One of the most frequently asked questions I get from potential patients is “How much tooth structure is lost with porcelain veneers preparation?” This is a very valid question as often there is no decay present in the proposed porcelain veneer teeth. The truthful simple answer is, extremely little. About the thickness of a contact lens or, another example, is the thickness of a fingernail. That’s all is required to “re-enamel” the tooth to its new white brilliant appearance. Now in areas that are deficient in size, shape or spacing, even less removal is required than the thickness of a fingernail.
The entire process is very conservative compared to the older technique of “pencil sharpener-type” full dental crowns of yesteryears. Those older style full dental crowns were very aggressive with their tooth structure removal. That was because the older style dental crowns required a metal inner core like a custom made “sewing thimble”. The porcelain was then baked or fused to the metal thimble (hence the name “PFM crowns” or porcelain fused to metal). The metal had to be a certain minimal thickness in order to be centrifugally casted. The porcelain had to be multiple layers thick to mask the metal showing thru. The whole process quite often looked “dead” with none to very little appearing “vitality” that’s why the term “caps” was used to describe them. Today’s porcelain veneers are an entirely different animal. Besides being almost paper thickness thin, like contact lenses, they are extremely strong once bonded to the tooth. Porcelain developers have patented entirely new porcelains ingots that are actually melted and injection cast like gold. These porcelain veneers reflect light, exactly like natural tooth enamel. They are virtually, (no absolutely!), indistinguishable from natural enamel. Because the porcelain ingots are pre-made before casting, any shade or color can be chosen. This is where the term “Hollywood Smile” is born. We can chose a stunning white shade that still looks natural due to the internal brilliance and florescence that the new porcelains naturally possess. Because there is no dark underlying metal, there is no telltale metallic dark opaque or black line at the gum line. Everything looks totally natural. The smile is transformed into the look of a photo model or a “Celebrity Smile”. The ravages of mal (bad) positioning or the lack of ever having straightening braces is instantly and permanently corrected. Genetically, some people are born with short or small shaped teeth. This is again instantly and permanently corrected with dental eneers with the added plus of permanent brilliant white appearance. OK, what if there is a tooth missing? As they say in Jamaica, “No Problem Mon”. The science of implantology has got to the extremely predictable stage and there are some instances where the tooth (clinical crown) can be replaced on the same day as the implant placement. Today’s Cosmetic Dentistry is NOT the same old dentistry your parents had years ago. This concept of minimal invasive tooth structure removal is not just confined to the front or anterior teeth. Granted, the back molar teeth are not as visible in most people’s smiles, but conservation of tooth structure is gradually catching on instead of the traditional full tooth cut down methods. Much more conservative tooth preparations are utilized to remove only the carious or broken segments instead of the full whole crown area. The fractional amounts of tooth structure are replaced with white naturally looking porcelain onlays and inlays, while the bulk of the natural tooth is left untouched in its natural state. New bonding techniques have replaced the old need of cementation which required substantial amounts of tooth structure removal for the crown’s retention. Conservation of natural tooth structure is the motto of today’s cosmetic dentist. Enjoy the benefits of having the beautiful smile of your dreams and display your new persona with pride of ownership without envy. As always, you deserve nothing less than the very Best!
In the Name of Better Dentistry
Dr. Arthur T. Forrest, D.D.S.
Fellow in the Pierre Fauchard International Dental Honors Academy