Porcelain Veneers

Porcelain Veneers… Not such a slam-dunk procedure as some may think.

I had a fellow referred to my practice by a colleague because veneers he had not placed were breaking and coming off.

This patient had porcelain veneers placed on eight (8) front teeth of both upper and lower arches. He was pleased enough with the appearance of his new look but dissatisfied with his speech. He had developed a lisping sound and a tendency to spit when he spoke.

He was extremely frustrated but really did not understand the problem. His request to me was to add length to the back teeth so that there would be less space between them during speech. He pointed out that space to me by bringing his upper and lower front teeth together edge to edge; as you might when biting a thread.

I informed him that this would not solve his problem, but rather would likely make his muscles very sore because we would be violating the natural physiologic position of his jaws. When we rest our jaws without thinking about them, as we do when reading or watching TV, we should have a space between our teeth. Our teeth should only touch when we are chewing or during other functions like swallowing, etc. This we refer to as “freeway space.” If violated, our body tries to create that space by flexing the jaw opening muscles. Pain in the face can be expected.

I obtained models of his teeth mounted on a device which corresponds to his joints. With function records, I pointed out to him that his veneers were contacting when he spoke. He admitted that they did but hadn’t told me because he liked the way they improved his appearance. Without passing judgement on what I thought were teeth that looked artificially white, I did feel that he carried the aesthetic length of the teeth quite well. The uppers were quite long, but even at that, barely visible when his lips were at rest.

The problem was that the veneers had been designed with a slight lingual cant. That is they slanted from gum to edge, inward. Had they been created with just one millimeter more forward position of the edge, he would likely not bang them together in speech.

The laboratory that made these veneers didn’t have proper (if any) guidance from the doctor as to the proper position for the incisal edge of the teeth. And when the doctor placed them into the patients mouth, they were never tested prior to permenant bonding.

Unfortunately, this fellow felt that the cost to remake even one arch of veneers was excessive. He kept telling me “really, they’re just teeth!” and “why do they have to be so expensive, do only movie stars get to have dentistry in this country?”, “I paid less than half of that”. I was unable to convey to him that his teeth are part of his body. They are not just something to look just so for a nice smile. Function is important for all the teeth, not just some of them.

Too many dentists, in my opinion, advertise smile makeovers without a thourough understanding of the function of those front teeth. Too many patients desire the look and seek out the dentist through ads or internet searches. I feel that advertising drives the price down. And there comes a point where cutting cost leads to cutting quality by using inferior cheap materials and rushing to save time.

The fellow mentioned here failed to see the value in doing it right. What he failed to realize is that he was a walking example of doing it wrong. He told me that I had a “sky is the limit” approach to cosmetic dentistry fees. I countered that sometimes “we get what we pay for.”