I've genetic enamel hypoplasia and most of my teeth have been filled/patched up to some degree. I wanted to get crowns for my entire smile line but my prosthodontist insists that it's better to be conservative and do veneers for some that don't require crowns. However, with my hypoplasia and the rate my teeth deteriorate, it's only a matter of time before the back of the tooth may start to erode if I only protect the front with a veneer. Why not crown it and avoid future problems altogether?
Why Do Dentists Always Recommend the Most Conservative Option when It Comes to Crowns Vs. Veneers?
Doctor Answers (13)
Crowns vs veneers, is conservative way safer?
Most commnon approach for prosthodontists is on a conservative side, especially in cases of full mouth reconstruction and enamel malformations. Usually porcelain veneers are not the great choice for patients with enamel hypoplasia. Hypoplastic enamel has defective structure of enamel rods and bonding strength of porcelai veneers will be altered, what can decrease the overall longevity of these restorations. However, in certain situations, for example lower anterior teeth that have small anatomic crowns, big pulp chambers, proximity of the teeth, placement of the crowns can be challenging or even risky. If your prosthodontist recommends you certain type of treatment it will be beneficial for both of you to discuss what particular factors he has in mind when choosing veneers, it will improve your communication and improve the trust between patient and the specialist.
Save tooth structure for the future
To answer your question of why dentists recommend conservative veneers over more aggressive treatment like crowns, I would say that we need to look at the trends in life expectancy. Today people are generally living much longer than we did 50 or 60 years ago. As a result, our bodies and associated parts have to survive with us. Years ago if a tooth received a crown at age 30 and by 50 the tooth was decayed and not able to be saved, the person would not have to live much longer without the tooth. These days, in that same scenario, a person could live to 90 + years old and have many more years to survive without teeth. That is why the "name of the game" is to preserve as much healthy body tissue as possible. The more conservative our treatment is now, the more we have to work with later if necessary.
As mentioned by the other doctors that answered this question, in your case crowns might be a better option. I agree, seek a second opinion, and do what feels right. If your hypoplasia is mild, perhaps there is still enough quality enamel to bond veneers properly.
Veneers or Crowns for Enamel Hypoplasia
In dentistry as in all forms of medicine the goal of the practitioner it to always be as conservative as possible when considering treatment for any medical/dental issue. In the case of Enamel Hypoplasia being conservative may not always be the best choice. This is a condition that does not allow for proper formation of enamel, making the teeth more susceptible to decay. For these cases I would lean towards full coverage crowns to ensure that as much of the tooth structure is covered as possible. Explain your concerns to your dentist and allow them to revisit you options with you. Good luck.
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Conservative usually great - there are exceptions
If you do have defective enamel, the bond of the veneers may be reduced, which will result in premature failure. If this is the case, crowns will be more conservative in the sense that you won't have to prep your teeth again due to failure. The main thing is, as always, find a skilled, highly recommended dentist that you trust and things should work out very well for you!!! Best wishes!
Conservative dentistry benefits the patient
I understand you have genetic enamel hypoplasia, which does result in the breaking down of natural tooth structure. I would guess you dentist, during a comprehensive evaluation, recommended a veneer restoration due to the desease progression in your case. You may not have experienced enamel breakdown on the tongue side of you teeth.
Your question is very good - and speaks to reason. I would ask your dentist again if he/she would consider full coverage crowns to address your valid concerns. This will only open a great dialogue for you to understand your situation better.
The conservative nature of your dentist leads me to believe you may have the right dentist.
Is it best to be conservative?
Modern dentistry has evolved to the technical level where the most conservative form of treatment is usually best. We always want to preserve as much of the natural tooth structure as possible. Aesthetic dentistry uses the porcelain veneer to alter tooth color, shape or appearance over the more aggressive full crown. After all, no one sees the back side of the tooth.
Your case is the exception. Enamel hypoplasia involves a defect in the structure of tooth enamel, making much more susceptible to damage and decay. In this case, conservative is not best. A full crown is indicated to protect the entire tooth surface. Otherwise, you will be looking at removing the veneer and replacing it with a crown at some future date.
Conservative not always the best option
Crowns can be done conservatively, preserving as much of the healthy tooth structure as possible. Optimal home care and regular professional visits will protect your investment in your oral health.
What's the Most Conservative Dental Care-Crowns or Veneers?
What the most conservative treatment? It's a fine line. Either CAN be right depending upon your specific situation.
As cosmetic dentists we want to preserve as much of your natural teeth as possible. No dental work lasts forever, and whatever you have done now will need to be replaced later in the future. Being very conservative now may mean that you have more options and more to work with later in the future when you need something replaced.
I think in cosmetic dentistry however the dentist can become fixated on what he thinks is the optimal for the tooth, and sometimes loses sight of what our patient really wants or needs from a larger perspective.
You sound concerned that you have had your teeth patched a lot, and that maybe the bonding you have had has not held up well over time. I'm imagining that you are wondering if you will have the same problems in the future if you have veneers now. I think you are wondering if the porcelain veneers will leave you prone to needing more repairs later.
I would make sure that all of your prevention is optimal (that probably means home Rx Fluoride gel, Fluoride varnish at every cleaning, a Sonicare and a night guard).
More than likely your dentist is correct, but like any other major cosmetic dentistry, make sure to ask questions, and make sure you get answers you can live with before starting any new porcelain veneers or crowns. Then, take their advice, come to a consensus and don't look back! Great question- Dr. Scott Greenhalgh, DDS
Crowns vs. veneers for enamel hypoplasia
Your situation is not very common and your restorative options are different from others. I think your prosthodontist may be right in suggesting crowns because hypoplastic teeth sometimes do not bond well and while veneers are almost always our first option (since they are more conservatively prepped than crowns) the bond is vital to their survival. I would still recommend getting a second opinion by a dentist who has treated patients like you with your specific condition. We now have all porcelain crowns that can be conventionally cemented which can eliminate the need for porcelain/metal crowns.