A clinician’s goal is to provide patients with optimal outcomes. Deciding which treatments will provide the best results for patients isn’t always straightforward, particularly when choosing between crowns and veneers. This decision has become even more important with the growing popularity of zirconia and pressable lithium disilicate restorations.
Veneers are a popular, frequently-requested restoration choice. They have the ability to last for years. Suitable candidates for porcelain veneers include patients with generally strong, healthy teeth, free from large fillings or areas of decay. A candidate’s teeth may exhibit slight malocclusion, might be mildly discolored or unevenly spaced. teeth that are less attractively-shaped or teeth that display small signs of tooth decay on the proximal or labial surfaces can often be addressed with porcelain veneers.
While veneers are a popular choice, there are cases when dental crowns may prove to be a better option. There are several factors which will indicate the choice of dental crowns:
Teeth that are suitable for veneers should have good lingual surfaces. If these surfaces expose any dentin or exhibit signs of decay, then crowns may be a more suitable choice.
People with bruxism who either clench or grind are unlikely to be suitable for veneers. Carefully selected crowns may be a better option and will provide longer-lasting restorations. When vertical dimensions are to be increased, or if the occlusion must be significantly changed, then crowns may be suitable. Veneers require relatively good occlusal stability to achieve the best outcome.
Signs of Active Caries
Although veneers can be placed when tooth decay is present but not severe, the presence of active and more significant caries could mean crowns are a better choice. With dental crowns, the margins are more likely to be placed sub-gingivally, providing more resistance to caries than margins of veneers.
Worn Tooth Enamel on Labial Surfaces
Occasionally, teeth may have thinner-than-normal enamel or significant enamel erosion. In these situations, crowns may be a better choice for treatment. When properly etched, dental enamel provides the best retention for veneers.
When Teeth are Significantly Rotated
Teeth that are significantly rotated, or where the occlusal relationship is abnormal, may achieve a better occlusion with dental crowns. Porcelain veneers can be good when teeth do not have to be significantly repositioned.
When porcelain veneers are used on adults with stable teeth and no abnormal oral habits, there should be minimal tooth movement and minimal changes to the occlusion. The most advanced materials can produce near perfect esthetic appearances that will last for many years. However, while prepping for veneers is relatively straightforward, the technique for successfully fitting them requires close attention to detail, as veneers take on some of the colors of the tooth stump. The final color of the veneer can be adjusted with dental cement, but this can lead to difficulties in exactly matching a veneer to natural teeth. In contrast, crowns block out the tooth stump color and can be much easier to match.
The introduction of zirconia and lithium disilicate has made it easier to match veneers and crowns situated adjacent to each other. During a smile makeover, this advance makes it easier to achieve an excellent outcome, even when combining different restorations. Veneers can be a wonderful choice for some patients, but crowns may, under certain circumstances, provide a better and more-predictable outcome. With the materials and techniques available today, patients can look forward to enjoying highly esthetic restorations that should provide years of reliability.
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