My front two teeth chipped when I fell down the stairs. My dentist has given me a choice of getting either veneers or crowns. But he is edging towards Zirconium crowns over Empress Veneers. I wanted to go for Veneers due to minimal tooth reduction but he says that quite some tooth will be lost anyway for veneers since he'll be leveling it. Will leveling really be necessary for veneers apart from the obvious front shaving
Is It Necessary to Level out Chipped Teeth Before a Veneer Can Be Placed? (photo)
Doctor Answers (12)
Chipped Front Teeth Can Be Fixed in Many Ways
You need to get more than one consultation to decide what treatment is right for you. Depending on your age and your needs, you can bond plastic onto your broken teeth and get a fantastic result. Veneers are the next choice-while you will have some modification of your teeth(flattened and shaped) less tooth structure is removed than when you do a crown. Make sure you are clear about the expectations for length of service and what you can expect for care and reasonable results BEFORE you begin your care. Crowns are your last choice if you can avoid them in any way. Good luck.
Preparation of teeth for veneers
To help prevent the veneer from fracturing under biting and chewing forces, the preped tooth must have smooth, rounded edges. Therefore, some leveling of the chipped edges is necessary so they are not sharp. This concept is true whether placing a veneer or a crown. The difference between a veneer and a crown is that a crown has full-coverage of the tooth, while the veneer will cover only the front surface and the edge of the tooth. Best, Dr. Elizabeth Jahanian
Is there any prior preparation to a veneer?
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Leveling is not necessary
I agree, Empress would be best, and no levelling is needed (some minor SMOOTHING, sure, but NOT significant leveling). In fact, I would AVOID a zirconia material for esthetic reasons. It would seem your dentist is not aware of current materials, properties or techniques. If zirconia is used, it MUST be a crown, as zirconia cannot be bonded. If this were MY mouth, I would not want crowns. While a plastic material CAN be placed, due to the location of the chips, the longevity would be in doubt. In order to get them to stay put, more tooth structure would be needed to be removed, and at that point there is little difference from a veneer preparation. Porcelain veneers look and feel MUCH more like natural teeth than the plastic alternative (composite restorations).
Web reference: http://www.bestseattledentist.com
Stay away from crowns as long as you can
Assuming that the only damage to the teeth is what can be seen from the grainy picture I would not recommend Crowns for your chipped teeth. I would even consider composite restorations as a place to start restoring your teeth.
Modern composites in the right hands and with proper layering techniques, can deliver excellent cosmetic results that last a good while, with minimal or no tooth reduction.
Minimally prepared veneers would also have to be considered. It seems to be your preferred option. And they are undeniably the go to option for color stability and cosmetic results. But be aware that even veneers may have to be replaced in the future.
Also not all veneers are born equal, and there will be great variability of results depending on the skills of the lab and the dentist
Some leveling may be neededed at the cutting edge of the teeth and the amount will also depend on how well the material chosen can successfully hide the crack line
If those were my teeth I would not crown them as a first option jut because: "they need leveling anyway "
I would go for veneers
I had similar fractures to my own front teeth and years ago had empress crowns made to correct the problem. Today knowing what we know in regards to bonding and materials I would have gone for a more conservative approach, namely the veneers. And, I agree with Dr. Wilcox, that emax would be a great choice for the material. About 4 times stronger than empress and very very close in esthetic characteristics. In terms of leveling, some reshaping might be necessary to get the best cosmetic result at the edge of the teeth. The porcelain will reflect light differently than the tooth underneath and if it were leveled slightly more it would be easier to mask this and the ceramist would have an easier time getting the uniformity of esthetics just right. It is also important to allow enough thickness at the incisal edge for strength.
Some dentists use the term 3/4 crown to describe this type of veneer.
Best of luck.
Tooth preparation for veneer
Veneers are cosmetic restorations that are bonded to the tooth structure, so removal of the tooth structure ( or leveling) should be very minimal. From your picture I see that mesial corners of the central teeth are missing and otherwise teeth are OK. My suggestion would be restore it with more concervative restorations - veneers and not with full coverage crowns. I would highly reccomend to obtain consultation with restorative specialist - prosthodontist a and then make your final desicion. Good luck!
Veneers are generally better than crowns for chipped teeth.
I disagree, there is considerable more tooth shaving for a crown than a veneer. Do not do a crown. Yes, the edge of the teeth should be more level to obtain a good result with veneers, so the edge and the front will be shaved, but a crown shaves even more of the front and all of the back and in between.
I have to say, it is not a great picture to make treatment recommendations, however based on what I see and in general, veneers are a much better option for fractured anterior teeth. Materials and bonding techniques are much better now compared to 10-15 yrs ago. I would consider traditional porcelain (feldspathic) which is the most esthetic translucent type or E-max (lithium disilicate) which is a very strong esthetic porcelain. Empress falls somewere in between.
The veneer material to be used depends on several things like: underlying tooth color, desired tooth color, missing tooth structure, bite relationship. The dentist and lab technician need to discuss the case with good photos to make a final material desicion.
I would NOT recommend zirconia crowns. They can be opaque and dead looking not to mention the significant increase in tooth shaving I already mentioned. I only would use this if the tooth structure is very dark or if there is a metal post. Crowns were used more in the past because veneers are more tricky to do well and a crown was easier to do, however now a days there is no excuse.
If your dentist insists on crowns or is not comfortable doing veneers, go somewhere else. I have seen teeth with half the tooth fractured succesfully restored with veneers.
You can also do direct bondings for now and decide later about the veneers.
Hope this helps
Veneers vs. Crowns
I think your assessment of wanting veneers due to less tooth reduction is absolutely correct. I see no reason to prep the teeth for crowns based upon the photo you submitted. Consider emax for the veneers and I think you can have a conservative, aesthetic and strong result.
It looks like veneers would be Great
Current thinking in medicine and dentistry is to preserve body tissues as much as possible. In general we are all living longer than in years past and we want to bank tooth structure for the future. Whenever possible, I say try to save as much healthy tooth structure as possible. Therefore I would want to restore these teeth with veneers. If you have a great lab to work with, they should be able to create beautiful veneers without levelling the edges completely.
That said, I can't see the entire tooth situation (from your picture) and if your dentist feels that crowns would be best, perhaps he can see something that I can't.
Bonded crowns would be more conservative (remove less tooth) than Zirconia, and look better too. There is a newer veneer material called emax which is esthetically like Empress, but stronger.