Treatment Planning

Planning for Dental Veneers?

Before embarking on veneers, the crucial first stage is the consultation and examination.

This is where you need to sit down with your dentist and discuss what you are trying to achieve. It is crucial that the dentist understands your expectations… What do you want? What result are you trying to achieve? What is it exactly that you don’t like about the shape, size, colour or position of your teeth? What is your budget?

Once they have examined you (X-rays may be needed as part of this) they can talk you through the various treatment options that are suitable for your teeth.

Veneer preparation is irreversible so once you have veneers, you are always going to need them and as such, and the decision should be given some proper thought.

Ask the dentist to explain the advantages and disadvantages of porcelain veneers compared to the alternatives, such as enamel shaping, tooth bonding, porcelain crowns, teeth whitening, orthodontic treatment etc. for your set of teeth so you understand and appreciate the limitations, benefits and the different choices. This is what we call ‘Informed Concent’.

Not all choices will be possible, available or appropriate and porcelain or composite veneers may not be able to correct the problem in question.

Assuming you are suitable, the dentist will need to look at the rest of your mouth first and identify any issues that need to be addressed or treatment that must be completed first before the veneers can be prepared.

This may include:

If you have poor hygiene, gingivitis or gum disease– your gums are likely to be swollen and bleed. This would make impression taking and bonding in veneers difficult- a poor impression means an badly fitting veneer and any contamination when sticking them in would drastically reduce the veneers lifespan.

Poor hygiene would also make it difficult to determine the best position for the margin of the veneers. You want the top of your veneers to just touch the gum or extend slightly underneath for the best aesthetics. To do this, we need you to have eliminated any swelling or inflammation by decent cleaning and flossing so we know where this should be. Improve your hygiene after instead of before the veneers and you have a problem… As your gums shrink down a little, the previously unseen margin of where the veneer meets the tooth can become visible.

  • Treating active disease

Whilst the look of your teeth may be of primary importance to you, it is important that any active disease is first seen to. Here we are mainly talking about our arch enemies tooth decay and gum disease. If you lose some of your back teeth because you failed to address these problems, your front teeth are going to end up taking more pressure and stress. This will increase the risk of wear, cracking or fracture of your veneers.

  • Other cosmetic procedures

It is important if you want to whiten your teeth (either because they are dark or you wish to see if you can get away with fewer veneers), this is done prior to picking the shade for your veneers. It is possible to match the colour very accurately this way. Doing this the other way round by placing some veneers that are whiter than your natural teeth and then trying then to use teeth whitening for the others is unpredictable and a recipe for a disaster.

It is important to let the colour settle for a few days before going in to have the shade taken- so don’t whiten up until the day of your appointment. A week’s break is ideal. If you are having any other porcelain work done such as an implant crown or bridge you will want to complete this all at the same time. This way the laboratory can use a single mix of porcelain and ensure a perfect colour match of these with your veneers.

How do i Know What my Veneers will look like?

When considering cosmetic (or as we say aesthetic work) it can be invaluable for you to see how the teeth may look following treatment.

You must be actively involved in the smile design process because it is your expectations, your teeth, your mouth and your smile- not the dentists! You must communicate your feelings and preferences for the colour, shape, length and width of the veneers. This will help ensure you are happy with the result.

Think of these techniques as a way to check you and the dentist are on the same page. If something needs to be changed either from your point or the dentist’s, it is easier and cheaper to know upfront and make these changes before going ahead with treatment.

There are a few ways the dentist can give you an idea of how things will look:

  • A diagnostic wax up

An impression of your top and bottom teeth is taken, poured up to create a replica in stone, and placed on an articulator that simulates how you bite . The technician will then grind down slightly the models (to replicate the veneer preparation) and then wax up new teeth shapes so you can see what your teeth would look like. This gives you a good visual idea and provides a great basis for you to discuss additional changes and features until you are happy. It also allows the dentist to assess in more detail your bite, the amount of preparation needed and predict potential issues.

As you can imagine, this takes quite a bit of time and effort on the technician’s behalf and therefore there will be a charge that you are likely to have to pay. The cost is normally per tooth and so will depend on the number of teeth that are planned to be done.

The amount you pay in comparison to the actual work is quite insignificant and it is of great benefit to you and the dentist. I urge you to not skip corners in these early stages- treatment planning and risk planning are the foundation on which quality dentistry is based.

Failing to plan properly as they say, is planning to fail and it can save a lot of disappointment, frustration, time, energy and expense down the track.

  • White filling material

This can simply be placed onto your teeth, sculpted and set with the blue light. It is not bonded on so can be simply flicked off afterwards. This is good for assessing how a closed gap or minor cosmetic changes or tooth bonding will look before actually going ahead. This has the advantage of being the right color and in your mouth so you can see what your smile will actually look like.

  • Temporaries

The diagnostic wax up (discussed above) can be used to make a set of temporary crowns or veneers which when in place will allow further assessment by both yourself and your dentist.

Sometimes you will need to wear a set of good fitting temporaries for 6 months before having the real work done. This will allow the dentist to assess your bite and see how you respond to any changes they have made. For example, if your teeth are very worn, the dentist may want to open up your bite to allow the length of the teeth to be increased. If they do this too much it may cause some discomfort in your joints so they will need to adjust the temporaries in order to get it right.

  • Computer imaging

Some’ high-end’ practices may have computer technology that allows you to preview your expected results via special software. The advantage is that you can make any changes immediately to see how they affect the look of your teeth.

  • Catalogues

Cosmetic dentists also use Catalogues with different sets of teeth and looks in, that you can select from. Imagine flicking through a book of haircuts at your hairdresser, it’s just like that. They can also show you a range of before and after photos of patients like you that they have treated and take you through their case to give you a good feel for what to expect.