Ultra-thin porcelain veneers
When porcelain veneers (laminates) are placed for a patient, the dentist has some options as to the specific protocol they use.
One of these is the no-shots/no-drilling technique that's possible with ultra-thin products like Lumineers®.
No shots & no drilling?
That's right. The idea is that ultra-thin porcelain veneers are so thin that they can be bonded directly onto the surface of a tooth without needing to trim it back first. Since no drilling is involved, an anesthetic isn't needed either.
How thin are they?
Ultra-thin laminates are generally defined as those that can be crafted to tolerances as thin as .2 to .3 millimeters. That's less than 1/64th of an inch, and similar to the thickness of a contact lens.
In comparison, the minimal thickness for a conventional porcelain veneer is usually on the order of at least .5mm.
What are Lumineers®?
There are a couple of brand names associated with the subject of ultra-thin porcelain veneers.
Due to its extensive marketing campaigns, Lumineers® (DenMat Holdings) is probably the best known. Others include Vivaneers® (Glidewell Laboratories) and DURAthin® (Experience Dental Studio).
Lumineers® are made out of Cerinate® porcelain (DenMat Holdings). It's exceptional strength is what makes it possible for these veneers to be so thin. They're only available to dentists through one of DenMat's Cerinate® Smile Design Studios.
On our pages, we tend to just refer to all ultra-thin products as Lumineers® since so many people are already familiar with them. For the most part, the remarks made about them apply to similar products as well.
One thing that makes ultra-thin laminates special is that placing them doesn't necessarily have to require any tooth preparation (trimming).
As advantages, that means that the patient avoids both the use of a dental drill and getting any shots. Additionally, there are some dental-related issues that are favored by a no-drill protocol.
But with these advantages come some disadvantages and criticisms. So it's probably best said that no-preparation placement isn't better than conventional protocol, it's simply different. And, in fact, using it frequently gives a sub-par esthetic result as compared to traditional placement.
How are the veneers placed?
In terms of what the procedure involves, here's how the no-prep protocol that can be used with ultra-thin laminates differs from traditional veneering technique.
A) Conventional placement.
They'll usually only need to trim an amount that's about the same thickness as the laminate they plan to place.
And although that's just a very slight amount:
- The patient will have to endure the drilling process.
- An anesthetic will probably be required.
- Temporary veneers will likely need to be worn until the next appointment when the final restorations are cemented.
For more details, use this link for an overview of the steps a dentist follows when placing conventional porcelain veneers.
B) No-shots, no-drilling veneer placement.
Since ultra-thin products like Lumineers® can be made wafer thin, they can be bonded right onto a tooth's surface without unduly increasing its size (see picture "B" in our graphic).
- There's no need for any tooth preparation, or an anesthetic either.
- Wearing temporaries isn't needed.
- The work involved with the procedure's first visit is as simple as just polishing the teeth so they're good and clean and then taking a dental impression. Really.
But this simplicity comes with trade offs. And you should know that not all dentists think that the use of this technique creates suitable results. And, in fact, there is continued, heated debate in the dental community about if and when a no-drilling approach makes an appropriate choice. (See this topic's next page.)
Actually, Lumineers® can be used with either protocol.
We're not trying to confuse the issue but the following point needs to be made.
Brands of ultra-thin laminates (like Lumineers®) can be placed using either traditional or no-prep technique.
That's because just because they can be made to minutely thin tolerances, they can be made with conventional dimensions too.
As yet another variant, dentists have the option of placing ultra-thins using minimal-preparation technique. This procedure is defined as the situation where the tooth is trimmed but less so or less extensively than it would when using conventional placement protocol.
The patient still reaps some benefits (minimal drilling, possibly no shots, no need for temporaries). Yet by trimming back the most prominent portions of the tooth, the dentist can create a better functioning or looking end result than they could with no-drill technique.
Applications for ultra-thin porcelain veneers.
Success has a lot to do with proper case selection.
People who know about products like Lumineers® probably do so because of advertisements they have seen. Ads can, however, lead a consumer to form unrealistic expectations.
Most people understandably draw the conclusion that the use of no-drilling technique can be used in their situation. And while in theory this may be true, any dentist can tell you that there's often quite a bit of difference between what's technically possible and what's in the patient's best interest.
When are they a good choice? / Who makes the ideal candidate?
