Porcelain-fused to metal crowns and bridges, where the metal substructure provides strength for the overlying porcelain, have been used for many years to restore broken down teeth. However, these crowns often have a couple of problems with visible metal margins and an unnatural appearance. The inherent problem with this sort of crown is that the porcelain has to disguise the underlying metal and attempt to match the appearance of the surrounding natural teeth; the net result is often a very opaque crown that lacks the vitality of the natural teeth. Modern ceramic materials such as alumina and zirconium can provide a strong sub-structure, thereby allowing a more aesthetic and natural-looking all-ceramic crown or bridge to be constructed.
Dental veneers can be a modern alternative to full crown preparation and are a popular treatment choice on television makeover programmes. A veneer is a thin piece of porcelain, or composite, made to fit over the front surface of the tooth to make it look straighter / longer / whiter (or all three). The tooth needs to be reduced to the right shape so that the veneers will make all the teeth line up correctly once it is fitted.
It is extremely important to plan any crowns and veneers and a diagnostic wax up of the proposed treatment should be prepared to allow visualisation of the likely final result. It also provides a template for the preparation of the teeth and is used for the construction of the provisional restorations.
Regardless of how conservative the tooth reduction is, once the tooth has been removed it cannot be put back, so this is not regarded as a reversible procedure. Also, there is a small chance that the nerve inside the tooth may be compromised and the tooth may need to be root filled after the treatment is completed. The risk of this complication is, on average, around 10% for each tooth, although this is dependent on the amount of tooth reduction involved.
Veneers will look at their best for 10-15 years or so with good maintenance, which means daily brushing and flossing, combined with periodic examinations by a dentist and visits to the hygienist. As time goes by the veneers may start to look a little less ‘perfect’ than the day they were fitted due to very slight dulling of the shiny porcelain surface, and the gums may recede causing the join between veneer and tooth to become apparent. Whilst these are not major issues that necessitate replacement, you may find that you will wish to replace them to have everything look as good as possible.
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