Dental bonding is a procedure in which a tooth colored resin material is applied and cured (hardened) with a special light, which ultimately “bonds” the material to the tooth. The final result looks and functions like the original tooth. Bonding is typically used for cosmetic purposes to restore and improve the appearance of a person’s smile.
Dental bonding is actually one form of veneering. Veneers are thin cells that fit over the front surface of the teeth to improve their appearance. There are 2 main kinds of veneers: porcelain and composite. Porcelain veneers are custom made of porcelain to fit patient’s teeth, whereas composite veneers are made of a tooth-colored resin that is either bonded directly from the cosmetic dentist to the tooth, or is custom made in the laboratory. So, when it comes to composite veneers, the patient can choose between direct composite veneers, that are applied directly to the teeth in a procedure known as “dental bonding”, and indirect composite veneers, that are custom made outside of the mouth in a dental laboratory.
The main difference between direct and indirect composite veneers is the application process and not the actual material used. Teeth are prepared in the same way in both techniques, but in the indirect technique patient receives a set of provisional veneers until the final ones are made. Indirect composite veneers are applied on the teeth with a thin layer of adhesive.
Direct composite veneers, often referred to as dental bonding, have the advantage of being applied in one single visit. Their disadvantage is that the final result depends a lot on the expertise of the cosmetic dentist. On the contrary, indirect composite veneers are fabricated in the laboratory, so they can easier mimicate natural tooth’s shade and translucency. Moreover, they can withstand more abrasions and resist fractures better than direct ones. Their disadvantages are that they are not completed in a single visit, so the patient has to receive a set of provisional veneers, and that they tend to cost more.
Composite veneers can be used to :
- Improve dental imperfections
- Repair chipped, broken and cracked teeth
- Improve the appearance of discolored teeth
- Close small gaps in between teeth
- Increase the size of a tooth
- Cover and protect roots that have been exposed due to gum recession
- Composite veneers are less expensive compared to porcelain veneers and crowns.
- The procedure is painless and usually does not require anesthesia.
- Because there is no necessity for extensive tooth enamel removal, the procedure is minimally invasive.
- Composite veneers can be easily repaired.
- If the final result is not satisfactory, composite veneers can be easily reshaped and improved.
- Composite resins present less strength compared to the ceramic material of porcelain veneers and crowns. They may chip and break off, if extensive force is applied. Luckily, resins can be repaired easily in a single appointment.
- Composite veneers do not last long. They should be replaced about after 6-10 years.
- Composite resin is not as stain-resistant as other dental materials and may develop discoloration, especially if the patient smokes or drinks a lot of coffee or tea.
- The final result of the dental bonding technique is highly dependent on the specialized dentist’s expertise.
Care of composite veneers
Taking care of the composite veneers helps extend their life. Self-care tips include :
- Brushing at least twice a day and flossing daily.
- Avoiding hard food, not biting ice and candy.
- Not chewing on pens or pencils and not biting your nails.
- Avoiding coffee, tea, and tobacco to avoid stains.
- Scheduling regular dental cleaning every 6 months.
A porcelain veneer is a thin layer of dental ceramic material that is fixed to the outer surface of a tooth with a special resin adhesive. Veneers essentially replace tooth enamel and enhance teeth cosmetically by masking a variety of minor to moderate dental imperfections. Once applied, teeth are shiny white and perfectly arranged. Veneers do not stain the way teeth do, and can last seven to 20 years, or even longer. That’s because porcelain is hard, strong, durable, translucent in an attractive, glass-like way, and highly resistant to chemical attack. Additionally, modern porcelain materials help fabricate resistant to fracture laminate veneers in very small thicknesses of 0.5-1mm. In this way the technique requires minimal reduction (trimming) of the teeth, so it is minimally invasive and thus biologically very acceptable.
What can porcelain veneers do?
- Change the color of badly stained teeth
- Cover minor cracks in teeth
- Restore chipped teeth
- Close minor to moderate spaces
- Cover misshaped teeth
- Build up teeth that have been worn down by grinding habits
What can’t porcelain veneers do?
- Take the place of orthodontics when teeth are badly out of position
- Attach to insufficient tooth structure
What is the process?
In the first consultation visit, the cosmetic dentist will take photos of the teeth, discuss about the pros and cons of various treatment options, and will present the patient with before and after photos of the work he has performed for others. Patient’s smile is then digitalized and processed with special digital tools, so the dentist is able to illustrate to the patient his looks after the proposed dental procedure. If he likes the result, the process goes on to the ‘provisional stage’.
