Porcelain veneers are very strong when placed on top of a stable foundation and bite forces are controlled. Porcelain is weak when forces are placed sideways. The first important aspect to control forces prior to placing veneers is to be sure the bite is correct and balanced. Chewing and grinding forces must be equally distributed on all teeth and not just hitting on one tooth. Hitting or grinding on one tooth especially from a sideways pressure can cause the porcelain to crack. The other important aspect to consider to prevent fracture is the foundation under the porcelain. If enamel is present, the tooth is strong and will not flex sideways. As more enamel is removed during the preparation phase, the tooth becomes more flexible. If too much enamel is removed during the preparation and the porcelain veener sits on top of dentin (the layer below enamel), the porcelain will bend on top. Porcelain is glass and glass will not bend, but only break. Therefore if the tooth is not stable and bend, the porclain will break away from the cement and fracture. These are the two main reasons why porcelain venners can fail. Your dentist can decided what is best for each patient and take into account other situations to ensure longevity of porcelain veneers.
Enamelplasty is the process of removing slight amounts of enamel without going into the underlying dentin of the tooth. Obviously, taking away any tooth structure is not the best. However, if the enamel is de-mineralized or stained, the benefits outweigh the risks. If the enamel is healthy we have to ask why it is being altered. First, if removing some healthy tooth structure will prevent long term damage such as a cavity, it is the right thing to do. Often grooves in back teeth harbor bacteria. These bacteria can lead to tooth decay. By opening up the grooves, and placing some type of restoration material or sealant in them, the long term prognosis for a healthy tooth is excellent. Now, lets talk about enamelplasty in cosmetic areas of the mouth. Often the teeth can have enamel removed to improve the shape of the tooth. As long as the enamel is not completely removed and it is polished after the adjustment, no short or long term problems will be present. Fluoride after this would be a good idea, though not necessary. Dramatic improvements in a person's smile can be made by reshaping the enamel. Considering the other more aggressive options that patients undergo to improve their smile, this is usually a first option, along with whitening. The third situation that enamelplasty is beneficial is to correct bite issues. Often, minor reductions of enamel can ensure long term stability of the bite, stop patients from grinding, eliminate headaches and improve jaw comfort. Always ask what option are available to treat you condition and remember that conservative dentistry is always the best.
The loose teeth can be addressed by your dentist. The jaw needs to be placed in the correct position, called centric relation and the forces distributed evenly on all of the teeth when you grind around. As far as the black triangles, when teeth are moved closer togher that can help eliminate the dark areas. Also, it the bone is in the correct place, the gum tissue can be expected to fill in. I am sure your smile can be improved with minor corrections.
The white color to the gums after bleaching is a chemical irritation from the peroxide in the bleach. this is nothing to worry about and usually returns to the normal color in a few hours. This happens if the bleach gets under the barrier that was applied. There are no long term affects from a one time exposure.
I would suggest that each front tooth be an individual crown if no bridge is done. A dental implant may be a good option for you. I would not want to remove the veneer and take away more tooth structure to place a crown. The implant can match the veneer great at the end of treatment. Good luck with your decision.