If a veneer is placed without trimming the tooth first, the tooth will end up being at least some degree larger.
In order to avoid the situation where this change is enough to create problems, a dentist will look for applications where:
- Only minimal changes are needed (so the laminate can be as thin as possible).
- Any resulting increase in size can be used as an asset.
Favorable pre-treatment conditions.
In general, here are the kinds of situations that make the most ideal applications for no-drill laminates like Lumineers®.
A) Teeth that just require minor corrections or color improvement.
One of the basic premises associated with veneer placement is that the restoration is opaque enough to mask (hide) the color imperfections of the tooth that lie underneath. Here's how this is accomplished:
a) With translucent veneers.
If a veneer is made out of porcelain that has relatively greater translucency (doing so will give the tooth a more life-like appearance), it will need to be comparatively thicker so it can effectively mask the tooth underneath.
This is the approach used with conventional placement technique. The tooth is trimmed back so a thicker/more translucent veneer can be placed without creating a result that's too oversized.
b) With opaque veneers.
Ultra-thin veneers are best for making small color changes.
If the veneer must be ultra-thin (like required for no-drilling applications), the only way to get the needed masking effect is to use porcelain that's relatively more opaque.
The problem is more opaque veneers typically look more artificial. (This is a criticism of Lumineers® and similar products in general. We discuss it here.)
By limiting the use of no-drill technique to just cases where only a minimal change is needed (such as making a small color change or masking slight blemishes), the veneer can be both ultra-thin yet comparatively less opaque (win-win).
B) Teeth that are already fairly straight.
Veneers can be used to improve the apparent alignment of teeth. But placing them without first trimming back portions of the most prominent ones can result in some teeth becoming very thick. (We illustrate and explain this issue here.)
Cases where teeth simply need to be resurfaced, as opposed to being "realigned," typically make the best choice for no-drill veneers.
Closing tooth gaps. (One of our digital smile makeover cases.)
C) Tooth gaps (diastema closure).
Since placing no-prep veneers will increase the size of the patient's teeth, dentists look for applications where this change can be used as an asset. These are sometimes referred to as "additive" cases.
The length and thickness that a Lumineer® would add could be used as an asset.
D) Small-sized or inclined teeth.
Other tooth conditions can benefit from the added dimensions that placing a no-drill veneer tends to add.
This includes comparatively small teeth. Or those that are slightly set back or lingually inclined (are tipped inward or backward as opposed to being flared out).
With these cases, the oversizing that the veneer creates helps to produce the look that's wanted.
E) Minor repairs.
Teeth having small chips or worn edges can make suitable candidates for no-drill laminates.
Less than ideal situations.
Even if your dentist determines that your case really isn't the perfect situation for an ultra-thin/no-drill approach, it doesn't necessarily mean that choosing it makes a terrible decision.
- For some people, the convenience or dental-fear benefits of no-drill protocol may outweigh the drawbacks associated with a slightly less-than-ideal outcome.
For example, when it comes to cosmetic appearance lots of people seem to make this choice.
- Going ahead and placing no-prep veneers when less-than-ideal conditions exist is often rationalized by both the patient and dentist alike.
But before choosing this route, make sure you have thoroughly discussed matters with your dentist so you understand the possible consequences, both short term and long.
Rejuvenating the appearance of porcelain dental work.
Lumineers® and similar products can be used as a way to extend the life of porcelain-surfaced crowns and bridges that are no longer cosmetically pleasing.
The idea is simply one where the veneer is bonded onto the front surface of the restoration, thus giving it a new look.
Since doing so only provides a cosmetic change, the dentist must examine the dental work in question and make a determination that it's otherwise intact and clinically satisfactory.
Is using this technique a good idea?
One needs to keep in mind that this is patchwork dentistry.
Rather than having a restoration that's just a single entity created in the controlled environment of a dental laboratory, you'll instead have "a restoration placed on a restoration" that's been assembled in your mouth.
a) With dental crowns.
If your dentist suggests this type of repair for an individual crown, ask about their rationale.
They may have valid reasons. But in most cases your costs and number of appointments needed for the work will probably be about same for either approach, with the crown remake having the more predictable long-term outlook.
b) With dental bridges.
It's easier to see the benefits of this technique when bridgework is involved. Veneering just one or a few teeth that spoil the appearance of a large bridge might offer a reasonable solution, at just a portion of the cost of replacing it.
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