There are multiple ways of achieving a beautiful smile and if teeth are not aligned properly, orthodontic treatment using braces or invisalign is usually the most natural and traditional option. Orthodontics, also known as the process of tooth movement to align teeth, allows an orthodontist the ability to move teeth into their most natural positions without removing tooth structure or adding material to the tooth surface. Some dentists around the country and in Miami, Florida are only offering alternatives to orthodontic treatment, such as porcelain veneer restorations or crowns. The application of veneers or crowns to create a smile makeover is referred to as “instant orthodontics” and this term can be found on multiple websites. Instant orthodontics with porcelain veneers or crowns is currently being scrutinized by many dentists, not just orthodontists, and the ethics of this type of treatment is currently in question. A recent publication by the American Dental Association reviewed the myths of instant orthodontics and the article was published in their journal, the Journal of the American Dental Association.
Let me explain a little more…
A dental veneer is a thin layer of material placed over a tooth to either cover a damaged surface or to improve the appearance of the tooth. There are generally two types of materials that can be used for a veneer, composite and porcelain. A composite veneer is a direct restoration, which means it can be built up directly on the tooth, while a porcelain veneer is usually made in a dental laboratory or milling machine and is then bonded on to the tooth. Porcelain veneers are more durable and stain significantly less than composite.
Using today’s cements and bonding agents, veneers can last from ten to thirty years. They usually need to be replaced within a lifetime as they may crack, chip, discolor or decay. The current cost of a veneer restoration is typically $1,000 and up per tooth.
Porcelain Veneers and Crowns
Porcelain veneers are commonly used on front (anterior) teeth, which are the primary teeth people will show when smiling. Porcelain crowns are commonly used to restore back (posterior) teeth, but can also be used on the front teeth. In many cases, minimal tooth preparation is needed when using porcelain veneers, but there are also times when a significant amount of enamel may need to be reduced in order to achieve an appropriate emergence profile from the gum tissues.
While there are good reasons to apply a porcelain veneer or crown when restoring a damaged or worn tooth, removing healthy tooth structure only to create the look of alignment may raise other significant concerns.
Why do people choose to do “instant orthodontics”? Instant orthodontic treatment is usually done when patients are in a hurry to get a Hollywood type of makeover on multiple teeth. In these cases, veneers can be used to close spaces, lengthen worn teeth and correct malposition by making teeth appear straight. They can also be used to create uniform color and symmetry or to strengthen teeth that are thin.
While instant orthodontics is definitely convenient, it does not come without risk. An instant smile makeover, using veneers or crowns, may shortchange patients from achieving natural alignment of teeth and often times may not correct uneven gum lines. If orthodontic treatment is required anytime after veneers are placed, there may be a significant risk of injuring veneers during treatment.
Damage to Teeth?
Instant Orthodontics, using Porcelain Veneers or Crowns, may not the best option for patients with healthy teeth that only want the appearance of straight teeth.
Only in rare cases is there justification for porcelain veneers to be used in place of orthodontic treatment. When multiple teeth need to be moved, orthodontic treatment is absolutely indicated. Tooth preparation per veneer may remove 3-30% of the enamel tooth surface. After 10 years, studies have shown that 50% of veneers need re-treatment or are no longer in satisfactory condition.
When a veneer is used to restore a tooth, care must be taken so the upper and lower teeth fit well against each other during speaking, swallowing, chewing and resting. Having a good occlusion (fit of upper and lower teeth when they come together) helps to prevent chipping, cracking or loosening. The better the function of teeth, the better opportunity of having lasting results.
Usually it is the dentist that determines which treatment option has the most predictable, long-lasting results for a patient. Treatment that preserves or at least minimizes removal of natural tooth structure is considered to be conservative. A comprehensive treatment plan that aligns healthy teeth with Invisalign or traditional wire and bracket braces can definitely be more conservative than having crowns.
Braces or Invisalign
With orthodontic treatment instead of veneers or crowns, patients can predictably achieve functional alignment of teeth for optimal comfort and health, while minimizing future wear and tear. An additional benefit is that natural tooth enamel can be preserved and additional material is not needed. If patients suffer from TMD, orthodontic treatment can be designed to correct malocclusion and provide relief from muscle tenderness, joint pain, headaches and more.
Consultation with an Orthodontist
If “instant orthodontics with veneers” has been suggested or recommended for you, seek a second opinion from a board certified orthodontist. The use of veneers to simulate straightened teeth can be harmful to healthy teeth. Young people especially should protect their healthy tooth structure as they have many years with their teeth and surely they’ll want to avoid having to redo dentistry years down the road.
If you would like to schedule a free orthodontic consultation with Dr. Derek Sanders, please call our office at (305) 598-3384. It will be our pleasure to help you.