Dental Veneer Bond Failures
Veneer Repair and Replacement
Porcelain veneer laminates have, without question, had a major impact on cosmetic and restorative dentistry.
Unfortunately there have been growing reports (horror stories, really) of veneers going bad or quickly failing. Some are reported to crack, chip, cause bleeding of the gums, temperature - pressure sensitivity, slide around and even fall off entirely. Others have been reported to change color... literally within 48 hours.. to a blue or grayish color.
It is very rare that a veneer treatment failure is caused by a faulty or bad veneer product. Failed treatments are typically caused by errors in technique. While it can be said that most dentists have similar training in the basics of lamination... the degree of talent and creativity is a function of any given dentist's investment in the technology choices.
In Dr. Nazarian's practice, choices are available for veneer types and brands, porcelain grade, fabrication process, cementation methods, contamination (of the bonding surface) control, tooth preparation methods and instruments, etching methods and compounds.
Diagnostic wax ups, which should be a standard in any kind of cosmetic or aesthetic treatments, are provided to assure the patient's participation in the selection of porcelain grade, style and color shading. Temporary veneers are created for the patient to wear and use for making modications BEFORE the final veneers are fabricated.
Treatment Failure: Case History Example
Our patient, as pictured here, had a miserable failure of an innapropriate match of veneer type, tooth preparation methods, appearance of un-natural color shading (her veneers looked fake), possible cementation or bonding error and..... (the most common error) an inadequate number of veneers for treatment.
Two veneers had already completely fallen off.
Veneer dentistry can be expected to endure for 15 - 20 years or more, depending on the oral health and dietary habits of a patient. Our young lady here experienced treatment failure in 3 years.
The close up photo reveals, unfortunately, a mild orthodontic overjet issue (occlusal disorder), errors in bonding, laminate design and inflammation of the gingival tissue which can lead to serious infection.
Although our patient was originally interested in re-treating her veneers, she understood that minor orthodontic treatment would be required to correct the overjet and eliminate the threat of her new veneers popping off again.
Dr. Nazarian provided Rapid Ortho that produced the needed overjet correction in a short amount of time.
Once the orthodontic treatment was completed, a diagnostic wax up model was created so the patient could participate in the creation of the cosmetic result she wanted. More importantly, she wore veneer temporaries that were adjusted as needed, assuring that the final veneer products were accurate in sizing and color shading (a common area of error).
She avoided the use of no prep veneers, selecting instead a premium feldspathic veneer that permits the specialized opalescence and luminescence shading qualities that are associated with smile makeover dentistry.
A total of 6 new veneers were placed, although 8 were recommended (8 to 10 veneers is the ideal). Teeth whitening is also planned for the lower arch.
The last photo in our series shows the dramatic difference obtained by following the standard protocols for assuring optimal function either before or during cosmetic treatments.
For our patient, the failure to address minor orthodontic issues not only created eventual veneer failure, but contributed to the feeling she didn't receive the "makeover experience" she was seeking.
Attention to detail can be critical when resources are being used to recreate.... or perhaps create for the first time... what Mother Nature failed to provide.
Occlusal characteristics of nearly any dental treatment (even ordinary fillings) can damage or destroy the investment of time and expense for any given procedure or plan of treatments.
Dr. Nazarian closely monitors the occlusal impact (or potential impact) on all cosmetic dentistry services to assure the treatment is sensible, produces the desired cosmetic result and is not compromised by an otherwise unknown issue of poor dental function.
Cosmetic Color Shading Failure: No Prep Veneers
The adjacent photograph represents a common complaint with no prep veneer products.
Notice how the laminates have a flat color with no shading whatsoever. They create the appearance of fake teeth... obvious to nearly everyone.
These types of veneer products are not fabricated from feldspathic porcelain but rather "contain" porcelain. Thin shell veneers lack the thickness required for creating veneers that have the appearance of natural teeth.