What happens to the teeth under dental veneers?
A veneer is a thin layer applied to the front surface of the tooth. This tooth-coloured material is used to correct aesthetic flaws and improve the appearance of teeth. It is attached to the tooth with a special adhesive.
This method is a conservative treatment preferred for correcting colour and shape irregularities in teeth. During the application, only a thin layer is removed from the front surface of the tooth, ensuring that the tooth structure is largely preserved.
So, what happens to the tooth under the veneer? Let’s examine this process together.
Preparing the teeth for veneers
Veneers are generally made of composite resin or porcelain. Tooth preparation for veneer restorations is a process that requires precision and expertise to achieve successful and aesthetic results. This process involves considering the patient’s personal needs and expectations, selecting the appropriate type of veneer, choosing the best material, preparing the teeth before treatment, and designing the veneer preparation.
Veneer types in terms of tooth preparation
Minimal preparation veneers
In this design, very little tooth structure is removed in the range of 0.3 to 0.5 mm, and usually only the enamel layer is affected. Sometimes, such veneers, which are much thinner than conventional veneers, are also referred to as ’no-prep’ veneers.
This preparation involves removing tooth structure, usually 0.5 mm or more, to make room for a thicker veneer. Traditional-thick porcelain veneers require this preparation.
More aggressive preparation veneers
In cases of trauma or when a significant colour change is desired, up to 1.5 mm of material loss may be required. These preparations can penetrate enamel and dentin and require the use of a suitable adhesive system when placing veneer.
Tooth preparation steps for traditional (Prep) veneers
Initial examination
The patient’s oral health is assessed, and treatment goals are determined.
Preparation of the teeth
The aim is to remove as little enamel as possible. However, in some cases, more enamel and even dentin may need to be removed.
Taking impression
Digital or traditional impressions of the prepared teeth are taken. The double thread technique is applied for veneers with subgingival end lines.
Placement of temporary veneers
Temporary veneers are placed to prevent sensitivity in cases with significant material loss.
Placement of permanent veneers
Before permanent veneers are bonded, they are tried in the mouth, and necessary adjustments are made. Colour matching can be optimised by selecting a suitable coloured bonding cement. The tooth surface is cleaned, and bonding is performed. Excess adhesive is removed, and final adjustments are made. Occlusion is checked.
Tooth preparation for no-prep veneers
Characteristics of no-prep veneers
- No-prep veneers (e.g., Lumineers) are a more conservative option that require minimal or no tooth preparation. These veneers are ultra-thin ceramic laminates, usually 0.3-0.5 mm thick.
- No-prep veneers areprepared in laboratories to enhance natural tooth aesthetics, and the results can be seen before bonding. This offers the opportunity to avoid excessive tooth structure removal.
- No-prep veneers are a suitable conservative treatment option for malposed, discoloured, traumatised,or fractured anterior teeth.
- No-prep veneers can only be used on perfectly aligned or slightly crowded teeth.
Tooth preparation for no-prep veneers
Tooth preparation for no-prep veneers is minimal and includes the following steps:
- If bonding to a ceramic surface (e.g., crowned tooth), a minor reduction to remove the glaze layer.
- A minor reduction of the incisal and/or occlusal surfaces if wrapping of the incisal edge or straightening of the teeth is desired.
- A minor enameloplasty of the tooth margins to reduce slight malpositions or sharp edges.
Will the tooth under veneers be damaged over time?
Yes, the tooth under veneers can be damaged over time. This can be caused by one or more of the following:
Cavity formation
Cavities can occur under the veneer, especially near the gum line, due to the accumulation of bacteria and plaque. The bonding cement, which weakens over time, can allow bacteria to infiltrate and cause cavities. Additionally, if the veneer does not fit well, it can create a suitable environment for bacteria to accumulate. If cavities are not detected early, they can lead to tooth sensitivity, pain, and infection. In some cases, small cavities can be treated without removing the veneer, while extensive decay may require the veneer to be removed. If the decay is not treated in time, the tooth may become further damaged and could even require root canal treatment.
Need for root canal treatment
A small percentage of teeth with crowns, veneers, or bridges may require root canal treatment. This condition is usually detected before permanent bonding, but symptoms can also occur months or years later. The risk may be particularly high in young teeth and in teeth that have undergone further preparation to mask advanced discolouration.
