Cosmetic Dentistry using minimal preparation porcelain veneers

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Hi, it’s Adrian Kat from Advanced Dental Artistry here in West Perth. I’d like to talk to you today about porcelain treatment. I suppose, when we’re talking about porcelain treatment, we’re really talking about cosmetic treatment. And, in cosmetics, we use porcelain in the crowns of veneers to enhance the smile and to create a beautiful smile.

A common question is “What’s the difference between a porcelain crown and a porcelain veneer?” If you type into “porcelain crown” and “images” in Google, you will normally come up with this diagram, which actually shows that in order for us to create a porcelain crown, we need to remove at least one millimeter to one and a half millimeters off the entire tooth.

So, what we’re doing here is we’re replacing the tooth enamel. We’re removing all of that tooth in order to use the porcelain to replace the tooth enamel. This should only be done, really, if the tooth is already weak. So that, meaning, that you’ve lost maybe 50% or 60% of the tooth to filling, and the tooth that remains is too weak to actually do more conservative treatment. When you look at images of teeth that have been prepared for porcelain crowns, you can see they’ve removed a lot of the tooth. We want to preserve as much natural tooth as possible.

So, what happens if a patient comes in needing a cosmetic change, but has sound teeth? We really want to be as conservative as possible, and, if possible, actually do very little drilling or no drilling at all. When Kristy came to see us, she came to see us because she didn’t like the color of her teeth. She didn’t like how her canines were very prominent, and she didn’t like how the teeth weren’t all at the right level. She also has some white staining on the front of her teeth. What we do is we then can use porcelain veneers.

What you can see here is one of the porcelain veneers, and you can see the light coming through. So that means that the porcelain veneer is very, very thin. So it’s very aesthetic because we can stain and glaze and change the shape, color, dimensions of the tooth, but it’s also very conservative because we don’t have to remove any or much of the tooth at all. So you saw the photo here, Kristy before, and this is her photo after.

What are the problems with porcelain? Well, if porcelain’s not done well, there’s a number of issues. One is the material. For example, with a case like this, you can see obvious changes from the porcelain to the tooth, and this is what we sometimes call gray or black lines above the porcelain. And this is because these are the older type of porcelain, where they used to use metal and then fire porcelain over top. One of the problems is the metal used to corrode, so you’d see a lot of black areas, and some people were sensitive to the metal, so the gums used to recede or lift away. That’s one thing that patients definitely don’t like when they’re smiling, seeing those grey lines or those lifted margins.

It’s the same if the porcelain is the wrong type of porcelain, if the bite isn’t taken into consideration, is that porcelain will chip. So, for example, if someone’s a grinder or a clencher, we sometimes need to use things like night guards in order to protect the porcelain. If the porcelain is the wrong type of porcelain, also, we will see chipping of the porcelain over time. This usually happens about three years after porcelain. Given that most porcelain should last around about 15 to 20 years, this is a very short time before we actually start porcelain failure, in this case, that was done in Bali.

Shade matching is important when you’re doing a small number of units. If you’re doing, say, one front tooth, or maybe two or three front teeth, make sure it blends in with the rest of the teeth. So shade matching, or getting a proper shade, is important because we need to make sure that it’s in harmony with the rest of the teeth. This crown here was done, and you can see nine years of the wrong color, but it’s also the wrong size.

So, how do we overcome some of these problems? Well, we have onsite technicians, and we’ve got Libby, who’s been a technician for almost 30 years, and she’s been working with me a long time. And what we do is, as a team, we design smiles and we design the actual porcelain. This is some of her work, on some of the front porcelain veneers, and you can see it can sometimes take up to three or four hours just to create one porcelain veneer. A lot of staining and glazing goes into that. This is actually a very close-up view of the porcelain, and you can see how beautiful they actually look.

One of the important things on our website is that all of our photos and all of our cases are actually patients that have been treated. At Advanced Dental Artistry, we never use any stock photos.

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