Have you ever been in a situation where you rushed to your computer and started googling “emergency tooth repair”, “emergency dentist” or find a dentist nearest to your location? Or maybe you were wondering on the internet why my crown or veneer comes off constantly?
Well let me explain to you, as a prosthodontist, what is happening that cuases debonding of veneer.
Tooth preparation for a veneer seems to be an easy task, but it is difficult, indeed. It is difficult, because it requires attention to a lot of details. It is difficult because, unlike filing a tooth for a full crown, you need to be extremely conservative in removing tooth structure and save a thin layer of enamel to bond to. Leaving “enamel” on the tooth surface is the key to success and “that” is exactly what makes this task challenging for some of our colleagues. Some doctors also file deeper with good intention to get better aesthetic results per recommendation of the Lab they are working with, Not realizing filling deeper means removing more enamel and much higher risk of failures.
Today was one of those days that a young patient came to my practice as an emergency witha request to have his veneer re-cemented for the second time. It was not that old that i’d say it lasted long enough. It was inserted only a year ago by his close friend, who I believe did his very best to provide a good service to his childhood friend.
The truth is, when 60% of the enamel is removed or filled during tooth preparation, there is a significant high risk for the early failure of the veneer, due to de-bonding of the veneer. In that case, it is not recommended to fabricate a veneer but the goal should be to switch to a full crown.
The whole notion of a veneer restoration is to achieve high aesthetics with minimal tooth preparation. If most of the enamel is filled down, “being conservative” is basically meaningless and now we should be concerned about the longevity of the restoration as well as the tooth itself.
I will post a few photos of veneer cases that I had done for the sake of comparison and better understanding.
Babak Noohi, DDS, MS