The Veneer and It's Role in Cosmetic Dentistry
The veneering technique could easily be viewed as the beginning of modern cosmetic dentistry. It dates back to the early 1980s, when dental manufacturers introduced ready made acrylic forms that were bonded to the teeth with composite. I remember those days, as quite a stir was created with the "Mastique" technique. Many of us found out within a year's time that the product would not survive long-term, and we ended up going back and making porcelain fused to metal crowns on those teeth. It was, however, a gutsy attempt to improve on the cosmetics in a more conservative manner.
In the mid 1980s there was a strong push to utilize the new hybrid and microfill composite resin materials that were on the market for veneering purposes. Again, I remember trying my hand at direct veneers utilizing those composites with enamel bonding. The material was much prettier than the dull, opaque acrylic we had previously tried, but we sadly found out that it didn't hold up much better than our first attempts.
On hygiene re-care appointments, I would inspect these restorations and find that the margins were staining and peeling away from the bonded surface. Thus, we discovered what was meant by the newest word in our vocabulary micro-leakage. We quickly concluded that there was nothing "micro" about it! What did come out of this early phase of modern cosmetics that was useful was a well-defined protocol on how to create a direct veneer using composite resin.
In the late 1980s when we were still not satisfied with the composite veneers, the technique for making porcelain veneers was created. When we combined the porcelain veneer technique with the new home bleaching technique, there was finally something to cheer about. Granted, we have tuned and improved the porcelain veneering technique from what it was back then. But even in the late 1980s, we had something that was both beautiful and durable. We, as dentists, were relieved that there was now a way to improve on shade matching. The problem that arose was that we were presenting an indirect procedure to the patient as a conservative means of improving their smile. I remember placing veneers on unprepared teeth, which was en vogue back then. Needless to say, it was a chore to convince the patient that they would adjust to the thicker feeling of the new teeth. Looking back, the early porcelain veneer technique was struggling to come up with an identity. Porcelain was trying to present itself as reversible and conservative. It wasn't until the 1990s that the technique was improved to look much like what is practiced today.
The defining moment came when cosmetic dentists began preparing teeth for the porcelain veneers. Proper reduction began to show up in laboratories, and the technicians rejoiced in that this allowed them to utilize all of the wonderful optical qualities of porcelain. Translucent veneers began to be the talked about as a technique. Because the composite manufacturers were introducing improved tinted luting resins to bond the porcelain to the tooth. Shade adjustments were once more in the hands of the clinician at the chair side by having the ability to alter the colors of the composite resin beneath the translucent porcelain. Porcelain etching and silanation was introduced to the dentist as a way to improve on the longevity of the restoration. Cosmetic dentistry was off and running. After a few years, however (dentists are never satisfied!), we began to realize that it was quite a trick to use translucent porcelain veneers. Your restoration was only as pretty as what was underneath, and what was underneath showed through the veneer. This sometimes created a big challenge to the dentist when a heavily stained tooth was veneered. In the late 1990s, a porcelain revolution occurred when pressed ceramic porcelain was invented. This was opacious, and therefore, allowed shading to once more be incorporated within the veneer. Masking of discolored teeth was no longer a problem, and the new pressed ceramic was much softer than the other porcelains. This gave us the ability to protect opposing teeth from wear.
Finally, when many dentists had forgotten the earlier direct composite veneer technique of the 1980s, the manufacturers of the composites presented us with the new, improved micro-hybrid translucent resins. Once more, direct veneers hit an upswing. New placement techniques shortened the chair time. Extended kits offering a vast array of enamel and dentin shades appeared, giving us shade-matching capabilities that had only existed with porcelain veneers. Our patients were excited about the one visit, no drilling approach and the benefit of simple repairing of the veneers when needed. We, as caring dentists, could now offer our patients a choice of a conservative technique using direct bonded composite resin, or more aggressive porcelain technique, when certain situations requiring low maintenance were needed.
Without the almighty veneer, whether it is made of composite resin or porcelain, cosmetics in dentistry would have suffered greatly. I cannot imagine practicing dentistry without being able to use veneers. I appreciate the technique for the simple reason that I can remember when everyone said that veneers wouldn't work and couldn't last. Well, we all know that they're here to stay. I can't wait to start using the next technique that they say won't work!