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I have been considering porcelain veneers for several years, but I keep hesitating because of some veneers I have seen that look too big for the person’s mouth. The teeth seem thick and almost rounded near the gums. They are so bad, it’s almost like horse teeth. Then I see other veneers that I would never know weren’t natural teeth. What causes that difference? Do teeth have to be shaved down to keep veneers from looking bulky?
Rachel
Dear Rachel,
What you have noticed is the difference between skilled and unskilled cosmetic dentists. One will simply place porcelain veneers on teeth. The other creates a beautiful smile makeover.
Porcelain veneers can change a tooth’s color, shape, size, and even correct the appearance of some minor alignment problems. But, adding porcelain to a tooth also adds volume. If the dentist does not account for the original position and shape of the tooth, the finished restoration can look too thick.
Why Veneers Can Look Bulky
Imagine placing a thin layer of material over the front of an object without removing anything first. Even if that layer is relatively thin, the object is now larger.
The same basic principle applies to veneers.
Some patients are attracted to the idea of no-prep veneers because they are advertised as not needing to remove any tooth structure. In the right situation, that can be an excellent conservative option. But, even if someone’s teeth would allow them to get away with no-prep, it doesn’t mean the dentist has the skill to do a gorgeous smile makeover. One particular no-prep veneer, Lumineers, is highly marketed to inexperienced cosmetic dentists as being “easy to place.”
But no-prep does not automatically mean better.
If your teeth are already properly positioned or project slightly forward, adding porcelain to their fronts may create too much volume. In that case, a cosmetic dentist should instead recommend removing a small amount of enamel so the porcelain can occupy that space rather than simply being added on top of the tooth.
The amount of preparation needed varies considerably from patient to patient and even from tooth to tooth, but generally you are talking about the depth of a fingernail. That’s hardly anything.
The Gumline Matters Too
You mentioned veneers looking rounded or thick near the gums. This is particularly important.
A restoration needs to emerge naturally from the gumline, in a smooth, flush finish. If its contour is too prominent, it can look artificial. Poor contours also make it more difficult to keep the area clean, which can contribute to decay and gum disease.
Beautiful veneers should not look like shells sitting on top of teeth. Ideally, someone looking at your smile shouldn’t be thinking about your dental work at all.
Bigger Isn’t Necessarily Better
Another common problem is designing every tooth according to an idealized template rather than the patient’s individual face.
Your teeth need appropriate proportions relative to one another, yes, but they also need to fit your lips, facial structure, gumline, and smile. That is one reason cosmetic dentistry requires an artistic eye as well as technical dental skill from post-doctoral training.
Even very white veneers can look natural when their shape, surface texture, translucency, and proportions are handled beautifully. Conversely, veneers made from excellent dental porcelain can still look artificial if their contours are wrong.
This is why your first step should be a consultation with a dentist who has strong cosmetic training. Ask to see before-and-after photographs of the dentist’s own patients, particularly cases similar to yours. Also, ask if they’ve had post-doctoral training.
Pay attention to more than whiteness. Look at the gumlines. Look at the shapes of individual teeth. Look at the teeth toward the sides of the smile.
Most importantly, ask yourself whether you notice the veneers—or simply notice a beautiful smile.
This blog is brought to you by a friendly Lafayette cosmetic dentist, Dr. John Theriot.