Lumineers® (ultra-thin porcelain veneers) -
When a dentist places porcelain veneers for a patient, they have some options as to the specific protocol they use.
One of these is the no-shots/no-drilling technique that's possible with ultra-thin veneer products like Lumineers®. Dentists refer to this as "no tooth preparation" (or simply "no-prep") placement.
Lumineers® can be placed without "shots" and drilling?
That's right. The idea is that ultra-thin porcelain veneers are so thin that they can be bonded directly to the surface of a tooth without needing to trim it back first. Since no drilling is involved, an anesthetic isn't needed either.
How thin are they?
Ultra-thin laminates are generally defined as those that can be crafted to tolerances as thin as .2 to .3 millimeters. That's less than 1/64th of an inch, and similar to the thickness of a contact lens.
Vs. regular veneers.
In comparison, the minimal thickness for a conventional porcelain veneer typically lies on the order of at least .5mm. That might not seem like much of a difference. But when an additional thickness is added to your tooth it really is.
Conventional veneers vs. Lumineers®.
What exactly are Lumineers®?
a) Vs. other ultra-thins.
There are several brand names associated with the subject of no-prep, ultra-thin porcelain veneers. Lumineers® (DenMat Holdings) is simply one of these brands.
While it's probably the best known one (due to both its extensive advertising campaigns and having been on the market the longest), there are some equivalent products. They include Vivaneers® (Glidewell Laboratories) and DURAthin® (Experience Dental Studio).
On our pages we tend to refer to all ultra-thin products as Lumineers®, since so many people are already familiar with them. But this procedure has developed into it's own technique. It's no longer just about one dominant brand, equivalent products exist and can be used in identical fashion.
b) Vs. other veneers.
One thing that makes the Lumineers® brand unique is that their veneers are made out of Cerinate® porcelain (DenMat Holdings).
This product is exceptionally strong and that characteristic helps to make it possible for these veneers to be so thin. Cerinate® products are only available to dentists through one of DenMat's Smile Design Studios®.
Details about no-tooth preparation placement.
One thing that makes ultra-thin laminates special as compared to conventional ones is that placing them doesn't necessarily have to require any tooth preparation (trimming).
General advantages of no-prep vs. conventional placement.
The fact that no tooth structure is trimmed away makes no-drilling placement one of dentistry's most conservative procedures. And at least in theory a reversible one. (Although possibly just in theory.)
Nothing to fear.
No requirement for tooth trimming makes this procedure ideal for people who want to make a change but are generally fearful of having dental work performed.
Minimal tooth sensitivity.
Since treated teeth remain generally undisturbed, post-placement sensitivity is seldom a problem. This isn't always the case with conventional veneers.
A very secure bond is created.
No-preparation veneers are bonded directly to tooth enamel and this is the strongest, most predictable and lasting type of bond created in dentistry.
In comparison, during the trimming process that takes place with conventional veneering technique it's possible that some of the tooth's dentin will be exposed (the tooth layer under enamel). Bonding to dentin is less secure than enamel.
Better, not best.
Even with all of these advantages, this technique does have disadvantages and criticisms. So it's probably best said that versus conventional veneers, no-preparation placement isn't better but simply different. (It has different preferred applications, see below.)
How are no-preparation Lumineers® placed?
In terms of what the procedure involves, here's how no-drilling protocol (the one that can be used with ultra-thin laminates) compares to traditional veneering technique.
A) Conventional placement.
Conventional veneers vs. Lumineers®.
They'll usually only need to trim an amount that's about the same thickness as the laminate they plan to place.
And although that's just a very slight amount:
- The patient will have to endure the drilling process.
- An anesthetic will probably be required.
- Temporary veneers will likely need to be worn until the next appointment when the final restorations are cemented.
For more details, use this link for an overview of the steps a dentist follows when placing conventional porcelain veneers.
B) No-shots, no-drilling veneer placement.
Since ultra-thin products like Lumineers® can be made wafer thin, they can be bonded right onto a tooth's surface without unduly increasing its size (see picture "B" in our graphic).
- There's no need for any tooth preparation, thus allowing the procedure to be generally painless (no anesthetic "shots" are needed).
