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Why get braces before veneers?

February 17, 2018 ,

by Dr. Olitsky

Most people are surprised that porcelain veneers can make crooked or gapped teeth look perfectly straight in one appointment.  This treatment is called instant orthodontics.  Patients often wonder when they should straighten or move their teeth with Invisalign or braces before getting porcelain veneers.  There are several reason to consider orthodontics before veneers.  They can be summarized by two “C’s”, conservative and compromises.

When teeth are out of alignment, that is what we call teeth when they are not straight, there are teeth that are tipped, rotated or moved from ideal positions.  In order to make the teeth look straight, a dentist is first required to prepare or drill a tooth back into alignment before starting the normal procedures for porcelain veneers.  While a porcelain veneer can be as thin as .3-.5 mm thick, the new final position is first planned out before the tooth is prepared.  If the final position of the new veneer is inside of the current tooth, then more of that tooth must be drilled away before there is room for the porcelain veneer.

Conditions like crowding and cavities such as the patient above, necessitate more tooth removal before porcelain veneers can be placed.  The end results are beautiful, but subtle compromises can exist.  Understanding ahead of time the risks means being able to make a better decision about braces or Invisalign before porcelain veneer treatments.

Veneers are ideally bonded to 100% enamel.  The enamel is the outer layer of tooth and creates the best and strongest bond with the porcelain.  A veneer bonded to enamel is impossible to remove with out drilling it off or using special lasers.  The bond to dentin, the inner layer of tooth, is less predictable.  As a dentist, we want to minimize the amount of dentin and maximize the amount of enamel for a veneer to bond.  If too much enamel is missing from a tooth, a crown is a better choice.  Instant orthodontics may require more drilling and crowns and therefore be less conservative of a treatment.

When teeth are not in the ideal positions, it becomes more challenging and at times impossible to avoid compromises.  Crowded teeth often have challenges associated with tooth proportions and arch width discrepancies making teeth look too narrow when straight.  Smiles with spacing may have the opposite effect when veneered straight, the teeth may look to wide for their length.  Moving the teeth would help both these situations look more ideal in the end.  Teeth can also be tipped too much forward or backward in the smile.  These effects can result in thicker than normal teeth if going straight to veneers, or darker situations called “Show through” where the natural tooth warms the final color of the veneer making it look more yellow than intended.  Teeth that are out of alignment by being too far under the lip or too far dropped in the smile may effect their final lengths or gum symmetry if gum surgeries to correct this compromise are not undertaken.

This patient closed his spaces with porcelain veneers without using braces or Invisalign treatment.  The results are completed in 3 visits over approximately 6 weeks.   The teeth can be moved orthodontically together over a period of 6 months to a year.  Adults require retention for life, so a retainer will be necessary and recommended to wear every night.  The tooth wear and color is also not improved with moving the teeth, so the patient may have elected to move the teeth then whiten them, but the wear could only be fixed with porcelain veneers or direct composite bonding.  The patient decided to use porcelain veneers to straighten the teeth and correct the other things about his smile he did not like.

Orthodontics can also be used instead of gum surgeries to make the teeth look shorter or longer.  Sometimes a gum surgery is the best choice and sometimes moving the teeth is a better choice.  It depends on smile design principles and will be planned out with you and your Smile Stylist.

It is difficult to know for yourself if orthodontics should be done prior to getting veneers, or instead of veneers.  Your Smile Stylist will discuss the most ideal options for your new smile.