The porcelain veneer procedure.
- The process. / What steps are involved?
Page Graphics | Animations.
This page outlines the individual steps a dentist follows when they make and place a porcelain veneer (dental laminate) for a patient. Although we only illustrate this process for a single tooth, several teeth can be treated simultaneously, as a group.
In most cases, this procedure is broken into two separate appointments. Usually the needed time span between the two is one to two weeks.
Step 1: Trimming the tooth.
a) With this procedure, the idea is that the enamel on the front side of your tooth is trimmed back about the same thickness as the veneer that will be placed. That way its overall thickness is not dramatically changed.
The front surface of the tooth is shave back about 1/50th of an inch.
While performing the trimming, your dentist will keep in mind some recognized guidelines as to the maximum amount of enamel that ideally can be removed, and try to stay within those limits. (Open the drop down box below for details.)
b) If your tooth has some areas of decay, your dentist will trim more extensively in those locations so to remove it.
c) At least in theory, porcelain veneers can be bonded over existing white (dental composite) fillings. However, replacing them with new ones helps to insure the most secure bond possible.
Walls (2002) determined that bond strength is maximized if the new veneer is placed within 2 weeks of placement of the new filling. (Fabrication time for laboratory crafted veneers typically lies on the order of 2 weeks.)
d) The outline form of the preparation will be given a shape where the edges of the veneer (where it meets your tooth) aren't easily seen or lie at a point where opposing teeth make contact.
e) There's some debate as to whether the edge of a porcelain veneer should end right at the biting edge of its tooth or wrap over to its backside. (Smales  determined 86% vs. 96% 7-year survival rates for veneers having these respective configurations.)
While this is an issue for your dentist to decide, if no temporary veneer is placed (see below) it will affect your experience. If the veneer wraps to the backside, the biting edge of your tooth will need to be trimmed slightly shorter and thus will look and feel different than before.
Exactly how much is trimmed away?
This tooth's preparation has been completed.
The precise amount of tooth enamel that's shaved off will vary with each case but it can be as little as .5 to .7 millimeters. That's about twice the thickness of an eggshell and when compared to most other dental procedures it's a very small amount.
In some cases, the dentist may decide to trim the tooth more, possibly on the order of 1.5 mm or so (about a 1/16th of an inch).
There are two issues at hand when this decision is made.
- More aggressive tooth preparation means that a thicker veneer can be placed. One that can both mask over the color of the tooth underneath yet still retain a high degree of restoration translucency (a characteristic that helps to create a very natural-looking appearance).
- On the other hand, excessive preparation may expose regions of tooth dentin (the hard tooth tissue under enamel). If so, restoration longevity may be affected. (See drop down box above).
Will anesthetic be needed?
It can be possible to prepare teeth for veneers with out the use of an anesthetic (a dental "shot"). But you may find that you want it.
Some teeth and tooth tissues are naturally sensitive to cold sensations (like those created by the dentist's suction device or the water spray from their drill). And if the veneer's edges will extend below the gum line, those tissues will need to be manipulated and may be sensitive.
[Open the drop down box below for information no-drilling/no-shots veneer placement.]
Selecting a matching shade of porcelain.
Step 2: Taking the shade.
Your dentist will use their shade guide to determine which color of porcelain most closely matches the teeth that lie to each side of the tooth they're veneering.
They may decide that different colors need to be used for different portions of the veneer. They'll also make notes about which regions of the laminate need to be comparatively more or less translucent.
Step 3: Taking the impression.
Once the trimming has been completed, your dentist will take an impression of your tooth and its surrounding teeth and gums. It's this copy of your mouth that will be used to fabricate your veneer.
There are two ways an impression can be taken.
Option A - Most dentists will take an impression using "impression putty."
This is simply a thick paste that's loaded into a tray and then squished over your teeth. It's allowed to sit for a few minutes until it's set and then it's removed from your mouth (see picture).
This impression is then sent to a dental laboratory and they will use it to make your porcelain veneer. Depending on what arrangements have been made, the turn-around time for this process is usually about 2 weeks.
Option B - Your dentist may have a dental milling machine that's coupled with a camera that can take an impression of your tooth optically.
Using this image, the machine can then grind your veneer out of a block of ceramic (a synthetic porcelain), in a matter of some minutes.
The obvious advantage of this technique is that your tooth can be trimmed and its veneer bonded in place, all in one visit.
As convenient as this sounds, if your dentist doesn't have one of these machines it can be for good reason.
- Milled veneers are ground out of a block of uniformly-colored ceramic.
- In comparison, veneers crafted by a laboratory technician can be characterized. Layers of porcelain, each having a different color and degree of translucency, can be use to create a veneer that truly mimics the unique characteristics of the neighboring teeth.
Step 4: Placing a temporary veneer (if needed).
In those cases where your veneer will be fabricated by a dental laboratory, you will usually have to wait 1 or 2 weeks while it is being made. The question then becomes whether or not you will wear a temporary veneer during this time period.
A) Situations where no temporary is placed.
