Composite Bonding
The two methods of composite bonding are direct placement, where the composite is applied directly to each tooth, or injecting a liquid composite into a template that has been pre-made by a technician.
You can see photos here of Composite Veneer cases done here at Oralé.
A veneer is a new front or facade on a tooth. It is placed on the front teeth. Usually some enamel needs to be removed from the tooth so that the veneers aren't too prominent or too thin. The amount of tooth substance to be removed depends on the position of the tooth. If it is turned or tilted, more tooth substance would need to be removed from the part of the tooth that is more protruding. We try to remove as little enamel as possible, but on protruding teeth there is an increased risk of sensitivity or pain afterwards. In these teeth root canal treatment (remove the nerve) may be required. This should be done as soon as possible to prevent the risk of the tooth going dark.
Composite veneers can also be placed on the lower teeth…
If veneers are being placed on the lowers, we have to remove enamel to allow the teeth to fit inside the uppers, so it can be more destructive than the uppers. The bite will determine the height of the lower veneers. Are the lowers very visible? Could you get away with just whitening them, or trying Invisalign along with whitening.
You should ask yourself if you might be happy enough whitening your teeth and perhaps an Invisalign aligner rather than a procedure like veneers that may require some removal of your tooth substance and after which you will always need some type of restoration on the tooth. It is not reversible. Another option is to reshape the teeth using composite on the sides and incisal edges, but you would have to be happy with the colour of your teeth or whiten them first.
A veneer is made from porcelain, milled ceramic or composite. The main difference between the materials is that composite is applied directly to the tooth and porcelain or ceramic are made in a lab and cemented onto the tooth, which takes two visits two to three weeks apart, as opposed to one visit for direct composite. This makes porcelain more expensive. It also means that there is no two week waiting period with temporary plastic veneers and/or sensitivity from having had enamel removed, although in those cases where little or no enamel is removed, temporary veneers may not be needed. Porcelain and ceramic are also harder than composite.
Composite is basically the same material used for white fillings, but a more polishable type of composite with a smoother finish is used for veneers (Nano-hybrid). Composite veneers will bond to composite fillings that are already present. Another difference is that composite is quick and easy to repair if it breaks, unlike porcelain. This, ironically, can make composite a better choice in people who grind or who are at risk of breaking or dislodging their veneers.
As composite is placed soft onto the tooth before it is cured with a light, it is particularly suitable for teeth that are slightly turned, have grooves, undulations or undercuts, or are slightly recessed. Braces (Or Invisalign clear aligners) is often the best treatment for mal-aligned or overcrowded teeth and an assessment by an orthodontist should be sought before deciding to go ahead with veneers. Dr Khan provides treatment with Invisalign. You can book a consultation with him to see if you're suitable.
Veneers can be used to change the colour (shade) and minor changes to the shape of your teeth and are a good option where bleaching won't work such as when teeth have been discoloured by antibiotics. If your teeth are extremely dark, opaque base layers can be used to help mask the underlying tooth. Small spaces can also be closed with composite veneers…
In some people their teeth meet edge to edge. In this situation crowns may be more suitable as they are stronger. A crown is a full coverage for the tooth, involving removing tooth substance from all sides of the tooth. A crown may also be a better option on a dead tooth, which is weaker and can get darker over time.
Some people grind their teeth in their sleep. A shield can be made to help protect the veneers at night. This doesn't guarantee against veneers coming off or breaking, but does reduce the risk. It would need to be worn every night, as one night of grinding could do damage. In this case veneers won’t be guaranteed and there will be a charge (€70 to €200) to repair or replace them, even if you get a nightguard. While crowns are stronger, composite veneers are actually not a bad option in those who grind due to their ease of repairing. Composite veneers can be a good alternative to crowns, as less tooth material is removed, as in this case.….
People who play contact sports should wear a gum shield. Veneers are probably not suitable for those involved in extreme contact sports such as boxing.
Care should be taken when eating certain foods such as granola, fruit with stones in them, seeds, nuts, popcorn, meat on the bone on ribs, chicken legs/wings, crusty bread, toast etc. Bite food at the corners of the mouth rather than the front, and chew on the back teeth. People who don't have back teeth should have the bite restored with either dentures (plastic or metal frame), bridges or implants.
An advantage of composite veneers over a restoration made in a lab (such as a porcelain veneer or a crown) is that the dentist placing the composite veneer has an overall view of your face, lips, opposing teeth etc which helps greatly in choosing the size, shape, angulation, orientation, occlusion (bite) and shade of the veneers. The patient also has the opportunity to view the veneers, and ask for any adjustments, before they are finished. Composite veneers are a cost-effective and relatively quick way to aesthetically restore the front teeth. It is a good idea to ask to see photos of cases the dentist may have. This will also help pick the shade.
Composite veneers can be placed directly on old composite fillings…
If the gum height needs to be adjusted, this can be done, but for multiple teeth we would refer you to a periodontist. If you have any cavities or gum disease, these should be treated first.
Composite veneers can also be combined with other treatment such as crowns or bridges. These two cases show composite veneers combined with a LuxaCrown bridge. LuxaCrown is a composite material used to make crowns or bridges that are suitable for the medium term. It is guaranteed by the manufacturer for 5 years and is a lower cost option.
This patient had a retained baby canine that was removed on the same day…
The following photos, taken 10 months post-op, show composite veneers combined with a Zirconia bridge….
Composite veneers can be combined with whitening to reduce the number of veneers required, which is a more conservative option. This example shows two composite veneers on the central incisors and whitening of the other teeth. It can be tricky to get a good colour match. The whitening would be done first and then the veneers made to match the shade. Indeed it is often a good idea to whiten beforehand the teeth that are to be veneered as this can result in a better aesthetic outcome.
Composite veneers can even be placed on old crowns or bridges which may be a more conservative (and cheaper!) option than trying to replace the crown or bridge. These patients had old crowns….
This patient had an old unsightly Maryland bridge. The contact point between the central incisors is long to mask the metal behind….
Because long appointments are needed, a booking deposit is payable when making the appointment. This is €100 per hour and comes off the total fee, but you lose the deposit if you fail to turn up or cancel on the day of the appointment. Composite veneers cost €190 each for 6 or more, €200 each for 4 to 5, and €220 each for 1 to 3. Any changes to the shade requested after the day of fitting will cost €50 per tooth.
Before your appointment, make sure your teeth and gums are clean and healthy and have a scale and polish done if necessary. On the day, avoid using lipstick or make-up as these will get on the dentist's gloves. As the appointment is long, avoid too much coffee or tea so you don't have to run to the bathroom in the middle of the procedure!
Porcelain is more stain resistant, but composite veneers can be kept clean by daily brushing and flossing. Veneers are not joined together so flossing is possible. A twice yearly dental Scale & Polish is recommended and an electric brush (such as Oral-B) will also help. The Oral-B Floss Action Head may also help as it has rubber flaps designed to clean between the teeth. An electric brush should be held on each tooth so the bristles can clean the gum line. You may decide to replace the veneers after a few years but they can look good for longer, depending on oral hygiene, smoking, dark food and drink like curry, tea, coffee, red wine etc. Some herbal and liquid iron supplements, and mouthwashes (especially Chlorhexidine such as Corsodyl) may also stain the veneers. You should avoid dark food and drink, especially curry, for a week after fitting, as the composite takes a week to fully cure. The gums can be kept clean and healthy using Oral-B Superfloss, which has a stiff end that can be threaded through above the teeth and a sponge section to clean the gum line around the veneer. This will help prevent plaque buildup around the edge of the veneers which can cause inflamed/bleeding gums and gingivitis.