Lower anterior teeth , crowns or veneers? 

By: Dr. Kamsiah BDS, MDSc

Lower anterior teeth are rather small and narrow. Crowding may over preparation of the teeth which can ends up with root canal treatment and more treatment. 

These teeth appear to be  relatively sound teeth that are mildly discoloured, slightly mal positioned, spaced, mottled, show obvious stained enamel cracks, have mild-to-moderate caries on the facial and proximal surfaces, are short in length, or are in other ways unsightly.

Selecting crowns or veneers for treatment

Some important clinical characteristics relative to this decision is intact lingual surfaces . 

If the lingual surfaces are worn through to dentin or carious, veneers are not indicated, and crowns should be placed. Lingual surfaces should be intact for veneers . 

If there’s lack of enamel on facial surface of teeth, it would be difficult to etch the enamel properly . Enamel provides the most adequate retention of veneers. Occasionally, teeth have either very thin enamel developmentally, or the enamel has eroded or worn off . When the facial surface is more than 50% dentin, crowns are a better treatment choice. 

Mandibular anterior teeth often have minimal enamel, making long-term attachment of veneers questionable. Veneers require enamel for optimum retention. 

However in this case , we still have considerable amount of enamel because they were minimally prepared . 

Significant caries and tooth breakdown above the cervical margin indicated that the best decision for these six maxillary anterior teeth was lithium disilicate crowns.

Matching the color of veneers and crowns

This task should be strongly considered during treatment planning. If several adjacent teeth in a treatment plan require crowns and some adjacent teeth could have veneers, color matching can be difficult. 

If all of the veneers and crowns are made of lithium disilicate or similar materials, the challenge is reduced. If aesthetic requirements are high, a better result will be achieved by placing crowns on all of the teeth involved in spite of the more radical removal of enamel required for the less needy teeth. 

Treating one tooth or multiples.

Every dentist knows the difficulty of matching the color of one tooth in relation to the adjacent teeth. Crowns block the tooth stump color, while with a few exceptions, veneers take on some of the color of the tooth stump. The final color of a veneer is related to the remaining tooth structure, the cement used, and the color of the ceramic. This combination of three colors makes matching one veneer to adjacent teeth very difficult. Even though matching one crown to surrounding teeth is difficult, in my opinion, matching one veneer to surrounding teeth is more difficult. However we didn’t face this problem with the six veneers . 

Difficulty of placing veneers vs. crowns-Most clinicians agree that the veneer procedure is more difficult than the crown procedure. Prepping teeth for veneers is usually quite simple, but seating them requires meticulous attention for proper positioning and color, as well as avoiding breaking the veneers during cementation. With experience and repetition, veneer placement becomes relatively easy and predictable, and the results can be excellent.

Material type for veneers.

Currently, lithium disilicate is the most popular material for ceramic veneers.  Fabrication of veneers using lithium disilicate is a relatively easy task for laboratory technicians, and the esthetic and strength are excellent. 

Advantages of ceramic veneers when indicated

In mature adults, the teeth have usually stabilized in positions that are related to occlusal contacts, muscle and tongue activity, chewing habits, and presence of any peculiar oral habits. When veneers are placed on the stable teeth, there is minimal post-treatment tooth movement or occlusal change. Every dentist has seen significant tooth movement that occurs for several weeks after crowns are placed.

Veneers, where indicated and properly accomplished, technically have near-optimum esthetic appearance for many years .

This case 

Although these six anterior teeth had significant facial caries and discoloration and required facial and proximal reduction, they had intact lingual surfaces. Veneers instead of crowns were planned for the patient.

The six anterior ceramic veneers on the teeth will served this patient well for several years to come.

Summary

Ceramic veneers are fantastic restorations for this sort of a case.  Making the decision concerning which is best for specific patients requires consideration of the numerous clinical characteristics . The materials and techniques available today for either type of restoration are the best in the history of dentistry. With proper placement, either restorative procedure will provide many years of service for patients.