Broken veneers are a common worry amongst patients, but not necessarily a common problem. Manrina Rhode explores what causes a fractured veneer and when to replace it.
I do a lot of porcelain veneers. Approximately eight to 10 units a day.
When I last counted, I had done 12,000!
When patients come for a consultation they can worry about veneers breaking or falling off. I reassure them that, completed well, this is a very rare occurrence.
Let’s talk about broken/fractured veneers. When it happens and what we can do about it.
The most common reason for a veneer to break is trauma to the face. This can be a significant fall.
I will always remember cementing 10 beautiful veneers one December before Christmas and the patient going out to a Christmas party. She fell over on her face and broke the beautiful veneers.
What is important to note here is, if she didn’t have veneers, even natural teeth would fracture with a fall like this. It meant opening an emergency clinic to get her teeth looking beautiful again before Christmas.
Usually actions that will break a tooth will break a veneer. Examples of this are knocking your tooth in an unusual way with a fork, breaking Sellotape with your teeth, opening packets with your teeth, opening beer bottles with your teeth.
I’ve been known to shout ‘noooooo’ across a table as I see someone trying to use their teeth as tools to open something, having seen the damage this can cause.
Veneers can also break due to a parafunctional habit in the mouth, a grinding habit.
If a patient decides to have veneers because they have shortened or misshapen their teeth due to a parafunctional habit, then placing a veneer to the correct size/shape won’t break that habit. It also won’t protect the veneer from fracture.
If a habit broke a tooth then it will break a veneer. The parafunctional habit needs controlling with a night guard. As well as possible equilibration to remove prematurity’s causing the patient to posture forward.
Once the occlusal issues are resolved and factors put in place to control the parafunction, then you can correct the length/shape of the worn tooth with a veneer.
Habits other than grinding can also break teeth. If these habits aren’t controlled before placing your veneers they can also break teeth.
Examples of these habits are biting finger nails. Sometimes dietary habits can cause teeth to chip. For example eating bones.
Be a detective
As a dentist you have to be like a detective.
If you see a break on a tooth that you want to correct with a veneer, work out why that break is there in the first place. Then you can make sure your veneer doesn’t have the same fate.
When to replace
With regards to restoration of the fracture – when multiple veneers are completed in the mouth at the same time as a set, it’s best to avoid replacing a single veneer where possible.
If one was to fracture for one of the above reasons, I would try to restore in composite. Often you can get a seamless result restoring in this way.
In the case of a large fracture, usually due to trauma, it is best to replace the whole veneer. But I prefer to wait at least three months between original placement and replacement to give the tooth time to settle.
I run a four-day course teaching dentists how to complete porcelain veneers in a minimally invasive, stress free way.
See my website for more details www.DRMR.co.uk.
Catch up with previous Aesthetic dentistry expert columns:
- Trust and communication
- The aesthetic dental consultation
- Aesthetic treatment of white spots
- Aesthetic treatment options for closing a midline diastema
- Treatment of a gummy smile.
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