Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth. These shells are bonded to the front of the teeth changing their color, shape, size or length and resulting in an improved appearance.

Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. Resin veneers are thinner and require removal of less of the tooth surface before placement. You will need to discuss the best choice of veneer material for you with your dentist.

Teeth that are discolored ? either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth

• Teeth that are worn down
• Teeth that are chipped or broken
• Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
• Teeth with gaps between them (to close the space between these teeth)

See the dentist: one for a consultation and two to make and apply the veneers. The procedure itself involves several steps. These are: diagnosis and treatment planning, preparation, and bonding. It is important to note that one tooth or many teeth can simultaneously undergo the veneering process described below.

• Diagnosis and treatment planning. This first step involves active participation between you and your dentist. Explain to your dentist the result that you are trying to achieve. During this appointment your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take x-rays and possibly make impressions of your mouth and teeth.
• Preparation. To prepare a tooth for a veneer, your dentist will remove about ½ millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 1 to 2 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed for an additional cost.
• Bonding . Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished and etched ? which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer's placement.

Advantages:

• They provide a natural tooth appearance.
• Gum tissue tolerates porcelain well.
• Porcelain veneers are stain resistant.
• The color of a porcelain veneer can be selected such that it makes dark teeth appear whiter.
• Veneers offer a conservative approach to changing a tooth's color and shape-veneers generally don't require the extensive shaping prior to the procedure that crowns do, yet offer a stronger, more esthetic alternative to bonding.

Disadvantages of dental veneers:

• The process is not reversible.
• Veneers are more costly than composite resin bonding.
• Veneers are usually not repairable should they chip or crack.
• Because enamel has been removed, your tooth may become more sensitive to hot and cold foods and beverages.
• Veneers may not exactly match the color of your other teeth. Also, the veneer's color cannot be altered once in place. If you plan on whitening your teeth, you need to do so before getting veneers.
• Though not likely, veneers can dislodge and fall off. To minimize the chance of this occurring, do not bite your nails; chew on pencils, ice, or other hard objects; or otherwise put pressure on your teeth.
• Teeth with veneers can still experience decay, possibly necessitating full coverage of the tooth with a crown.
• Veneers are not a good choice for individuals with unhealthy teeth (for example, those with decay or active periodontal disease), weakened teeth (as a result of decay, fracture, large dental fillings) or by those who had an inadequate amount of existing enamel on the tooth surface.
• Individuals who clench and grind their teeth are poor candidates for porcelain veneers, as these activities can cause the veneers to crack or chip.

About 10 years. After this time, the veneers would need to be replaced.

Hygiene practices including brushing and flossing as you normally would.

Even though porcelain veneers resist stains, your dentist may recommend that you avoid stain-causing foods and beverages (for example, coffee, tea or red wine).

Alternatives. Veneers offer a nice intermediate option. Veneers may be best suited for individuals who want to change the shape of their teeth more than just a little bit-as is done with bonding-but not enough to require a crown.

Depend on what part of the country you live in and on the extent of your procedure. Generally, veneers range in cost from $500 to $1300 per tooth. The cost of veneers is not generally covered by insurance. To be certain, check with your specific dental insurance company.

Reviewed by the doctors at The Cleveland Clinic Department of Dentistry.
Edited by Michael W. Smith, MD, April 2003, WebMD.

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