In the next stage, the cosmetic dentist takes initial impressions of the teeth and then the dental technician fabricates a model of the teeth and a provisional set of veneers out of plastic. The patient can actually wear these provisional veneers for up to 2 weeks to see if he likes the effect, the shape and the shade of the veneers. It is interesting that up to this point, teeth are left intact. Provisional veneers are bonded on the teeth surface reversibly, so if patient changes his mind they can be removed without causing any damage to the enamel.
If the patient is satisfied with the provisional veneers, tooth preparation begins; tooth substance of about 1mm or less in thickness is removed from the front surface of the teeth in a process known as reduction. Then, impression of the reduced teeth is taken and sent to the dental laboratory, along with specifications for the shade and form of the veneers. On the final appointment, the cosmetic dentist checks how veneers fit, their shade and shape and, if everything is satisfactory, they are bonded with a resin adhesive.
A filling is one of the most common dental procedures. It is a treatment to restore the function, integrity and morphology of missing tooth structure resulting from caries or trauma. It is a painless procedure which includes cutting the decayed tooth substance and replacing it with a material that can be resin composite or amalgam.
Amalgam or ‘silver filling’, has been the most popular and effective filling material used in dentistry for more than 100 years. Although its use tends to be eliminated in many countries due to concerns on its mercury content, it still has some advantages. It is a relatively inexpensive material when compared to other filling options and, most importantly, produces very strong and long lasting fillings – a really crucial factor for back teeth that must withstand extreme bite forces. The controversy surrounding amalgams has to do with the mercury content. When chewing, the amalgam releases small amounts of mercury vapor that you then inhale. However, several studies conclude that the amount of mercury released from the amalgam in the mouth is very low and less than the amount that most people are exposed to in their daily environment or in the food they eat. This is why the American Food and Drug Administration, the WHO and the ADA consider “Dental Amalgam as a safe, reliable and effective restorative material”. Nevertheless, people who have high exposure to mercury (through their jobs or people who eat large amounts of seafood) may want to avoid amalgam; pregnant women should also avoid amalgam. Besides being so reliable, the most common drawback of amalgam fillings is their unattractive appearance. The silver color of the fillings, especially on lower teeth, may make the patient feel less confident about their smile and is absolutely contraindicated when it comes to patients with great cosmetic concerns, like people in the show business. Aesthetics is the reason why composite fillings have gained ground over the years.
Resin composite fillings or ‘white fillings’ are made of a ceramic and plastic compound. Because resin mimics the appearance of natural teeth, these fillings blend right in. Resin composite bonds to the tooth surface and this means that only the decayed part of the tooth has to be drilled for the filling to stay in place. On the contrary, amalgam doesn’t adhere to the tooth, and therefore healthy tooth substance is often removed in order to achieve a retention shape for the filling. The drawabacks of resin fillings are that they need to be replaced sooner, usually after 5-7 years (whereas amalgam fillings last 10-15 years) and that the process of placing them is more involved, so requires more chair time.
The decision on which type of filling is appropriate for each case is made according to the size and location of the cavity, patient’s dental history, cosmetic concerns and cost. When it comes to front teeth, white fillings are always the therapy of choice. For the back teeth, strength of the filling should always be the objective and, in order to be combined with aesthetics, a new technique has been developed, the inlays/onlays technique.
Also known as partial crowns, inlays and onlays are indirect restorations or fillings. This means that they are made outside of the mouth as a single, solid piece, that fits the specific size and shape of the cavity. The restoration is then cemented in place in the mouth. This is an alternative to direct restorations, made out of composite, amalgam or glass ionomer, that are built up within the mouth.
Inlays and onlays are used in molars or premolars, when the tooth has experienced too much damage to support a basic filling, but not so much damage that a crown is necessary. The key comparison between them is the amount and part of the tooth that they cover. An inlay will incorporate the pits and fissures of a tooth, mainly encompassing the chewing surface between the cusps. An onlay will involve one or more cusps being covered. If all cusps and the entire surface of the tooth is covered this is then known as a crown.
Historically inlays and onlays have been made from gold and this material is still used today. In our days, tooth-colored materials such as ceramic/porcelain or special dental composite are usually preferred because of their better aesthetic result.
Inlays and onlays are indicated when teeth are weakened and extensively restored.