This can be the plan for cases where just a minimal amount of tooth structure has been removed (like in our picture above). Admittedly, on close inspection your tooth will look a little strange. But just how much of an issue this is is something that you'll have to decide.
Since a surface layer of your tooth has been trimmed off, you may notice that it has an increase sensitivity to hot and cold foods and beverages. You can also expect that it will feel a little rough to your tongue and lips.
B) Situations where a temporary is used.
It's more common to place a temporary veneer when treating cases where there's been a need to trim a relatively greater amount of tooth structure.
These are teeth whose appearance would be noticeably strange, or where the issue of thermal sensitivity might be a problem for the patient.
If having a temporary placed is important to you, and your dentist has not yet discussed this issue with you, you absolutely need to ask about it when your appointment is initially scheduled.
A dentist frequently uses a mold that's filled will plastic and then slipped over your teeth to form the temporary. In some cases, this mold is made from a wax/plaster mock-up of your teeth that due to the time involved in making it must be arranged for in advance of your appointment.
Step 5: The pre-cementation evaluation.
At this point, your porcelain veneer has been fabricated and is ready to be bonded onto its tooth. If a temporary veneer has been placed, your dentist will remove it.
A) Checking the fit.
Your dentist will first need to evaluate how your veneer seats on your tooth.
To do so, they'll set it in place, inspect it, remove it and trim it, repeatedly, until they are satisfied with its fit. (In most cases, an anesthetic will not be needed during this step or any of those that follow.)
Evaluating the veneer's fit and shade.
B) Evaluating the shape.
Even though the laboratory or milling machine that has crafted your laminate has crafted it to what it thought was the ideal shape, you and your dentist may decide differently.
Possibly certain edges need to be shortened, squared off or rounded so it looks right. If so, your dentist will complete these changes.
C) Evaluating the color.
Your dentist will have chosen a shade of porcelain for your veneer that they expect will result in a close match with your tooth's neighboring teeth. But because it's translucent, its precise color can be fine tuned by way of the shade of the cement that's used to bond it in place.
Testing with "trial" paste.
Your dentist will choose cement that they feel will provide the best color match. And then place some of that cement's corresponding "trial paste" into the veneer. (Trial pastes have the same color properties as their corresponding cement but don't create a bond with the tooth. They're just for testing purposes.)
The veneer can now be placed on your tooth so you and your dentist can evaluate how its color will look. If it's not a good match, your dentist can repeat this same evaluation using other shades of trial pastes, until the right color cement is found.
!! It's important for you to understand that this is your last chance to make an objection about the color of your new veneer. Once it's been bonded in place, it can't be changed.
Step 6: Bonding the veneer.
Once you and your dentist have determined that its shape and shade are right, your veneer can be bonded into place.
Your dentist will first wash out the trial paste and clean and prepare your laminate's internal surface. They'll also wash off and polish the surface of your tooth, so it's clean and ready.
Etching the tooth. Bonding the veneer in place. Trimming the excess cement.
Etching the tooth.
They'll then etch the surface of your tooth with an acid etching gel (the green in our illustration) for about 15 to 20 seconds. (At a microscopic level, this etching process creates a very rough enamel surface. It's this texture that the veneer's cement bonds to.)
(The dental lab will have already prepared the internal aspect of you veneer by etching it with hydrofluoric acid.)
After washing the etching gel off your tooth and drying it, your dentist will apply a layer of clear "bonding agent.". (This creates the actual bond with the tooth's etched enamel surface.)
Cement (having the color previously chosen) is then placed inside the veneer, which is then squished into place.
Once it's been positioned properly, your dentist will set the cement by way of shining a "curing" light on your tooth.
This light (which has a blue coloration) activates a catalyst in the bonding agent and cement, causing them to set in about a minute.
The completed restoration.
Step 7: Wrapping things up.
The veneer is now securely attached to your tooth.
There will be some excess cement that your dentist will need scrape and floss away. (Actually, they'll probably have removed most of it before fully cured it. That makes getting it off easier.)
They'll also need to evaluate your new restoration's contours and trim and polish them as is needed.
As a last step, your bite will be evaluated so to confirm that it hasn't been altered by the placement of your veneer.
Your dentist's curing light set your veneer's cement, so from that standpoint it's ready to be used, even immediately. Despite that, it's not a bad idea to be cautious with your tooth at first.
It's shape might be slightly different than before (either a planned change or an oversight). Or in the case where an anesthetic was used or your jaw is still stiff from staying open during your procedure, initially you may find yourself closing your teeth together in completely abnormal ways.
Experiment with and settle into the use of your new laminate. If you notice anything that seems strange or amiss, don't look for trouble. Just let your dentist know.
Step 8: The follow-up appointment.
Most dentists will want you to return to their office in about one week.
They'll want to evaluate how your gums have responded to the presence of your new veneer. And if you have decided that its shape needs to be adjusted some more, they can do that at this appointment too.
Some people may notice that their veneered tooth as some hot and cold sensitivity. If you do, let your dentist know during this visit. While it's common that it will resolve on its own, they may be able to speed the process up.
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