The alternatives to porcelain veneers are:
- Teeth Bonding (composite veneers))
- Orthodontics (Invisalign) )
Because removal of tooth structure is a permanent thing, it is best to consider the least destructive options (what we call 'minimally invasive'
techniques) first. Dental veneers in most cases require some preparation of the tooth underneath- even those that claim to be 'no prep' or 'minimal prep', most of the time require some minor drilling.
The first and least invasive cosmetic option for improving your smile is tooth whitening. This may give you that boost in confidence that you are looking for without the need for further treatment.
You may also get a big cosmetic improvement by replacing old worn fillings, improving your gum health, watching the foods that stain your teeth and stopping smoking.
Let's look at each of the options in a bit more detail:
- Teeth bonding or dental bonding
This is essentially the same process as a composite veneer
only the term veneer refers to covering the whole front tooth surface and dental bonding can also be used to mask certain more minor imperfections or to help change the shape of teeth.
It is essentially placing a white filling
that blends in with the natural colour of your tooth or teeth to cover any blemishes or replace lost tooth. Little or no tooth removal is necessary for this procedure which is very effective and inexpensive for repairing minor chips, fractures or discolouration.
In skilled hands it can be also used to close small spaces between teeth or change for example, a number three tooth to look like a number two tooth, if the number two tooth simply never grew. In other words to shape a canine to look like a lateral incisor.
If the alignment of your teeth is an issue then moving your teeth with orthodontics or braces is the best way to ensure you keep your own natural teeth for life. You won’t have to watch what you eat or how you care for your veneers because your teeth are exactly that… your teeth.
Porcelain veneers can correct slight misalignments in the positions of your teeth but they cannot correct bite problems or move teeth that are some way out of position.
They are not a substitution for braces to correct overbites, under-bites or severely crowded or crooked teeth.
Orthodontics however can only change the position and not the colour or the shape of the teeth. This means that sometimes a combined approach is needed and either tooth bonding, whitening or veneers should be considered once the braces have been taken off.
One of the major issues putting adults off getting orthodontic treatment has been the idea of wearing traditional fixed train track braces for one or two years.
Invisalign has been a bit of a revelation in this respect and now offers an appealing alternative to achieve results similar to conventional braces, particularly in the post-teen age group. Invisalign is a series of clear plastic trays or aligners that are worn sequentially, applying light pressure to teeth to gradually alter their position.
They are removable and hardly visible when worn, but they are more limited in the range of issues they are able to treat, when compared to normal fixed braces.
Only natural teeth will whiten; that means no porcelain (crowns, veneers, implants, bridges) or white filling material
will change colour with application of the bleach. If you already have some of these in visible areas of your mouth, you need to be aware that if you whiten your teeth, they may stand out more and require changing for cosmetic purposes.
Not all colour issues can be solved with whitening, but they can certainly be helped. Even severely ‘tetracycline’ stained teeth can be greatly improved with a bit of dedication over a number of months. That said, the even-ness of colour and brightness that you can get from porcelain generally isn’t achieved.
Whitening will not change the shape or position of teeth. As such, it is very good when combined with orthodontic treatment as part of a restorative plan and can help reduce the number of teeth requiring treatment or the amount of tooth that needs to be drilled away to get the desired colour.
Whitening is a personal favourite of mine, If appropriate, I will always recommend getting your teeth whitened before you do anything else cosmetically as it doesn’t hurt your teeth, is relatively inexpensive and the improvement may give you that boost of confidence about your smile that you have been looking for. Thus avoiding the need for more extensive and destructive procedures.
Dental Crowns require drilling away considerably more tooth than veneers since space must be made for the crown to sit completely over the top of the tooth and not just to attach it to the front like veneers.
Cosmetic crowns are thus much more damaging where healthy untouched teeth are concerned. In these circumstances, they should be avoided most of the time in favour of cosmetic bonding, orthodontics, whitening or veneers.
If teeth are quite heavily filled and restored this is a different story. Here, veneers are much less suitable and crowns become a good way of actually strengthening the teeth whilst improving the appearance.
Crowns are also more reliable when you have a bite that is particularly heavy, awkward (eg. if you bite edge to edge), or where you have a grinding habit. The extra stresses in these circumstance are more likely to cause problems and failures with your veneers
Sometimes a combination of crowns and veneers can be a good solution and since the technicians in the lab can use the same mix of porcelain, they can be made to match perfectly so you would never tell be able to tell the difference.
Just to re-iterate; crowns purely for cosmetic reasons are very destructive, particularly on young healthy virgin teeth. This can often lead to problems with the nerve and multiple replacements in the future. Please carefully consider all the other options availlable.
This can relate to the teeth or the gums. I will often just reshape someone’s tooth or teeth slightly using a bur or fine sandpaper disc.
Jagged edges can be made to look smooth again and uneven teeth squared up. Sounds ideal… and it is, but only very small imperfections, chips etc can be treated this way. It is not a good idea to reduce tooth enamel too much or you can expose the underlying dentine which can be quite sensitive and will wear more quickly.
You can adjust a tooth a little and gain a noticeable improvement. Patients are very happy, no aneasthetic, cheap and quick- there is not much to lose if you are suitable, as all the other cosmetic treatment options still remain. Porcelain veneers are appropriate when a superior final result is wanted and where certain imperfections can't be changed by other means.
Gums are a different kettle of fish. Gingival re-contouring is a more advanced technique and generally involves use of low-grade laser to reshape your gums as part of the perfect smile. It is nearly always used in conjunction with porcelain veneers or crowns and can have some dramatic effects or give the whole veneer makeover that little bit of an extra edge. It is certainly not always necessary to do this, but uneven, worn or oddly shaped gums can be evenly shaped and improved greatly before having porcelain veneers made.
Now which is the most suitable treatment for you is not an easy question . Only a dentist who is examining you is in a position to take you through the most suitable options for your mouth.