Inlays, especially the metals ones that are superior in strength, are usually indicated when there has been repeated breach in the integrity of a direct filling. They are also indicated when placement of direct restoration may be challenging to achieve satisfactory parameters (shape, margin, occlusion). They are usually reserved for larger cavities; small cavities can be restored with direct composites, in order to preserve as much tooth substance as possible.
Onlays are indicated when there is a need to protect weakened tooth structure without additional removal of tooth tissue unlike a crown, e.g. restoring teeth after root canal treatment to give cuspal coverage. It can also be used if there is minimal contour of remaining coronal tooth tissue with little retention. In this case, placement of a crown would be more aggressive solution, as it requires more tissue removal.
Inlays versus Dental fillings
Inlays are a type of indirect restoration(filling) that is used to restore extensively damaged or decayed teeth. When compared to conventional (direct) fillings, inlays have several advantages :
- They are extremely strong and durable: well-made gold inlays, in particular, have exceptional longevity with proper care.
- Ceramic inlays have better physical properties than traditional resin composite fillings for posterior teeth.
- The composite inlays do not contract to the same degree as a filling after being placed, so there is less chance of the restoration failing or creating a gap between the filling and the surrounding tooth structure.
- Inlays can give the restored tooth a natural. aesthetic appearance : ceramic inlays allow an excellent shade match that makes the restoration almost indistinguishable from the surrounding natural tooth.
- Inlays allow the dentist to achieve better contours, contact points, and occlusion than direct fillings because they are custom-made for the patient in a laboratory.
- Resin inlays have less microleakage and less postoperative tooth sensitivity than direct resin composite fillings.
However, the technique has some downsides :
- Inlays are much more expensive than a filling.
- The process requires two appointments.
- It is a highly technique sensitive technique that cannot be performed by all dentists.
- Tooth preperation for inlay placement requires more tooth substance removal. As a consequence, the risk of loss of tooth vitality is higher.
- Ceramics can be brittle, so porcelain inlays -especially on molars- may fracture.
When it comes to smile transformation, it is often very difficult for the patient to explain and envision their dream looks. Sometimes they do not even realize the impact a stained, yellow or narrow smile can have on their appearance. Cosmetic dentists, on the other side, have the experience and the knowledge to understand how a specific treatment will change an individual’s looks by taking into consideration every aspect of the face, not simply the bite or the color of the teeth. Changing the size, shape or depth of the teeth with crowns, veneers and implants can smooth wrinkles around the mouth, fill out the jaw line, or balance the appearance of the smile. The difficult part for the dentist is to persuade the patient that their perception about his ideal smile will be the best for him, and this is where digital smile design technology is used.
Practically, this is a professional altering of the patient’s digital photograph by using the smile vision imaging system. Smile analysis is performed by using facial measurement formulae relating teeth to the face, as well as other parameters, in order to customize the appropriate sized teeth to each specific individual. Patient is presented with his new smile simulation, desired changes are digitally made and then the process moves on to the next stage. In this, a mock-up smile made of tooth-colored wax is fabricated and, based on that, provisional teeth are made. These provisional teeth can be worn by the patient for up to 2 weeks, creating, in effect, a “trial smile”- one of the rare instances in medicine or surgery where a patient can view and evaluate changes before the final result. In the end it is the patient’s wants and needs that guide the treatment, and this is why the Digital Smile Design Concept is considered the most modern, patient-centered design approach available.
1. What will happen to my teeth after veneers, will they be more sensitive to caries?
The integrity of veneered teeth is only marginally compromised, and the veneer is bonded to the existing teeth. There is no higher incidence of decay provided the veneers are properly fitted and cared with regular flossing and brushing with toothpaste. In general, it is good dental advice to keep your sugar consumption low and confined to meal times to prevent decay.
2. Do porcelain veneers stain with tea, coffee and wine?
No. Porcelain veneers never stain.
3. Will I be able to chew normally with veneers?
Yes. You can do regular activities with your teeth and you will not have any pain on teeth or gums. However, veneers and especially composite ones, may chip or come off with abnormal use and forces such as when biting ice, chewing on pens and pencils, biting nails, hard food or candy.
4. If I have my upper teeth treated with veneers, will my lower teeth be more yellow?
This is certainly a factor that will be discussed during your evaluation and smile design so that everything matches and blends well. Most patients usually whiten the lower teeth to ensure a good match.