Damage to the veneer
Poorly made veneers can change colour over time. Although veneers are durable, they can break or crack like natural teeth. Especially bad habits such as nail biting, ice chewing, teeth grinding can damage the veneers. Damaged veneers not only spoil the aesthetics, but can also expose the natural tooth to potential damage.
Gum problems
Poorly made veneers can cause gingivitis and gingival recession. Gingival recession can expose the edges of the veneers. Especially with prep-less veneers, plaque accumulation can be more difficult because there is no finish line, which can lead to periodontal complications. Good oral hygiene helps to reduce these risks.
Deterioration of the bonding cement
Over time, the structure of the bonding cement can deteriorate, which can lead to bacterial leakage, and the veneer may fall off.
How are the lower teeth affected?
Lower teeth can be affected by veneers just like upper teeth. In general, the potential for damage to the teeth under veneers over time is similar to that of the upper teeth. However, there are some considerations specific to the lower teeth:
- Preparation of the lower teeth for veneers aims to keep the enamel in the same way as the upper teeth, but there is a risk of dentin exposure due to the thinner enamel, especially in the cervical region close to the gingiva.
- In patients with unfavourable contours or poor oral hygiene, veneers on the lower teeth can also cause gingivitis and gum recession.
- When veneers are applied to the upper teeth, the colour matching of the lower teeth is an important factor to achieve a harmonious smile. For this reason, it is generally recommended to whiten the lower teeth when applying veneers to the upper teeth.
- An edge-to-edge occlusion is a contraindication for veneers and this may apply to the lower incisors.
- No-prep veneers can also be applied to the lower teeth. In some cases, minimal facial enamel reshaping (enameloplasty) can be performed to reduce crowding or to remove the prominence of the canines.
How to care for veneers?
The main points to be considered for the care of the veneers are as follows:
- Avoid biting into hard foods for the first 24 hours, as the veneers need to harden completely during this time. Eat only soft foods during this time.
- Continue regular dental check-ups (usually every six months). At these check-ups, your dentist will assess the condition of the veneers, perform cleanings, and detect potential problems early.
- Avoid routinely using mouthwashes containing alcohol, as alcohol can soften the composite and weaken the bonding of porcelain over time. If you choose to use a mouthwash, choose an alcohol-free mouthwash.
- For home use, only products containing sodium fluoride should be used. Products containing stannous fluoride or acidified phosphate fluoride are not recommended, as they can corrode the porcelain surface.
- Acidic food and drinks can slowly degrade ceramics. Try to minimise or avoid foods and beverages containing staining agents such as tobacco, coffee, tea or red wine, as the edges of the veneers may stain over time.
- If you play sports, make sure that there is no direct impact on your veneers. For sports such as handball, racquetball and football, it is recommended to use a plastic protective mouthguard (sport guard).
What should I do if a veneer chip or fracture occurs?
If a chip or fracture occurs in one of your veneers, it can be repaired with a simple bonded composite. A larger fracture may require replacement of veneer.
If veneer is removed, do not panic. Try to save the veneer; it can usually be re-glued. Call your dentist as soon as possible. If you are away from home and seeing another dentist, have your contact Magic Touch Dental Clinic before bonding.
How to recognise that the tooth under veneer has decayed?
Here are some important signs and symptoms to look out for to recognise that the tooth under veneer has decayed:
Tooth sensitivity
This is pain or discomfort, especially when consuming hot, cold or sweet foods and drinks. This can occur when decay has progressed to the enamel and dentin layers.
Constant toothache
This is a dull or sharp pain, especially when biting. As the decay progresses, it can affect areas close to the nerves of the tooth, which can cause constant pain.
A feeling of discomfort or pressure
A feeling of pressure or discomfort around the affected tooth. This can be a sign of inflammation or infection caused by decay.
Swelling of the gum
Redness or swelling of the gum near the veneer. When decay progresses and begins to affect the gum, it can lead to inflammation.
Bad breath
A persistent bad breath or an unpleasant taste in your mouth. Decaying tissues and bacterial build-up can cause bad odour.
Is it a bad idea to veneer healthy teeth?
Veneering healthy teeth with aggressive preparation for purely cosmetic purposes is generally not recommended. However, veneers may be considered to improve the aesthetic appearance of healthy but discoloured, slightly crowded, misshapen, or spaced teeth.
Veneer application should be performed by an experienced and skilled dentist. Proper preparation, bonding, and contouring are crucial for long-term success. Therefore, we recommend that you contact Magic Touch Dental Clinic, which has specialists in this field.
