Lumineers ® / Consulting with your dentist about placing Lumineers ®.

At an extreme, here is an example describing a situation where placing Lumineers ® veneers using a "no drilling, no shots" technique might be a poor choice.

Porcelain veneers are sometimes used to change the apparent alignment of crooked or overlapped teeth.

With traditional porcelain veneers technique, before the veneers are placed the misaligned teeth are trimmed back in a fashion where their front surface is in more even and regular. The idea is that it is not so much that the porcelain veneers themselves will be used to provide the idealized alignment of the patient's teeth but a combination of trimming back protruding portions of the irregular teeth and minor variations in the thickness of the individual veneers that together give the patient's smile its new appearance.

In the case of trying to use a "no drilling" technique (such as that typically advertised in association with Lumineers ® porcelain veneers) the only possible way to make a change with the apparent alignment of the teeth is by making each porcelain veneer a different thickness, in some cases by a great extent. With this type of approach it would be quite easy for the final veneering product to be one where some individual teeth have been made quite a bit larger (thicker, over bulked, over contoured) than they were originally.

Of course in real life making decisions is seldom simple. So many veneering cases will offer a situation that lies somewhere between the ideal "no drilling" Lumineers ® veneers case and one where this approach is simply not appropriate. Each case is a judgement call. You will simply need to rely on your dentist's knowledge and experience in regards to advising you about the appropriateness of using "no drilling" Lumineers ® technique with your precise situation.

Why all of this talk about over contoured porcelain veneers?

Beyond just cosmetic appearance, the contours of a tooth also affect factors associated with a tooth's long-term health and function. It's easy to see how a dental patient could find an oversized tooth to be cumbersome, even to the point where it might affect their speech, biting movements, or simply the way their lip lies across their teeth. However, with time people often adapt to these types of changes.

As a separate issue, the contours of teeth can have an effect that influences factors associated with maintaining the long-term health of both the teeth and the gum tissues that surround them. The contours of teeth affect the ease with which dental plaque can be removed. When dental plaque is not removed effectively, problems such as tooth decay and gum disease can occur.

Gum disease considerations.

In those regions where dental plaque is not or cannot be removed effectively gum inflammation is likely to occur. The long-term success of a set of porcelain veneers will, at least in part, be determined by the stability of the gum tissue that surrounds the teeth. This is because even the slightest amount of gum recession (like that caused by gum inflammation) can spoil the cosmetic appearance of a set of porcelain veneers. Of course, at an extreme, beyond just minor gum recession persistent gum inflammation can lead to tooth loss.

Tooth decay considerations.

Anything that interferes with dental plaque removal from around a tooth, such as an over contoured porcelain veneer, can tip the scales in favor of tooth decay formation in those regions that lie at the edge of the porcelain veneer.

Why over contoured dental restorations are harder to clean.

An over contoured porcelain veneer can result in a gum line shape that interferes with effective dental plaque removal. This shape can hamper the access of a toothbrush's bristles into those regions where dental plaque accumulates. These same contours can disrupt the natural cleansing action created by a person's lips and cheeks as they rub against a tooth's surface. In general, when the clinical judgement of the dentist is vague, under contouring a dental restoration is typically the better choice than over contouring. Placing a bulky porcelain veneer breaks this rule of thumb.

Good oral home care is always paramount.

Several researchers have evaluated how over contoured dental restorations can affect the health of the gum tissue that surrounds teeth. Some of this research (Deng, 2001) suggests that over sizing the contours of a dental restoration as little as .5mm can adversely affect the health of the gum tissue surrounding the tooth, whereas a .2mm increase shows no statistically significant change.

Since Lumineers ® veneers can be fabricated as thin as .2mm in thickness this seems to confirm that placing them using a "no drilling" technique can produce acceptable results. Of course this implies that the ideal conditions for using this technique existed initially. The potential for problems exists when "no drilling" Lumineers ® technique is employed when the ideal conditions do not exist, thus resulting in teeth that are over contoured.

We will state that some of the researchers (Ehrlich, 1980 and Kohal, 2003) that have studied the effects of the contours of dental restorations on the health of gum tissue around teeth have found that the most significant factor involved is simply the degree of effectiveness of the person's oral hygiene regimen. Those people who put the effort in and do effectively remove dental plaque do not develop problems. The question then becomes, in those situations where "no drilling" Lumineers ® veneering technique is considered even though the ideal initial conditions do not exist, can the individual be relied upon to consistently provide the level of thoroughness with their oral home that is required, throughout all of the years of their life?