Replacing 30-Year-Old Veneers to Improve Smile Esthetics
Discoloration, marginal staining, and composite repairs had become unacceptable to the patient
Dimple Desai, DDS
For more than 30 years, thin all-ceramic porcelain veneers have provided clinicians with a method to improve anterior esthetics using minimally invasive techniques. Studies throughout the literature have shown remarkable success rates for porcelain veneers, and the failure rates cited are often single-digit percentages. However, because the population is living longer and many patients are treated with veneers at a young age, these restorations often require removal and replacement for a variety of reasons, including chipping, fracture, and discoloration.
The 65-year-old businesswoman who presented to the practice in this case had teeth Nos. 5 through 12 treated with porcelain veneers when she was in her 30s (Figure 1). Although the veneers appeared structurally sound, they had become discolored over the years, and dark stains were present in the marginal areas (Figure 2 and Figure 3). In addition, several of the veneers had been repaired with a composite resin material, which added to their unesthetic appearance. The patient requested that the old veneers be replaced with new ones to restore the esthetic appearance of her smile.
Radiographs were acquired to ensure that the underlying tooth structure was sound along with a series of photographs to assess treatment options that would meet the patient's esthetic goals. Because her smile was wide, the decision was made to extend veneer placement into the buccal corridors to achieve optimal esthetics and also better balance her smile (Figure 4 through Figure 7). The proposed treatment plan involved placing minimally invasive porcelain veneers on teeth Nos. 4 through 13. Although teeth Nos. 5 and 11 demonstrated gingival recession, these areas were concealed by her low smile line, so further treatment was deemed unnecessary. Orthodontic treatment was proposed for her lower arch to straighten and repair her crooked and chipped anterior teeth, but she declined due to the extra time that this would require.
After the patient approved the diagnostic wax-up of the proposed final outcome, her teeth were prepared, and a polarized photograph was taken with a preparation shade tab for communication with the laboratory (Figure 8). The provisional veneers were fabricated chairside using a "shrink wrap" technique. The preparations were cleaned and spot-etched and bonded, and then a provisional material was flowed into a putty matrix and placed onto the teeth. Once the material was set, the provisional veneers were trimmed in the mouth, and the occlusion was verified. The provisional veneers would remain in the mouth for a period of 2 weeks to assess function, phonetics, and esthetics (Figure 9 through Figure 11). A photograph of the provisionalized patient with facial reference glasses was acquired to confirm her midline position (Figure 12) and sent to the laboratory along with all of the other pretreatment photographs and an intraoral scan for fabrication of the final veneers.
At the delivery appointment, the patient expressed that she did not want the final color of the veneers to contrast too much with the color of her unrestored natural mandibular teeth. Before seating the final restorations, the decision was made to use two try-in paste shades to allow the patient the opportunity to visualize and select the final color. A neutral shade was used for teeth Nos. 4 through 8, and a light plus shade was used for teeth Nos. 9 through 13, and then a polarized photograph was taken of the final restorations (Figure 13). The patient chose the neutral shade, which was used to seat the final veneers (Figure 14 and Figure 15) and restore the esthetics of her smile (Figure 16).
About the Author
Dimple Desai, DDS
American Academy of Cosmetic Dentistry
Newport Beach, California