5. How long will porcelain veneers last?
They can last for one decade or two, as long as you take care of them properly. While the veneer itself is inert and non-living, the tooth or teeth to which they are attached and the surrounding gum tissues are living and may change. For example, gum line shrinkage may expose or reveal root surfaces. This is sometimes a reason why even a very well fitted veneer should be replaced after a period of time.
6. Will my veneers come off?
No. Well fitted veneers generally do not come off. If, however, this happens, the veneer can generally be rebonded. If it chips it can sometimes be rebonded or otherwise replaced.
7. Is whitening not enough for my teeth? Why do I need veneers?
It depends. Professional tooth whitening can lighten your teeth up to 8 shades. In some cases such as severe tetracycline stains, however, this whitening procedure is not enough to achieve the whiteness you may want. Permanently stained teeth can be re-surfaced with veneers to make them look perfect. Porcelain veneers are stain-resistant, so you won’t have the problem coming back.
8. Composite or porcelain veneers? Which is best for my teeth?
It depends. Composite veneers and especially the dental bonding technique can be used to fix flaws and chips in your teeth, and even to close gaps between teeth. It is a very good solution for minor aesthetic problems of one or two front teeth, because it is minimally invasive. However, there are two major issues with dental bonding: durability and quality. Dental bonding usually lasts 3-5 years before it starts to chip, stain and wear away, so it needs to be repaired. Porcelain veneers, on the other hand, can with proper care last 15 years without being stained or worn. The quality of both techniques has a lot to do with the skill of the dentist, however dental bonding is more demanding. The cosmetic dentist has to be very experienced to use the appropriate shades and layers of resin on each tooth, and still sometimes cannot match the exact color, translucence and other qualities of natural teeth the way porcelain veneers do.
9. Can veneers be an alternative to braces?
The answer is “yes” and “no”. Braces are designed to move teeth into place and correct bite and jaw problems. There are certain situations that can be handled with braces that cannot easily be corrected with veneers. However, in many cases where we are dealing with slightly crooked teeth, veneers can provide a much faster treatment option. In other cases, veneers can be a useful tool for finalizing smile transformation after orthodontic therapy; with them we can alter the shape and color of the newly aligned teeth in case they are not pleasing for the patient, thus creating the perfect smile for him.
10. How do I know that I will I be pleased with the result of veneers?
First of all, you have to carefully select an experienced cosmetic dentist that will provide you with many examples of before and after results of treatment, to see the work he/she has performed for others. Communication between you as a patient, your dentist and the laboratory technician are critical to the process of providing the best possible smile enhancements to meet your expectations. The use of a special blueprint will also be a useful tool, since sometimes there are differences between your and your dentist’s perception of how your final looks will be. Provisional teeth can be fabricated and worn for up to 2 weeks, creating a ‘trial smile’- one of the rare instances in medicine or surgery where you can view and evaluate changes before the final result. And, most important of all, placement of provisional veneers does not require tooth preparation and does not damage your enamel; so you may change your mind without having caused any irreversible damage to your teeth.
11. Should I replace my amalgam fillings?
Not necessarily. Dental amalgam (silver filling) was in the past the most common dental filling material and, because it contains mercury, concerns have been raised over the years about its use. As far as the mercury release, several studies conclude that the amount of mercury released from amalgam in the mouth is very low and less than the amount that most people are exposed to in their daily environment or in the food they eat. Although in some European countries like Germany, Sweden or UK there is a tendency to eliminate the use of amalgam, the major Health Organizations continue to accept amalgam use. According to the American Food and Drug Administration, the WHO and the ADA, “Dental Amalgam is a safe, reliable and effective restorative material”. Consequently, the decision to replace old amalgam fillings is not based on the material itself, but on the integrity of the restoration. If the amalgam fillings appear to have cracks, signs of decay, chips, or if they have caused tooth discoloration, they have to be replaced.
12. Why do I need an onlay? Can't I have a filling?
An onlay is a type of indirect filling reserved for larger areas of damage or decay, where a filling or inlay won’t work due to the amount of tooth structure that is missing. An onlay is an extremely durable solution, creating a seal over your tooth that will prevent further damage, fracture, infection or inflammation. It will protect your tooth the same as a crown would do, but it is a less aggressive restoration that requires less tooth structure removal. On the contrary, placing a simple filling on a severely damaged tooth puts tooth integrity into great risk, and may even result to tooth loss due to fracture.