Cosmetic Dentistry: A single case (simulated two ways) so to compare treatment outcome with porcelain veneers vs braces.
Patients seeking an improvement with their smile are often attracted to the possibility of placing a set of porcelain veneers, as opposed to having orthodontic treatment (braces). Here's a digital smile makeover that we've simulated two different ways, treatment with veneers and braces. With each approach, we discuss some of its relative advantages and disadvantages.
Digital smile makeover #1: How this case might turn out if veneers are placed.
Dental history and concerns:
1) The request from this person was simply one where they wanted to see what they would look like with "straight" teeth.
It seemed to us that this task could be accomplished by either placing a set of porcelain veneers or else by realigning her teeth using orthodontic treatment (braces). Instead of simulating just one approach or the other, we decided to create an "after" picture for both.
2) From the limited information available to us by viewing the 'before' picture, we developed the following impression.
- Overall, this seems to be a healthy mouth. (The gum tissue looks good. We don't see any obvious dental problems or missing teeth.)
- There is a generalized tooth misalignment, both top and bottom.
- To a very minor extent, the outline shape of some of the teeth (mostly their biting edges) might be improved upon.
- Lightening the teeth a little might make a nice improvement.
Cosmetic dentistry solutions: An approach involving porcelain veneers.
1) We'll let our "after" picture above speak for itself. What we've tried to illustrate is that yes, porcelain veneers can be used as a way to change the apparent alignment of teeth.
The way this is done is as follows. When veneers are made, protruding aspects of offending teeth can be trimmed back modestly. And the thickness of veneers placed on recessed teeth can be made relatively thicker. In combination, these two changes can create the illusion of straighter teeth, without the need for orthodontic treatment.
2) Disadvantages. - Just because it can be done, doesn't mean that placing veneers is our favorite solution for this case. We prefer the idea of realigning the teeth with braces. Here are some of the reasons why.
A) It can be difficult to get a "perfect" result with veneers.
Look at the alignment of the lateral incisors in our "after" picture. In the "before" picture, these teeth stick out somewhat. And in our "after" picture they still do a little bit.
That's because we've tried to simulate that there are limitations regarding how much tooth structure can be trimmed away when veneers are placed. And with some cases, that makes it difficult to create the "perfect" alignment.
The veneers for adjacent teeth could be made thicker, so to even things out. But relatively bulky veneers can be awkward for the patient, and possibly detrimental to the long-term health of their gums.
B) It can be expensive to get a "perfect" result with veneers. (In more than one way.)
Now, take a look at the "after" picture again and take note of the "V"-shaped spaces on the lower arch. (They're off to each side of the four center teeth. You may need to compare this makeover with the one below to understand what we're referring to.)
Sure, restorations could be placed that could fill in these spaces. But the question always remains, how many teeth will need to be treated to effectively mimic the overall regularity and evenness of teeth that have been realigned using braces? In reality, it may turn out to be a fairly large number.
If a large number of teeth are treated, it means increased costs, both initially and due to maintenance (both planned and unexpected) that's required over the years. (Yes, you have to expect that your veneers will need to be replaced at some point during your lifetime, possibly more than once. No "permanent" dental restorations really ever end up lasting forever. Especially when their cosmetic appearance is a major concern.)
2) Advantages. - As an advantage, the veneering approach is the "instant gratification" and "least effort" method. Orthodontic treatment can take 1 to 2 years and is a bit of a lifestyle inconvenience.
In terms of limiting the number of veneers needed (and minimizing treatment costs), a person may decide that the relatively lesser appearance achieved by treating fewer teeth is perfectly satisfactory to them.
Digital dental makeover #2: Realigning the teeth with braces.
Without question, it seems to us that this case really shouldn't be considered to be a 'cosmetic dentistry' case at all but instead an 'orthodontic' one.
Solutions: An orthodontic approach.
1) If an orthodontic approach is chosen, the treatment plan would simply be one of realigning the teeth using some type of dental braces.
2) Disadvantages. - For most people, the biggest drawback of this approach would probably be how long the treatment will take and the fact that they feel that wearing braces looks goofy and is too much of a lifestyle inconvenience.
In regard to treatment time, yes, the orthodontic work required here would probably take a year or so, possibly two. As far as the inconvenience factor goes, it might be possible to treat this case using removable braces (Invisalign ®).
2) Advantages. - The clear advantage of using an orthodontic approach is one of long-term maintenance. After treatment, the only maintenance required would be one of wearing a retainer (possibly as infrequently as just several nights per month). That's a pretty small price to pay compared to a lifetime of planned and unexpected repair and replacement sets of porcelain veneers.
3) Teeth-whitening treatments are an option. - If they so desired, it seems likely that the color of this person's teeth could be lightened using teeth-whitening treatments, either at-home or in their dentist's office.
This treatment will tend to relapse over time, but touch-up maintenance should still be much easier and less costly than replacing a set of veneers.