Problems / Disadvantages of Lumineers® and similar ultra-thin veneer products.
The placement of ultra-thin porcelain veneers, like Lumineers®, Vivaneers® or DURAThin®, using a no-drilling/no-shots protocol has its critics.
The two primary problem issues that are usually brought up are:
1) Placing them may result in below-average esthetics. – Ultra-thin veneers have a reputation for needing to be comparatively opaque, as opposed to more translucent and lifelike like regular porcelain veneers.
2) They may create tooth bulkiness. – No-drill (no tooth preparation) placement can easily result in bulky, over-contoured teeth.
That can make new veneers hard to get used to. It can also make the teeth they’re placed on harder to properly clean.
Proper case selection is the key.
In response to these criticisms, dentists who favor the use of Lumineers® (or similar products) are quick to point out that these issues can be kept in check by way of proper case selection.
It’s also important to state that every patient should consider all possible alternatives before opting for any type of veneering procedure.
Potential problems and concerns associated with Lumineers® placement.
1) Difficulty in achieving a natural-looking end result.
a) Ultra-thin veneers frequently need to be very opaque.
The wafer-thin veneers placed using a no-drilling protocol are often criticized because with some applications they must be made out of comparatively more-opaque porcelain, or placed using relatively more-opaque cement, so they are able to adequately mask over the color of the natural tooth structure that lies underneath.
How tooth enamel handles light.
(Use the in-text links for an explanation.)
Why is having opaque veneers a problem?
If a veneer (or veneer/cement combination) doesn’t accurately simulate enamel’s light-handling effect (as in it’s too opaque and keeps light from entering), your tooth’s appearance won’t look quite right. It might look white, but it won’t look perfectly natural.
Take the case where an ultra-thin veneer is used to lighten the color of a darkly stained tooth.
- Since it’s so thin, to effectively mask the stained tooth structure that lies underneath the veneer must be made using relatively opaque porcelain.
- But due to this opaqueness, light will tend to be reflected off the veneer’s front surface and not penetrate into it like it does when it strikes enamel (the link below illustrates this point).
- Because of this difference in light handling, the veneer won’t look truly lifelike.
(This is the exact same problem that occurs with dental bonding. This page explains and illustrates this phenomenon in detail, just substitute the words “dental bonding” with “opaque veneer.”)
How traditional veneers differ.
Because they are thicker, conventional porcelain veneers can be made out of comparatively more-translucent porcelain, yet still be able to mask dark tooth structure that lies underneath them.
And due to this translucency, light will be able to enter into the veneer and reflect back out in a fashion that truly mimics the lustrous look of a natural tooth. (This page explains and illustrates this issue in detail.)
A lot of people simply don’t appreciate this difference.
We do have to admit that when it comes to the issue of obtaining a precisely lifelike result, many people just don’t seem to care.
The ease and pain-free advantage that no-drilling/no-shots technique offers simply outweighs the disadvantage of a less than perfectly natural-looking outcome.
Trends have changed.
That’s probably because people’s attitudes about tooth appearance have changed over the last couple of decades, likely due to the explosion of tooth-whitening options that have become available over this same time frame.
Whitening processes tend to rob tooth enamel of translucency. And as a result, the patient ends up with a set of uniform snow-white “Chiclets” (teeth).
Nowadays, it seems that that is the look a lot of people are seeking. And if that’s the one you want, it’s easy enough to get with a set of Lumineers®.
b) Problem situations.
Especially in the case where only one or a few veneers are being placed, the increased characterization that’s possible with a (thicker) conventional veneer may be an important asset in creating a perfect match with the patient’s neighboring teeth.
It’s the characterization of a veneer that helps it to look lifelike or match well.
- A – This tooth displays pronounced color uniformity and lack of characterization (the term “monochromatic” applies).
It would be relatively easy for a dentist to place an ultra-thin veneer that would match this tooth.
- B – This tooth demonstrates a fairly high degree of translucency at its biting edge (the grayness you see). And its color is not perfectly uniform.
It would be relatively difficult to mimic this look with an ultra-thin no-prep veneer.
2) Bulky, over-contoured teeth.
Another criticism of placing Lumineers® using a no-tooth-preparation technique is that it can result in teeth that are bulky and over-contoured.
It’s easy enough to see how placing no-prep veneers could result in this outcome. After all, if you bond a shell of porcelain over the surface of a tooth without trimming it back first, its overall dimensions will be larger. It’s only a question of how much, and if it’s enough to cause problems.
Case selection is key in avoiding this outcome. When Lumineers® are placed to just make minor enhancements and upgrades, the results can be acceptable. But when what is trying to be achieved lies beyond general guidelines, a problematic outcome can be expected.
