Ceramic veneers have been a popular choice in cosmetic dentistry for over twenty years, but like any dental procedure, they come with challenges that patients should be aware of. Are veneers bad for your teeth?
While they can enhance a smile, issues have emerged over time, including concerns with tooth preparation, cement, bite alignment, gum health, and other factors.
In this article, we share some potential issues that dentists have learned from seeing these veneers in use based on a review of several clinical research results in the related literature.
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Toggle1. Bulky Appearance
Bulky veneers should be avoided because they look unnatural to others. Bulky veneers often result from insufficient enamel reduction during preparation, leading to an unnatural appearance that others can easily notice. To avoid this issue, the dentist should carefully remove a small to moderate amount of enamel, ensuring the veneer fits seamlessly with the natural teeth.
If the size and shape of the natural teeth are good before veneers, and the patient is happy with how they look, the veneers should match that shape. To do this, the dentist may need to remove a small to moderate amount of enamel during preparation. It’s best to keep the preparation within the enamel to avoid future problems.
For a natural look, veneers should be designed to match the original tooth shape, avoiding excess thickness. Dentists can use digital design tools or try-on veneers to test the final appearance before cementation.
2. Color of Veneers
Thin veneers, about 0.3 millimeters thick, get their color from three things: the natural tooth, the cement, and the ceramic. When teeth are a normal color, thin veneers can be a beautiful and conservative option.
But, thin, opaque veneers with opaque cement can lighten dark teeth and might look too dull. Dark teeth usually need thicker veneers or crowns for the best appearance. Matching the veneer color with nearby teeth is easier with deeper cuts, but deep cuts often cause more issues. Dentists should decide if thin or moderately thick veneers can work with the tooth’s shape and color, or if crowns are better for strength and color. The best option is the most conservative treatment, whether it’s whitening, minor orthodontics, or veneers with minimal preparation.
3. Long-Term Color Stability
Fired-ceramic veneers have color baked into the material. This allows for color changes in different parts of the veneer, like a darker base and more translucent tips, and it stays stable over time. Pressed-ceramic veneers, on the other hand, start with a single color. Technicians add stains on the surface to create variation.
Dentists and technicians have different opinions about which type lasts longer. It depends on the lab’s skill and the type of ceramic they work with. Both fired and pressed veneers, when made well, can keep their color for many years without fading.
4. Postoperative Tooth Sensitivity and Pulpal Death
Cutting veneers too deep into the dentin often leads to tooth sensitivity and sometimes even pulpal death. Some technicians prefer deeper cuts to get the perfect color and shape, but this can cause problems. Check out our blog on the problems with the Turkey Teeth trend to learn how extreme shaving can lead to irreversible dental issues.
So, what is the best way to prepare teeth for veneers? Should there be no preparation, shallow cuts in the enamel, or deep cuts into the dentin?
When veneers are placed on deeply cut dentin, and a total-etch procedure is used before bonding, there’s a high risk of not sealing the dentin well enough, leading to irritation and sensitivity. If a large amount of tooth structure needs to be removed for the desired look, crowns are a better choice than veneers. Crowns can be placed with cements that do not harm the pulp or cause sensitivity, unlike resin cements used in veneer procedures, which can cause unpredictable issues.
5. Overhanging Ceramic or Resin Cement
Veneer overhangs make the areas between the teeth rough, making it hard for floss to slide through smoothly. When veneers are finished poorly, it can lead to problems with oral hygiene. Over time, the gums may become red and swollen.
Veneers should be finished carefully using finishing strips. This way, floss can move freely between the teeth without getting caught. It may cause a little gum irritation during the appointment, but this will heal in a few days. It’s much better to deal with minor irritation at the start than to have long-term issues like roughness, bleeding gums, and difficulty cleaning.
6. Stains on the Gingival Margins
Sometimes, veneers can develop stains around the gum line. These stains can happen for two main reasons. First, contamination of the gum area during the impression can cause a poorly fitting veneer. Second, moisture at the time of seating interferes with the cement, causing stains.
To avoid this, non-chemical gingival packing cords should be used during impressions and seating to keep moisture out of the area and prevents staining.
7. Discoloration Under Veneers
Some dentists use ferric sulfate to control bleeding when making veneer impressions or placing them. This method works fine for opaque restorations, like metal or opaque ceramic crowns. But with veneers, the iron salts in ferric sulfate can seep into the dentin, causing gray stains to appear within weeks.
