Indications For Non Prep Veneers
With they primary purpose of upgrading and enhancing a patients appearance non prep ceramic veneers have become a standard procedure in many dental practices. Adhesive bonding technology now allows the dentist to place restorative material of minimal thickness on the surface without any preparation. These type of bonding, bonding porcelain to enamel creates the most solid and secure bond and long-term durability. The main advantage of non prep veneers is that the tooth structure is preserved and there are no harm to the pulp tissue. In addition to that post operative sensitivity is eliminated. Besides that they are more comfortable for the patient because they are painless, so there is no need for anesthesia, impression is easier, because tissue management is not needed and there are no need for provisionals. They can be done in two visits which mean less chair time for the patient.
All of these features are quite used in marketing and advertisements which made them very popular and common treatment. They are often advertised as reversible which, in the true sense, is questionable. Though removal is possible, the procedure cannot be reversed without some damage to the enamel. Lots of advertisements claim this advantage of no-preparation veneers of being reversible, but it is not easy to remove the veneer and resin cement without any harm to the enamel. Therefore, it may not be a true advantage that the no preparation veneers are reversible.
With all this great features non prep porcelain veneers can be a good alternative to traditional dental veneers. However the cases in which they are indicated must be carefully selected. In a really small number of cases veneers can be placed without reducing any tooth structure at all, while many other cases require only minimal reduction of tooth structure.
One of the best and most common indication for non prep veneers are multiple diastema cases. Even though orthodontic treatment is a good option, most adults do not want to spend several years and multiple appointments to enhance their smiles. For immediate esthetic results carefully planed no prep veneers can be great solution (picture1). Although this is a common indication diastema closure can be done without any preparation in limited number of cases. For example in cases with large diastemas we need to carefully evaluate the amount of unsupported porcelain and maybe suggest orthodontic treatment over veneers. On the other side the lack of SSdiastema would be a contraindication to no-prep veneers. Without inaf space, no-prep veneers lead to bulky embrasures faciolingually. Bulky appearance and over contoured veneers are not only the esthetic problem. Overcontured gingival margin can even lead to periodontal problems.
The next indication is minor color changes. This indication is very limited because most of the patient are coming to the office with major pigmentations and color changes. So if teeth would have major color changes it would be hard to mask them with thin ceramic layer. For patients who wont’s drasticly whiter teeth no prep veneers wouldn’t be so good solution. It would be impossible to achieve bigger color changes with thin ceramic layer and natural look. For radical color change we need at least 0.2 mm of ceramic for every shade change. If we would try to change color for more shades they would look very artificial and flat due to lack of translucency and depth of color. Teeth will be white, but they will be more opaque white.
Non prep veneers are good option for masking exiting class III, IV, and V restorations. These restorations are very common and they are often esthetic problem due to surface discoloration of composite resins. If there are inaf preserved enamel to provide adequate bonding no prep veneer are great solution for this esthetic problem. In cases of big class IV defects, these type of veneers would be contraindicated and crown may be better solution because of the large amount of unsupported porcelain and lack of tooth-colored backing.
Restoring chipped or cracked teeth can be easily done with non prep veneers. If there are sufficient enamel remaining to provide adequate retention this is a good indication for non prep veneers. With bond partially in enamel and partially in dentin, depends on damge, we can create adequate support for most biting pressures. If teeth are significantly damaged or compromised better solution would be crowns.
When choosing non prep veneers we also need to consider the patient’s expectations. It is very important to discuss and explain cosmetic dentistry options available to patient. Though the characteristics of no prep veneers sound very appealing, for patients who are insisting on perfection in the shape of their veneers and drastic changes, we need to go to a minimal-prep or full-prep procedure. The patient must be a good candidate for veneers, too. Healthy foundation in patients mouth for cosmetic dentistry procedures is necessary. Oral health is one of the most important characteristics of a good candidate for porcelain veneers so the patient have to be free of gum disease. In case of gingival recessions non prep veneers are contraindicated. If we would try to perform root coverage it would be very difficult to achieve this design due to undercuts in the root area.
No prep veneers can do the stunning smile makeover results when the indications are right. They are one one of the most conservative of treatments, but there are some rules in which cacses they can be done. Only small number of patients are considered as ideal for no-prep veneers and a larger group of patients are minimal-preparation cases. The majority group of people seeking smile enhancing are people with major discolourations, large class III restorations, space management issues and tooth wear. These cases will require some kind of tooth preparation for better result. No-preparation veneers can’t be the best treatment for all patients seeking esthetic enhance and each case should be evaluated individually. But whenever possible we should to choose no-preparation veneers or even minimal-preparation veneers over preparation in order to preserve health dental tissue.