(An excellent way to get to evaluate how the addition of ultra-thin veneers may affect the size and thickness of your teeth is to view a pre-treatment diagnostic wax up of your case.)
a) What are some of the potential problems?
1) An artificial appearance.
Placing restorations that create larger, fuller teeth can easily result in a look that’s artificial. In extreme cases, the term having “horse teeth” may certainly apply.
Of course, the degree to which this occurs is the key. And toward keeping it to a minimum case selection is always a primary determinant.
Some people don’t care.
Despite this outcome, the convenience and comfort of being able to take advantage of no-drilling/no-shots placement may be so attractive to some people that this is an easy enough trade-off to choose. Having bigger, larger teeth is not a concern as long as they’re whiter and more perfect.
2) Problems with function.
Another area of concern is how the increased size of the veneered teeth will affect the person’s daily activities.
- Larger teeth can be cumbersome, affect a person’s speech, or even the way they bite into things.
- Fuller teeth can also change the way a person’s lips are supported by or rest over their teeth. In extreme cases, it may be difficult for the person to close their lips together.
Fortunately, over time people tend to adapt to these types of difficulties. It’s just a matter of how extreme the change has been.
3) Plaque retention – Periodontal and tooth decay problems.
No-tooth-preparation veneers (like Lumineers®) must be ultra-thin so they don’t add too much bulk to the tooth.
(A primary concern is the amount of thickness added at the gum line.)
The underlying problem.
- Make it more difficult to remove dental plaque at the gum line.
- Tend to interfere with the natural cleansing action created by a person’s lips and cheeks as they slide over a tooth’s surface.
(In general, under contouring a dental restoration typically makes a more benign error than over-contouring. And placing no-drill Lumineers® seems to break this rule of thumb.)
Problems that may develop.
When dental plaque cannot be adequately removed, issues associated with tooth decay and gum disease may occur. Of the two, experiencing gum problems is the more common occurrence (persistent gingivitis, periodontal disease).
The consequences of either can be problematic to resolve.
- Repairing cavities frequently means that the restoration must be replaced. In extreme cases, the decay may be so extensive that just replacing the veneer may no longer be an option for the tooth.
- Treating gum disease can be successful. But any degree of gum recession that occurs (either triggered to the disease process or its treatment) can easily spoil the appearance of an entire set of veneers.
The solution. / The dilemma.
The way to ensure that a veneer’s contours don’t promote plaque retention is to make its gum line edge as thin (knife-edged) as possible. And generally speaking this is easy enough to do.
The dilemma lies in the fact that in some cases doing so may compromise the esthetics of the restoration. That’s because the thinness of the veneer in this region may not effectively mask over the underlying tooth structure. (For example, this could be a problem in cases where veneers are used to lighten the color of teeth.)
(Here’s a solution for this problem if the patient allows.)
Research into the matter.
- Increasing the contours of a tooth as little as .5mm can cause adverse effects.
- A .2mm increase resulted in no statistically significant problems.
Since Lumineers® can be fabricated as thin as .2mm in thickness, the above findings seem to confirm that placing them using a “no drilling” technique can produce acceptable results.
Ultimately, a person’s oral home-care habits may be the most important factor.
Some studies (Ehrlich, 1980 and Kohal, 2003) have determined that the most significant issue associated with over-contoured restorations is the effectiveness of the person’s oral hygiene. Those people who put in the effort and do an effective job do not develop problems.
b) Problem situations.
Here’s an example of the type of case where the placement of no-drill Lumineers® could easily result in teeth that are too oversized.
Placing no-drill veneers may be able to even out the alignment of teeth …
… but at the expense of making them too bulky.
That’s the crux of the problem we’ve been discussing. With a no-tooth-preparation approach, the veneers alone make up the needed thickness variations. And as you can see, using this method can easily result in bulky or over-contoured teeth.
Preparing (trimming the teeth back) as a first step …
… gives a result where the teeth are even yet not bulky and over contoured.
With it, the most prominent portions of the teeth are trimmed back first and then the veneers are made and placed.
Note: Lumineers® can be placed using no-drill or conventional veneering techniques. It is the method of placement that is the issue here, not the specific brand of veneer.
Page references sources:
Deng X, et al. Effects of change of crown contour on health of gingiva.
DiMatteo AM. Prep vs No-Prep: The Evolution of Veneers.
Ehrlich J, et al. Alterations on crown contour–effect on gingival health in man.
Kohal RJ, et al. Effect of different crown contours on periodontal health in dogs.
All reference sources for topic Ultra-thin Porcelain Veneers.