Using aluminum chloride instead for managing the gums during veneer procedures can be an alternative way. It doesn’t cause discoloration under the veneers. A helpful way to avoid using such agents is to have patients rinse with 0.12% chlorhexidine gluconate twice a day for two weeks before the procedure. So, the gums become pink and firm, allowing for clean impressions without bleeding. Patients should continue using the rinse during the veneer fabrication and for two weeks after placement to ensure the best results.
8. Debonding of Veneers
When ceramic veneers are properly etched with hydrofluoric acid and placed on enamel that has been etched with phosphoric acid, they are very hard to remove. However, if veneers are placed on dentin, they may come loose over time.
Dentists should avoid cutting too deep into the dentin when preparing for veneers. If deep cuts are needed, such as to remove decay or replace old restorations, a crown is a better and stronger choice.
9. Chipping on Incisal Edges
Veneers that dentists place directly on the chewing surface of the incisal edge can chip after a few years. Fixing these chips is difficult or sometimes impossible. To avoid this, it’s better to place the veneer margins slightly behind the incisal edge but not in the bite area of the opposing teeth. When dentists do it this way, using a “butt” joint, the veneers are less likely to chip.
10. Open Lingual Margins
After a few years, the resin cement on the back edges of veneers may wear down more than the ceramic or the tooth. Some patients may notice a line between the veneer and the tooth when their tongue touches it. To prevent this, lab technicians should make the margins as tight as possible.
This area is the only part of the veneer where the join between the tooth and the veneer might bother patients. In extreme cases, the open margin can be made larger, etched, and repaired with resin. However, this fix may not last long.
11. Gingival Recession
It’s impossible to completely avoid gingival recession, but it’s possible to hide the veneer margins. Some dentists suggest placing the margins above the gum line, which is fine if changing the tooth color isn’t the goal.
On other way can be placing veneer margins at the gum line or slightly below if the tooth color is different from the veneer. This placement keeps the veneers looking good for many years. In contrast, PFM crowns rarely stay esthetic for that long, as receding gums expose the metal and create a chalky look at the margins.
Summary
Ceramic veneers are very popular and have been used for many years. Despite their great success, they come with some challenges. In this article, we highlighted common issues and shared ways to prevent or reduce them. When placed correctly, ceramic veneers are some of the most beautiful and long-lasting dental restorations available.
References
In preparing this comprehensive overview of the challenges associated with ceramic veneers, I have drawn upon key insights from three significant studies in the field:
- Alothman, Y., & Bamasoud, M. S. (2018). Success of dental veneers according to preparation design and material type. Open Access Macedonian Journal of Medical Sciences, 6. doi:10.3889/oamjms.2018.353
- Castelnuovo J, et al. Fracture load and mode of failure of ceramic veneers with different preparations. The Journal of prosthetic dentistry. 2000; 83(2): 171-180. https://doi.org/10.1016/S0022-3913(00)80009-8
- Christensen, G. J. (2006). Facing the challenges of ceramic veneers. The Journal of the American Dental Association, 137(5), 661–664. doi:10.14219/jada.archive.2006.0263Â
This article synthesizes findings, primarily from Christensen (2006), and offers a practical analysis of the common challenges patients may encounter with ceramic veneers. For more detailed and specialized information, I recommend reviewing these sources.
Frequently Asked Questions (FAQ)
The failure rate depends on various factors, but improper placement, deep cuts, or cement issues can increase the likelihood of failure over time.
Teeth under veneers can become sensitive if too much enamel is removed. Deep cuts into the dentin may lead to sensitivity, irritation, or pulpal death if not properly sealed.
As you age, veneers may experience chipping, discoloration, or gum recession, which can affect their appearance and longevity.
Veneers may extend slightly under the gum line to improve aesthetics.
Yes, if veneers are not finished properly, overhangs can trap food and make flossing difficult, potentially leading to gum issues.
People with veneers should brush and floss just like they would with natural teeth, paying extra attention to the gum line to prevent issues like gum irritation or staining.
If veneers are not renewed when needed, they can chip, debond, or stain, potentially causing further dental issues like decay or gum disease.
Veneers may not be suitable for individuals with poor oral hygiene, severe decay, weak teeth, or those who grind their teeth, as these factors can reduce the success of veneers.