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Since veneers are now in high demand, many dentists offer them as part of their list of treatments. But if the veneers are not properly done, however, the impact can be huge on a negative scale. Below is a list of essential ‘do’s and don’ts’ to help dentists make their way through this demanding but gratifying aesthetic treatment process.
Veneers are highly complicated because they almost always involve more than one tooth and matching colours is therefore tricky. The dentist also needs to be very practiced at using a wide range of different materials. Getting a perfect result is vital for your patient – and following that, for your success as a dentist! Learning to do veneers does not happen overnight; it must be carefully studied, learned and practiced on live patients, before mastered properly. This most of all will prevent unhappy patients from flocking back to you, to demand “re-dos” or take legal action.
Are the right teeth being addressed?
Patients most often ask for their six anterior teeth have veneers placed on, simply because these are the teeth visible to them in the mirror. However, when a patient smiles, many times we can see as much as the anterior 8 or even 10. This should be carefully explained to the patient by the dentist and the work should be always done on the widest possible smile area. Otherwise, it might be more sensible to deal with the four anterior teeth and discuss whitening or bleaching treatment on the others.
Communicating with the patient
Most patients do not understand the process of making or fitting veneers, and why should they? This is why they have sought a dentist’s expertise. Therefore it is your responsibility to make sure that you have asked all the right questions, and carefully noted the answers – you need to be sure about what your patient expects and then be able to offer a matching treatment, where possible. This communication should stretch all the way through from the initial consultation and making of a treatment plan, to the trials and fitting; not only with the patient, but also with the ceramist. To produce perfect results, it is vital that all three parties – patient, dentist and ceramist – are on the same page.
Many dentists and laboratories would agree that making porcelain veneers is more an art form than a technical process. Dentists of course perform most of the process of communicating with their patients and fitting the veneers, but it is the ceramist who makes the final product. Therefore it is crucial to work with a ceramist who has plenty of experience and is skilled at his or her craft – this is paramount for patient satisfaction and not having to return to re-do the work if the patient is not pleased with the colour match or fit.
The patient’s soft tissues should always be in harmony with veneers, otherwise the aesthetic result will be compromised. Changes to soft tissue can be made through orthodontic, minor surgery or by bony crown lengthening. This always needs to be explained to the patient and included in the treatment plan, especially where a specialist is needed, to avoid surprises later.
Staining underneath veneers
Using ferric sulphate solution around ceramic restorations can cause black pigmentation to appear around or underneath the veneers. Aluminium chloride is a superb haemostatic material and should be the preferred choice when placing veneers.
Documenting the work
Before and after photographs are not just great to show patients, or display in your clinic or on your website. Pictures, x-rays and models all serve as legal documentation, should there ever be any dispute about the work done with your patient. And during the test and fitting process, they are invaluable references for your ceramist.
A skilled laboratory technician is required to prepare veneers. A wax-up will permit the dentist to see what the final result would look like. It is a really good idea to duplicate the wax-up and then practice the design before it is tried on the patient. This allows the patient – and the dentist – to see what the veneer would look like in the mouth. It is also a perfect time to discuss any doubts the patient might have.
Taking two full-arch impressions
There is nothing worse than having to call a patient back for another impression, when the first one did not come out right. Therefore it is very easy, and takes no time at all, to take two impressions when the patient first comes in. This way there will never be a problem with the lab, even if the first impression (that you thought looked prefect) had a mistake.
One of the most ethical decisions a dentist can sometimes make, if refusing a certain treatment. Perhaps the client has expectations that simply cannot be fulfilled. Sometimes the dentist may get the feeling that a particular patient will never be satisfied. There might even be heavier psychological issues at play, if not clinical ones. Sometimes saying no to give someone a treatment they are requesting, is the best thing to do.
Veneers are always in a place where they are exposed to both the patient when he or she looks in the mirror, as well as the public. They can also affect the patient’s speech. This is why, although veneers can be the trickiest of dental procedures, they can also provide a highly rewarding challenge. But most of all, for a dental professional to see a patient walking out of their clinic, smiling widely and not just happy with their veneers, but perhaps experiencing a life changing rise in self-esteem, is simply great!
Johanna Bergstrom is a writer associated with AceDentalResource, where people can get high quality dental veneers for those perfect shiny teeth.