- The dental work involved with the procedure's first appointment is quick and comparatively easy. It can be as simple as just polishing the teeth so they're good and clean and then taking a dental impression. Really.
- No temporaries are needed. Unlike with conventional technique where temporary veneers are sometimes needed to cover the patient's trimmed teeth (because they may be rough, sensitive or unsightly), with no-drilling protocol they are never required.
But all of this simplicity comes with trade offs. And you should know that not all dentists think that the use of this technique creates the best results. And in fact, for decades there's been continued, heated debate in the dental community about if and when a no-drilling approach makes an appropriate choice. (See this topic's next page.)
Actually, Lumineers® can be used with either protocol.
We're not trying to confuse the issue here but the following point needs to be made.
Lumineers® (and similar ultra-thin products) can be placed using either traditional or no-prep technique.
- Just because they can be made to wafer-thin tolerances (.2 to .3 mm in thickness) doesn't mean they have to be.
- They can also be made to conventional dimensions too (.5 mm thickness or more).
It simply depends on what the patient's case calls for.
C) Minimal-prep veneers.
As yet another variation, dentists have the option of placing ultra-thin veneers using minimal-tooth preparation technique.
This procedure is defined as the situation where the tooth is trimmed down, but less so or less extensively than it would when using conventional placement protocol. (Typically .3 to .5 mm vs. .5mm or more for conventional veneers.)
The patient still reaps some benefits (minimal drilling, likely no "shots," no need for temporaries, etc...). Yet by trimming back the most prominent portions of each tooth, the dentist can create a better functioning or more esthetically pleasing end result than they could with no-drill technique.
Minimal-prep brand names.
Each of the ultra-thin veneer brands mentioned above (Lumineers®, Vivaneers®, and DURAthin®) can be placed using minimal-prep technique. MAC® (MicroDental Laboratory), daVinci®, and IPS e.max veneers are suited to this type of placement too.
Applications for ultra-thin porcelain veneers (Lumineers®) vs. conventional ones.
Success has a lot to do with proper case selection.
People who know about products like Lumineers® typically do so because of advertisements they have seen. However, ads can lead a consumer to form unrealistic expectations.
Most people understandably draw the conclusion that the use of no-drilling technique can be used in their situation. And while in theory this may be true, any dentist can tell you that there's often quite a bit of difference between what's technically possible and what's in the patient's best interest.
Who makes the ideal candidate?
When a veneer is placed without trimming the tooth first, the tooth will end up being at least some degree larger.
In order to avoid the situation where this change is enough to create problems, a dentist will look for applications where:
- Only minimal changes are needed (so the laminate can be as thin as possible).
- Any resulting increase in tooth size can be used as an asset.
Favorable applications for no-prep veneers.
In general, here are the kinds of situations that make the most ideal applications for no-drill laminates like Lumineers®.
A) Making minor color changes.
Veneers lighten teeth by simply covering over and masking the darker tooth structure that lies underneath. There are two ways an effective amount of masking effect can be created.
1) When using comparatively translucent veneers.
When a veneer is fabricated using relatively translucent porcelain (doing so tends to give the tooth a more life-like appearance), it will need to be comparatively thicker, so it can effectively mask the color of the tooth underneath.
This is the approach used with conventional placement technique. The tooth is trimmed back so a thicker/more translucent veneer can be placed without creating a result that's too bulky or oversized.
Ultra-thin veneers are best for making just small color changes.
2) When using comparatively opaque veneers.
In cases where ultra-thin veneers are placed, the only way to get the needed amount of masking effect is to use porcelain that's relatively more opaque.
The problem is that more opaque veneers typically look more artificial. (This is a criticism of Lumineers® and similar products in general. We discuss it here.)
By limiting the use of no-drill technique to just cases where only a minor amount of color change is needed (such as lightening teeth just a shade or two, or masking slight blemishes), the veneer can be both ultra-thin yet comparatively less opaque (win-win).
B) Making minor alignment changes.
Veneers can be used to even out the apparent alignment of teeth. But not trimming back portions of the most prominent ones first (which is the case with no-drill technique) can result in an outcome where the restorations make the teeth very thick. (We illustrate and explain this issue here.)
