Updated: Feb 2019
Porcelain dental veneers have not been around in dentistry for that long compared to other types of dental treatments such as silver fillings, gold fillings, crowns and dentures. When dental veneers first came out around 25 years ago, they were a major innovation in dentistry. Dental veneers were initially researched in the UK dental schools, and one of the first dental schools that started doing research on this type of treatment was at the London Hospital Medical College Dental School.
Once research had been done on them, the dental hospitals started to use veneers on patients who were under the care of the dental hospital itself. Once these initial cases had promising success, scientific papers were written up about them and fairly soon afterwards, they started to be used in the high street practices.
Even when dental veneers were available for general dentists to use, over 98% of dentists did not really use them. The reasons for most of the dentists not taking up this new technology was that they hadn’t been taught how to do porcelain veneers when they were training at the dental school and therefore they didn’t feel confident in using veneers on their patients. Of course, you could have done reading on research papers and also read the latest articles; when dental veneers first came out there weren’t many courses, in fact there were no practical courses, available for dentists to go on.
Another important reason why the vast majority of dentists did not use porcelain veneers on their patients is that they were not readily available on the NHS and at their time when they came out, over 95% of all dental treatment was carried out on the NHS. Over the next 10 years, more scientific dental papers came out and they started to make dentists more aware of their advantages.
A really good example of where porcelain veneers could be used was in the case of a condition called tetracycline staining. Tetracycline staining was quite common in patients born between 1960 and 1970. Tetracycline staining occurred in patients who when they were very little at about three to five years of age, became ill and when they went to the doctor’s, the doctor gave them an antibiotic called tetracycline.
The illness that you may have had need not be anything severe and many were just where somebody had a cold or a sore throat and were given antibiotics. Of course back then, it was usual to give antibiotics to treat a cold even though nearly all called colds are caused by a virus and not bacteria. Patients who had tetracycline staining on their teeth, had different levels of disfigurement from mild to severe. If you went to your dentist asking for advice on how to make your teeth better because they had been stained when you had been taking this antibiotic when you were little, the only available treatment was to carry out crowns on all your teeth.
It became quite common for patients to have nearly all the teeth crowned in order to improve the appearance that had resulted from the tetracycline antibiotic. The reason why tetracycline antibiotic discoloured the teeth, was because when the child took the antibiotic the enamel of the teeth was still growing and the antibiotic molecules got absorbed into the enamel that was developing. This caused the enamel to be abnormal because an extra molecule became absorbed and this resulted in the subsequent staining called tetracycline staining.
So what has this got to do with porcelain veneers? To have crowns done on all your teeth was a very major task and it would result in having your teeth trimmed down quite extensively in order for the crowns to go over your teeth. From our section on crowns, you will see that crowns can have problems in the short term and also in the long term so they are not always an ideal form of dental treatment. Porcelain veneers were one of the treatments that eventually replaced having crowns done on all your teeth for tetracycline staining. Later on still, tetracycline stained teeth were treated by having a combination of laser tooth whitening and porcelain veneers.
Fortunately, it is now quite rare to have to have tetracycline staining treated by your dentist because either those patients have already been treated or because those patients are now approaching midlife and they are not bothered anymore about the tetracycline staining.
Porcelain veneers were a major innovation in dentistry and still continue to be widely used. Tthe main ways in which porcelain veneers have evolved compared to when they first came out 25 years ago are in the tooth preparations used, the bonding technique and the type of dental porcelain they used. In addition, dental porcelain veneers can also be made in just one visit using a porcelain milling machine.
Porcelain dental veneers are used for a wide range of circumstances and conditions. These include changing the colour of your teeth, changing the position of your teeth, changing the shape and to build up a tooth or teeth which have broken. Porcelain veneers are generally limited to the top front for teeth, although they can be used on the canine teeth as well. Further back than the upper canine teeth, it is not very common for a dentist to use the back three molar and molar teeth for porcelain veneers. More than 80% of all porcelain veneers are placed on the front four top teeth and relatively few on the lower teeth.
So how long do dental veneers last? The factors which determine how long dental veneers last can be put into three main headings: dentists’ skill and dental factors, patient factors, general wear and tear.
Dentists’ skills, Assessment. We can label this number one out of all the above three factors, as it is the dentist’s skill that will really determine how long your dental veneers will last. Assessment: here we can use the term ‘if you fail to plan, you will plan to fail’. The assessment that the dentist carries out is extremely crucial in determining how long your dental veneers will last. An experienced cosmetic dentist will go through a long list of assessments that need to be carried out before even considering if porcelain veneers will actually work for you and even if there are the right treatment for you.
If say, the patient has a habit of grinding their teeth at night, or clenching their teeth in the day, this will almost certainly be a contradiction to providing dental veneers that will last. This is because dental oscillate veneers cannot take up the heavy unnatural biting forces of clenching and grinding of teeth unconsciously. Although, placing veneers on a patient who clenches or grinds, is not recommended, it may still be able to be carried out if you address the problems of the clenching and grinding. One way around this is to have a night guard made, which the patient wears in order to minimize any destructive excessive forces on the porcelain veneers. The assessment appointment will include a long list of factors to check, but also x-rays will be needed to make sure that the teeth are healthy enough to have porcelain veneers on them.
Dentists’ skills: tooth preparation techniques. A porcelain veneer can be extremely thin, nevertheless it still has a certain thickness and therefore the underlining tooth enamel will need to be trimmed back in order to accommodate the extra bulk of the veneers, otherwise the tooth can look more bulky than what you started off with. With the tooth preparation, the two factors involved are the amount of tooth preparation but also the way in which the tooth preparation is carried out. You don’t want not enough tooth preparation to be carried out, because that can make the veneer bulky or even so that it fractures later on; on the other hand too much tooth preparation is really bad as well, because it can reduce the amount of enamel for bonding later on but also it can weaken the tooth. A good careful dentist will use something called a ‘putty index’ in inverted commas to accurately gauge the correct amount of tooth preparation that needs to be carried out.
This advice will continue in part 2 of the article. Thank you for reading.