To veneer or not, the dentist's dilemma?

Porcelain crowns and veneers 19 year post op

 Most patients seeking a better smile seek guidance from their dentists on how to improve their smile. Most are already familiar with porcelain veneers since they have friends or family who have chosen this route. The esthetic results are often determined by the lab and the dentists mission is to prepare and impression their teeth properly. Usually the lab provides a cosmetic wax up done over the patients study model. This wax up can be used to dress rehearse the case prior to tooth preparation and can be used to fabricate good looking temporization as well. At least some of the esthetic decisions are determined with the help of the lab. 

Patients seeking a treatment plan by a dentist about cosmetic dentistry would probably do best if they find a dentist equally familiar  with doing both esthetic restorations with composite as well as performing makeovers using veneers. Often the resulting veneers look good, but somewhat "fake", since the restorations tend to be more monochromatic that natural teeth and have somewhat stylized carvings. Digital designing can sometimes improve the appearance of the carvings since digital lab designers can sometimes use a digital library of  good looking natural teeth to help design and mill their restorations, but this is not possible if the veneers have an outer layer of feldspathic porcelain. Feldpathic porcelain is usually the most esthetic ceramic material, but it is usually shaped and carved by a ceramicist in an "analogue" manner. This makes the appearance dependent on the skill of the ceramicist involved. 

Many patients could benefit from good looking direct composite restorations, especially if they are more or less happy with their teeth but have small areas that need repairing or need small additions. When these are done properly the resulting restorations can greatly enhance smiles with minimal or no preparation of the patient's teeth. The results often do not alter the overall shape and character of a patients smile, just enhance it. Their friends may not even know what was done. They will only observe that their friend's smile is looking good! In my mind, this is the best that esthetic dentistry can offer, since the patient doesn't lose the look of their smile, but just enhances it. 

Another advantage of direct bonded composite restorations vs porcelain veneers , is that they are easier and less expensive to replace or repair. Since nothing lasts forever, this most likely will eventually become necessary, regardless of which type of restoration is chosen. 

There are many instances when porcelain veneers are the correct choice for a smile makeover. Adding overall length, changing the color of a smile without bleaching or when extensive additions are needed, porcelain veneers or even full crowns may be the best choice  Obviously, for those contemplating a smile makeover, their best option is to visit a cosmetic dentist versed in all types of esthetic procedures so that they can be fully informed about what option is best to improve their particular smile.