The porcelain veneer procedure.

- The process. / What steps are involved?

Preparing
the tooth.

Link to Tooth Preparation section.

Bonding the veneer.

Link to Veneer Bonding section.

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.
  • It is possible for dentists who have the necessary equipment to make and place a tooth's veneer in a single appointment. We discuss that process here.

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.

Shaping a tooth's surface.

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 [2004] 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.

Takeaways from this section.
The depth of the preparation is confined to enamel.

For the most part, a dentist will try to limit the depth of the trimming to just the tooth's enamel layer.

That way, all aspects of the veneer's internal surface will be bonded directly onto enamel. (The type of tooth structure with which the most secure and predictable bond can be made.)

It's permissible that in some areas the trimming may extend deeper and on into the tooth's dentin layer. Dentist's have agents that can adhere to this type of tooth tissue too. It's just that the bond created is less secure than with enamel.

At minimum, your dentist's goal will be that at least all of the edges of the veneer will end on enamel. However, the further the tooth's preparation strays from the ideal (a 100% enamel surface), the more likely the veneer is to fail.

Exactly how much is trimmed away?

A tooth that has been prepared.

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.

Trimming more.

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.]

Takeaways from this section.

Ultra-thin porcelain veneers (like the brand Lumineers®) offer an alternative to "traditional" laminates (the subject of this page). And in some applications, their placement doesn't require any tooth trimming at all.

While this technique does offer that advantage, its use also comes with some disadvantages. We discuss these issues in detail here.

Using a shade guide.

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.

 
Takeaways from this section.

A veneer's color can be adjusted when it is cemented onto its tooth (see below). And that means that the shade recorded at this point is less critical than with some other procedures.

Even so, we discuss general issues associated with shade matching here.

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.

A dental impression.

A dental impression.

Option A -  Most dentists will take an impression using impression "putty" or "paste."

This is simply a thick goo 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.

Placing retraction cord around a tooth.

Placing retraction cord before the impression is taken.

Placing retraction cord.

It's common that a dentist will have prepared (trimmed) your tooth so the edge of your veneer tucks just underneath the gum line. And if so, they'll probably pack retraction cord (a string similar to yarn) in the crevice between your tooth and its gum tissue just before taking its impression.

  • Once in place, the cord pushes the gum tissue away from the tooth.
  • Then, right before the impression is taken, your dentist will remove the cord.
  • The idea is that even though the retraction cord has been removed, your gums will still remain pushed away from your tooth's surface for a few moments.
  • This lag provides an opportunity for the impression material to squeeze into the space below the gum line, thus capturing the full extent of the tooth's preparation.

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.
Takeaways from this section.

Characterization can be added to milled veneers by "staining and glazing" them. This is a process by which different colored stains are applied and then fused to the porcelain in a high-heat oven.

While this process can create reasonable results, this type of characterization is only a front-surface phenomenon and does not create the same life-like luster that variances crafted into the full thickness of a veneer can (as described here).

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.

Takeaways from this section.

When just a single tooth is being treated, it's look may be different enough that a temporary may need to be placed.

In comparison, when several teeth are being treated as a group (like all 6 upper front teeth), it's likely that their combined look will at least be uniform. If so, their appearance may not seem as strange or objectionable (at least to others).

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.

Takeaways from this section.

Your dentist would probably prefer not to place a temporary unless it's absolutely necessary.

A temporary veneer needs to be secure enough that it stays in place well but is also easy to remove at your next appointment. Keep in mind that unlike a temporary dental crown that entirely encases its tooth, this type is just anchored on the front side. And this difference can make creating a successful temporary a bit of a challenge.

Dentists have solutions for these challenges but they usually come at the expense of creating some degree of gum inflammation (because you can't floss and clean around the temporary veneer thoroughly). Inflamed gum tissue can be harder to manage when a veneer is cemented, primarily because it bleeds easily.

If you decide that no temporary is needed, your dentist doesn't have to be concerned about it coming off, or being able to get it off. And during your cementation appointment, it's more likely that they'll have healthy gum tissue to work with. And that's a very positive thing for the outcome of your case.

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.

Takeaways from this section.

Temporary veneers aren't usually cemented, they're just held in place by the way their plastic has set and locked in place on and in between your teeth.

Getting them off is easy enough. Your dentist will just use their drill and trim the temporary in half, then tease its parts off.

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.)

The try-in process.

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.

Takeaways from this section.

Without question, the goal of this step is to get everything as right about the shape of your laminate as possible. But you don't have to be too worried if you have some minor reservations about what you notice.

Further refinement can still be made later on after cementation. In fact, at this point while your veneer just sits loosely on your tooth, trimming it too much might be the bigger concern.

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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.

Take note.

!! 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.

Takeaways from this section.

Just in case you missed it, the last point we mentioned bears repeating. This point in the placement process is the absolute last chance you have to express any objections you have about the color of your veneer.

Once it has been cemented in place, this issue is a closed matter.

[Having said that, there is one possible way a change might still be made (via whitening treatments). However, this is not a process you want to have to rely on. This is a stop-gap measure that may or may not work.]

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.

The placement process.

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.)

Cementation.

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.

A tooth with its porcelain laminate in place.

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.

Precautions.

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.

Takeaways from this section.

As a way of helping you protect your new restorations, your dentist may present you with a night guard to wear.

The fragile nature of porcelain veneers makes them susceptible to fracture when exposed to excessive forces such as those associated with tooth clenching and grinding.

Since you have no control over these activities when you sleep, routinely wearing a guard can help to prevent this type of damage.


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.


A comparison of veneers that have minimal and extensive characterization.

Single-appointment porcelain veneers.

It is possible for dentists who have invested in the necessary equipment to both make and place porcelain veneers in a single visit. The process involved is exactly the same as we describe on our "crowns in an hour" page.

A prime consideration when considering the use of this method is that the type of veneers placed are monolithic in nature, meaning they're milled out of a single uniformly-colored block of ceramic.

And due to this fact they generally lack the same lifelike characterization that can be built into handcrafted veneers (example A vs. B in our graphic).

 

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