Esthetic Oral Rehabilitation with Veneers

Porcelain veneers had long been considered to be only an esthetic solution. However, their range of indications has been steadily increasing, making ceramic veneers a highly viable alternative to classic, far more invasive forms of restorative treatment. Today, veneers can be used to handle esthetics (discolored teeth, fractured and worn teeth, diastemas, dental defects, etc.) and to restore the biomechanics of the dentition, as well as many other indications.

Classifications of Veneer Preparations Referred to as no, minimal, or conventional preparation, veneer classifications—or lack there of—create a large gray zone of misunderstanding and miscommunication with patients and within the dental profession. Left unanswered, questions regarding tooth structure removal, finish lines and margins, and other aspects can cause confusion in practice. Flaws and inaccuracies in previously proposed preparation guidelines make those guidelines irrelevant . To dissolve uncertainty, this veneer classification system was proposed to aid with diagnosis, treatment planning, patient education, consent and understanding, and communication among dental team members, and to provide viable solutions to public requests for elective procedures

Diagnosis A majority of dentists nowadays design their dental treatment plan with the objective of maximizing esthetics. As such, many dental practitioners are working collaboratively to achieve higher esthetic outcomes . Historically, esthetic outcomes were opted as less significant than function and emerged in a later stage of dental treatment planning. This approach resulted in a compromised treatment outcome and, possibly, patient frustration. A case example is an adult male patient seeking a solution to “reduce the too forward-placed prominent front teeth.” Oral and dental examinations revealed that he had severe overjet and overly proclined incisors. The patient was told he would need extraction of the upper premolars to reduce the overjet and incisor proclination. The patient became upset because he had implants to replace the missing maxillary teeth. Thus, the restorative treatment plan for this patient aimed to restore function over esthetic consideration. For that reason, it is recommended that every patient have a comprehensive examination to consider the face and dental esthetics. The patient can then make an informed decision after discussing his/her expectations and treatment outcome goals. The primary objectives of treatment should consider biology, function, stability, and esthetics all at the same time when formulating a problem list and treatment outcomes. The dental practitioner ought to formulate treatment objectives after a comprehensive assessment of a patient’s face, smile, and dental structure. The objectives should not be solely based on restoring dentition. The teamwork approach among dental professionals is well established . It promotes a higher level of dental care. Moreover, this collaboration should extend not only among dental specialists but also to medical professionals in order to provide the best treatment outcome. An example is excessive gingival display upon smiling. The treatment approach should be chosen based on diagnostic findings and treatment objectives. If the resultant gummy smile is due to hypermobility of the facial muscles even though there are good facial and skeletal proportions, then the treatment objective should aim to reduce the excessive muscle elevation during smiling by injecting C. botulinum toxin. However, in cases of excessive gingival display that is associated with a long face and vertical maxillary excess (VME), orthodontic treatment alone or combined with orthognathic surgery should be selected based on the severity . Furthermore, a gummy smile due to short clinical crowns requires treatment with crown lengthening and restoration. There are various treatment options among the disciplines. Selecting the appropriate treatment depends on the evaluation of facial proportions, occlusion, and the patient’s desire and expectation. The treatment, therefore, begins with a proper and thorough diagnosis of the patient, not just the dentition.