Think of no-prep veneer placement as a way of tweaking and perfecting a smile, such as correcting minimal tooth misalignments or straightening out minor incisal (biting) edge discrepancies. Not as a substitute for involved orthodontic work.
Closing tooth gaps. (One of our virtual smile makeover cases.)
C) Closing tooth gaps (diastema closure).
Since placing no-prep veneers ultimately increases the size of the patient's teeth, any time this change can be used as an asset makes an ideal application for this technique.
Dentists sometimes refer to these types of situations as "additive" cases.
Probably more so than with any other type of case, patients who have spaces between their teeth frequently make good candidates for no-tooth preparation veneers. Even more so if the teeth involved are relatively small or lingually inclined (see next section).
The extra thickness of a Lumineer® would be a benefit for this tooth.
D) Enhancing the appearance of small or inclined teeth.
This is another class of "additive" cases, meaning situations where the added bulkiness that results when no-tooth preparation veneers are placed can be used as an asset.
- Improving the look of comparatively small teeth. (Such as improving the appearance of "peg" laterals.)
- "Straightening" the alignment of lingually inclined teeth. (Teeth that are tipped inward or backward as opposed to being flared out.)
As with the other examples given on this page, just relying on the veneer to make minor improvements is typically the key to a successful outcome.
E) Minor repairs.
Teeth that have small chips, minor wear on their biting edges or an irregular outline form can make appropriate candidates for no-drill laminate placement.
As with all veneering techniques in general, just improving the appearance of the tooth should be the goal. Other types of restorations (especially dental crowns) make a better choice for rebuilding or strengthening damaged teeth.
F) Masking existing fillings.
White fillings (dental composite) tend to deteriorate and stain over time. Placing ultra-thin, no-prep veneers over these types of restorations can provide a more esthetically pleasing and durable tooth surface.
What about when precisely perfect conditions don't exist?
Even if your dentist determines that your case really isn't the perfect application for an ultra-thin/no-drilling approach, it doesn't necessarily mean that choosing it always makes an absolutely terrible decision.
Weigh the pros and cons.
For some people, the convenience or dental-fear benefits of no-drill protocol may outweigh the drawbacks associated with a slightly less-than-ideal outcome.
For example, when it comes to the esthetic results, lots of people seem to accept this compromise and have ultra-thin veneers placed.
Watch out for case rationalization.
Going ahead and placing no-prep veneers when less-than-ideal conditions exist is frequently rationalized as being acceptable by both patients and dentists alike. But before choosing this route, make sure you have thoroughly discussed matters with your dentist and understand all of the possible short and long term consequences.
The use of no-prep veneers for cases that lie outside of accepted norms is precisely when this technique is most likely to create a compromised outcome (in terms of appearance, function, maintaining dental health and case longevity).
Rejuvenating the appearance of porcelain dental work with Lumineers®.
Placing no-drill Lumineers® is sometimes promoted as a way to improve the appearance of porcelain-surfaced crowns and bridges that are no longer esthetically pleasing. Other ultra-thin veneer products might be used in the same way.
Lumineers® can be used to rejuvenating the look of a deteriorated porcelain crowns.
The idea is simply one where the veneer is bonded directly onto the front porcelain surface of the restoration, thus giving it a new look.
Since doing so only creates a cosmetic change, the dentist must examine the dental work in question and make sure that it's otherwise intact and clinically satisfactory.
Is using this technique a good idea?
One needs to keep in mind that this is patchwork dentistry.
Rather than having a restoration that's just a single entity created in the controlled environment of a dental laboratory, you'll instead have "a restoration placed on a restoration" that's been assembled in your mouth.
a) With dental crowns.
If your dentist suggests this type of repair for an individual crown, ask about their rationale.
They may have valid reasons. But in most cases your cost and number of appointments needed for the work will probably be about same for either approach, with the crown remake having the more predictable long-term outlook.
b) With dental bridges.
It's easier to see the benefits of this technique when bridgework is involved. Veneering just one or a few teeth that have spoiled the appearance of a large-span bridge might offer a practical solution, at just a portion of the cost of replacing it.
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