What are the Risks, and Potential Complications of Porcelain Veneers?
Like any dental treatment, porcelain veneers are not without their risks. Things can and do go wrong from time to time. It is always important that you understand the limitations, side effects and potential problems that could occur with any treatment you are considering, and the costs that may be incurred to correct it.
The risks of porcelain veneers are:
Veneers are not removable, they are put on with the intention that they are never coming off. Admittedly most people who choose to have veneers are looking for a permanent solution to their cosmetic problems, but don’t be fooled into thinking you can just have them popped off at a moment’s notice and be back to square one. Once you have porcelain veneers, you will always need them.
In nearly all cases to a lesser or greater extent, the front surface of your teeth will need to be filed down removing some of the enamel to make way for the veneer. Even ‘minimal prep‘ or ‘no prep’ veneers tend to require some drilling. Whilst they are less damaging (more conservative) for a tooth than a dental crown, they are more destructive than tooth bonding or composite veneers.
When you have hot and cold things to eat and drink, teeth expand and contract slightly and these thermal changes can potentially cause cracking of the veneer over many years. If the thickness of cement is greater than the veneer itself, polymerization contraction (the shrinking of the material as it sets) can sometimes cause cracking of the thin porcelain.
Your gums shrink up as you get older- this can be accelerated by gum disease or toothbrush abrasion but occurs naturally at a rate of 1-2mm every 10 years. This means the margins of your veneers that were once hidden, or at the gum line will become visible in the future and this may or may not be acceptable to you. Whilst only a cosmetic problem, the veneer may still be holding strong, it may, if you decide you want it corrected,it may need to be replaced.
- Breakages- chipping and fracturing
This is more likely if you have an unfavourable bite (edge to edge), or grind your teeth. If you are a bruxist, wearing a splint is crucial to protecting your veneers. Other chips or break could possibly occur when chewing hard food items such as pips in olives, seeds or nuts so you would need to be extra mindful.
You should be prepared to pay the price for replacement porcelain veneers if this type of accidental damage occurs. Very minor chipping and fracturing may be smoothed or repaired without the need to replace the whole veneer. However any more than a minor chip and the whole thing will often need to be replaced. You sometimes can get away with repairing the fracture with a bit of white filling material but if it is the incisal edge (most common) getting this to stay on can be tricky.
A longitudinal study found that veneers that needed replacement were only slightly higher at 11% than those that could be repaired -8%.
Whilst porcelain veneers are far more stain resistant than tooth bondings or white filling material, staining can still be a problem. Most people remain happy with the aesthetics, 80-100% of the time, according to a study over 10 years. 92% of veneers were deemed acceptable at 5 years and 64% at 10 years.
It is by looking at this kind of data and speaking to people who have had the procedure that we get an idea of what things may be like in a few years time. The importance of watching your diet and careful cleaning cannot be over emphasized in helping to keep your veneers looking good.
28% of these problems were in fact repairable meaning only 4% actually needed replacement at a 10-year recall.
Where appropriate every effort should be made by the dentist to keep the margins in enamel, however sometimes colour or tooth position may dictate going a little deeper into dentine in order to mask things completely.
Sensitivity to hot and cold may be a side effect if dentine is exposed. This is much more likely if temporary veneers are not placed, though it can happen with finished veneers too but generally to a lesser extent. After the final veneers are fitted, this sensitivity would be expected to disappear after a about a week.
- It may fall off
Whether due to the bonding procedure, the fit of the veneer, decay, stress from your bite, mechanical failure of the cement or the porcelain, or simply improper care- the veneer could de-bond and pop off. If this happens, keep the veneer and take it to the dentist to see what they can do.
Dentists should (no guarantees) if everything else is still intact and fits accurately, be able to clean the veneer and your tooth and re-attach it. If you lose it or swallow it, unfortunately a new one will certainly need to be made.
How can a Veneer Fail? Why Would a Veneer Need to be Replaced?
A porcelain veneer can only really fail completely in three ways:
- It comes off and can’t be put back in for whatever reason
- It chips or fractures and cannot be repaired
- The aesthetics become unacceptable.
In these circumstances, a new veneer must be constructed and made by the laboratory. They will match it as best as possible to the remaining veneers assuming it is part of a set. They are very good at getting this match right you will only have to have the veneer in question replaced, not all the others. As a temporary measure some white filling material can be placed on the tooth to give your smile and protect the tooth underneath/ reduce any sensitivity.
On occasions, it may be necessary if a veneer comes off or breaks repeatedly to progress to having a crown.