Porcelain Veneers And Other Porcelain Restorations
In the last few years great changes have taken place in the technique and use of porcelain restorations in dentistry. The big changes are a result of better porcelains being developed by dental suppliers and huge changes in the ability to bond porcelain directly to teeth. In this article we will talk about porcelain veneers, full porcelain crowns, and porcelain inlays and onlays.
I have used porcelain veneers in my practice for about 7 years. They are a more conservative option than capping (crowning) which requires trimming much more tooth structure to prepare space for the crown material. Basically, they are similar to a fake fingernail. They are very thin and completely cover the front of your existing tooth. They also look much better and hold up much longer than their predecessors-- plastic veneers or direct bonded composite restorations. They look extremely natural, are very durable and maintain their color. They are particularly well suited for front teeth with spaces, discoloration, or misalignment, that don't have existing large restorations.
The technique for placement is easy on the patient. Little shaping of the teeth is necessary so no local anesthetic is required. After the dentist prepares the teeth to be veneered an impression is taken of the teeth so a mold can be prepared to send to a dental laboratory. The laboratory fabricates a custom fit veneer and returns the veneer to your dentist. On your second appointment the veneer is tried on for fit and bonded directly to your tooth. All that remains to be done is polish edges and your restoration is ready for normal use. Maintenance on your part is simple. Just floss and brush as you normally would.
A crown or cap is necessary when teeth are misaligned, spaced, discolored and also have large restorations (fillings) or large decay areas. Full Porcelain crowns have been around for years. They had a major drawback. When cemented on with traditional dental cements they had a tendency to crack and split. The nature of porcelain without reinforcement is that it breaks easily. This lead to the development of crowns with metal frameworks to support the porcelain. The problem with the metal frameworks was that the metal color had to be blocked out, more had to be taken off the tooth to make room for the metal, and light was blocked from passing through the entire tooth making it difficult to make the crown look really life-like.
A solution was developed. If we can bond porcelain veneers to the front of the tooth why not extend the veneer around the entire tooth to kind of hold the tooth together (as a crown does) and bond the porcelain crown directly to the tooth. (Note: traditional dental cements essentially have no chemical bond to either the tooth or the restoration. They are held on by the parallel shape of the prepared tooth and friction between the cement, tooth, and crown. Basically, the cement is just a filler) With this technique the tooth itself serves to reinforce the porcelain instead of the metal it was bonded to with the porcelain to metal crown. Light passes through porcelain unimpeded by a metal backing making these crowns as close as natural as we have been able to accomplish. With improvements in properties of new porcelains developed by suppliers a very esthetic and strong restoration was born.
The third porcelain restoration I want to discuss is the porcelain inlay or onlay. In general, we are talking about placing inlays and onlays in posterior teeth. They are a esthetic replacement for metal colored fillings. They had been used in the past for these restorations but the same problems were encountered as with the porcelain crowns. They were easily broken and we really didn't have room in the inlay or onlay situation to reinforce them with metal. By bonding them in position the reinforcement problem was solved with an added benefit. By bonding the tooth and the restoration we have actually made the tooth stronger than a traditional cemented inlay or onlay.
Another new technique may have further advantages over the porcelain inlay or onlay. More on this in a future article.
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