shaving the layer off my tooth, then dentist cut my gum and it would bleed every time I brushed my teeth for a few days after. Then I noticed that the blood was running down between my tooth and the veneer and getting trapped at the bottom and it started to look discolored after only a few days. I went back to the dentist and he told me it would seep out and be fine and if he had to take it off he would need to charge me another £500 for a new veneer. I was young and timid so I took his word as gospel but about a year later I began having pain in my front tooth. Basically my tooth was rotting under the veneer and to cut a long story short I have had YEARS of problems with that front tooth since including: 2 crowns, 2 root canals and an apicectomy (cutting open of the gum to remove an infection in my bone under my nose!!!). If the apicectomy had not solved the infection I would have had to get an implant. My vanity has basically cost me thousands and a lot of pain. Now, what if that happens to more than one of your teeth? I have gone from having a healthy yet discolored tooth to having a tiny spike of a tooth left... Forget the quick vanity fix and go down the orthodontics route and get braces. You'll save yourself a whole lot of grief and pain and money in the long run. I don't understand why dentists don't tell people the true risks involved with getting veneers. You are weakening a tooth by shaving it down in size and if you are not religious about your dental hygiene the veneer may have to be replaced by a crown and will probably involve root canal treatment as well!

btkm8unsl0w5r4

MusRo wrote: »

Hi Madonna,
The best advise I could give you is "DONT DO IT!!!!". I had a veneer added to a front tooth when I was in my late teens as my tooth had a toffee colored stain on it. Worst decision I ever made... The procedure involved shaving off a millimeter of my healthy front tooth and then a veneer like a false nail was glued to the tooth. The initial results were fab but while shaving the layer off my tooth, then dentist cut my gum and it would bleed every time I brushed my teeth for a few days after. Then I noticed that the blood was running down between my tooth and the veneer and getting trapped at the bottom and it started to look discolored after only a few days. I went back to the dentist and he told me it would seep out and be fine and if he had to take it off he would need to charge me another £500 for a new veneer. I was young and timid so I took his word as gospel but about a year later I began having pain in my front tooth. Basically my tooth was rotting under the veneer and to cut a long story short I have had YEARS of problems with that front tooth since including: 2 crowns, 2 root canals and an apicectomy (cutting open of the gum to remove an infection in my bone under my nose!!!). If the apicectomy had not solved the infection I would have had to get an implant. My vanity has basically cost me thousands and a lot of pain. Now, what if that happens to more than one of your teeth? I have gone from having a healthy yet discolored tooth to having a tiny spike of a tooth left... Forget the quick vanity fix and go down the orthodontics route and get braces. You'll save yourself a whole lot of grief and pain and money in the long run. I don't understand why dentists don't tell people the true risks involved with getting veneers. You are weakening a tooth by shaving it down in size and if you are not religious about your dental hygiene the veneer may have to be replaced by a crown and will probably involve root canal treatment as well!

Sounds like you had a rubbish veneer that leaked done by a poor dentist (must have been really bad). A proper veneer is totally bonded to the tooth and nothing can get under it, the gum intergrates perfectly around it.. And they look great. As you will see above the process of making, preparing and cementing a veneer is very hard, thats why you want somebody good doing it (not all dentists are equally skilled). Yes the front of the tooth needs removing but sometimes its the best option sometimes its not. Like everything in dentistry a bad veneer, implant, crown or bridge will be crap but a good one can last for decades. How do you know you will get a good one - goto a good dentist who take a lot of time and uses good labs and has a lot of experience. Goto a specialist if needed.

ballsymchugh

Jayson Early Dragon wrote: »

Sounds like you had a rubbish veneer that leaked done by a poor dentist (must have been really bad).

if there was blood getting inbetween the prep and the veneer, then it was probably that iranian guy in forest hill in london that wasn't a dentist at all!!

ok, my two cents, i would agree with orthoman, be as conservative as possible, and straighten them. if it goes right, the fee is paid once, whereas veneers have a finite lifespan and usually need to be replaced after 10-15 years.
plus, having 6 veneers is high maintenance. you just may not be suitable (for ortho too for that matter). which is why they should really show the 6-9 months pre camera work that's done on 10 years younger (i have an inside informant!!).

MusRo

if there was blood getting in between the prep and the veneer, then it was probably that iranian guy in forest hill in london that wasn't a dentist at all!!

Nope it was an incompetent dentist from ****snip mod edit****.. I sometimes think I should travel back there and sue him after all the hassle he caused.

Mod edit: Cut that name out, if you ever want to sue, best not have it on up here,

moneyman

Just curious, what's wrong with 6-month braces?

I had braces years ago but my front teeth aren't straight. They still protrude a little. I think I may have not worn my retainer consistently after I got them off which has led to this. I've worn them religously the last few years but I think the damage was done. No one told me how important it would be to wear them. Would 6 month braces not help?