| Lumineers®
Indirect bonding without shots.
 The
newest form of esthetic dentistry involves bonding ultra-thin porcelain veneers,
generally without anesthetic, to unprepared or lightly prepared teeth.
This has been made possible because of a new innovation in dental materials.
LUMINEERS BY CERINATE is a cosmetic solution for permanently stained,
chipped, discolored and misaligned teeth. It may even be used to
revitalize old crowns and bridgework. LUMINEERS are a porcelain
veneer that can be made as thin as a contact lens and are placed over existing
teeth, most of the time without requiring the removal of sensitive tooth structure (unlike
traditional veneers discussed
on the bonding page).
| The technology used to fabricate this product involves pressing porcelain
particles into veneers about one third of a millimeter thin. It is
something of a breakthrough because it is difficult to prepare a veneer this
thin with the strength and masking properties necessary to restore broken,
misaligned and discolored teeth. Lumineers are made from a modern
glass ceramic
containing a very high density of leucite crystals. This makes for a
remarkably strong and durable veneer. |
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The advantages to this type of esthetic restoration are as follows:
- Since in most situations, Lamineers require little or no modifications
to the underlying teeth themselves, they can be done from start to finish
without shots most of the time.
- Most cases return from the lab within 7 to 10 working days, so the
patient can expect to receive his or her veneers within two weeks of the
impression appointment.
- Since the veneer is bonded entirely to tooth enamel, the bond is very
strong (the strongest bond in all of dentistry) and the restorations are
clinically proven to last for a minimum of 20 years.
- Lumineer veneers are proprietary which means that the veneers are built
only by certified lab technicians. This is no small consideration
since the dentist cannot "cheap out" by using a discount lab where
technicians are not as well versed in the art. Denmat must maintain
high standards or risk damaging the reputation of the product. The
work that comes back is always very good.
- The porcelain to enamel bond is one of the strongest in dentistry.
Lumineers, once bonded to the teeth have very good track record for strength
and longevity.
The disadvantages of Lumineers are as follows:
- The Teeth that will receive the lumineers and the gums that surround
them should be in reasonable
condition. There can be no active decay in the teeth, and any fillings
present must be in fairly good condition prior to doing the veneers. With a seriously damaged tooth that
has been extensively repaired
with composite, it is often best to place an all-porcelain
crown on it instead of a veneer. Crowns cover
the entire surface of the tooth and protect it from further decay.
- Oral hygiene must be good before the veneers can be done. If the
hygiene is poor, then the gums may recede away from the margin of the
veneers making the result less than optimum. Also, bleeding gums will
interfere with the bonding process and often causes a line of discoloration
under the porcelain at the gum line.
What can be accomplished with Lumineers?
Discolored teeth
The above teeth show severe
tetracycline stain.
Note that The veneers not only mask the original color of the teeth, but are
used to make the teeth appear longer as well. In this case, eight upper
teeth were veneered as well as eight lower teeth. It is often necessary to
place veneers on more than just the front six teeth because otherwise, the
"smile" would not be wide enough. The veneers may be ordered in
varying degrees of opacity. In this case, relatively opaque veneers were
chosen to mask out the unattractive color of the underlying tooth structure.
Unattractively arranged teeth
These teeth were crooked, as well as yellow and
discolored. Veneers were used to lengthen, straighten and whiten the teeth.
In this case the smile was wide enough to require the veneering of 8 teeth.
It is often financially more feasible to veneer only the four front teeth, but it would then be unwise
to make the veneers much brighter than the color of the existing canine teeth.
Four bright veneers would look "fake" next to the natural color of the canine
(eye) teeth.
This brings up the question of how many teeth to veneer.
The most ideal smile is created by placing veneers on 8 to10 top teeth (from
second premolar on one side to second premolar on the other side) If the
decision is made not to brighten the smile, or otherwise to alter the shape or
form of the arch (the dental arch is shown in the diagram below), it may be
sufficient to veneer as few as two (see "closing spaces" below) or four
incisors.
Closing spaces
In this case, only three teeth were veneered in order to close
the spaces between them (the two central teeth and the patient's left
lateral incisor). This patient whitened his otherwise yellow
teeth with bleaching trays prior to the application of the veneers.
Hollywood smiles--Making a reasonably good smile perfect
In this case, this patient had relatively nice looking teeth
to begin with. However, she spent a lot of time in public and wanted
a perfect smile. In her case, ten veneers were placed (second premolar to
second premolar). This sort of dentistry is becoming more and more
common as the general affluence of the average American increases and dental
awareness spreads because of mass communication, and entertainment shows such as
Extreme Makeover. Note, however, that unlike the veneers done on the
program Extreme Makeover, Lumineers require little or no tooth modification, and
almost never require shots to make the patient numb.
The Lumineers on the right were photographed directly after insertion,
about 2 weeks after the picture on the left was taken. This sort of
thing is fairly typical in uncrowded cases in which the upper and lower
teeth do
not bite edge to edge. More modification of the teeth is necessary if
the teeth are overlapped. In most cases, the modifications are small
enough that local anesthesia is still not necessary. If the upper and
lower teeth are biting edge to edge, it is generally necessary to veneer the
lower teeth as well as the uppers in order to allow lengthening of the upper
teeth.
This gentleman is in his mid 30's. His
central incisors were so worn and malformed, that he had previously
had all-porcelain crowns placed on them. Needless to say, the
neighboring teeth looked rather yellow and worn in comparison.
We did Lumineers on six of the adjacent teeth (first premolars,
canines and lateral incisors) leaving the original porcelain crowns
in place. The result is on the right. In this instance,
the patient's left lateral incisor needed to be reduced in depth a
bit to allow for the thickness of the porcelain, and all six teeth
required about a millimeter in length reduction to allow for the "incisal
wrap" to make the edges of the teeth more graceful.
We chose to make the canine teeth pointed and prominent since he
felt that that was what people were used to seeing when he smiled.
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This lady simply didn't like the shape or
arrangement of her teeth. She chose a more square and flatter
arrangement for the incisal edges. In fact, we keep a "smile
book" that has hundreds of images of smile styles to choose
from, and this particular arrangement specifies flat incisal edges
(the lower edges of the teeth in this set of images), square edges
facing the midline and rounded edges away from the midline.
She also chose short and rounded canine teeth. Because her
natural teeth were already too short, no changes were made to the
teeth prior to the impression.
This lady had severe tetracycline stain, a
problem not amenable to bleaching. In this case, due to
the wide smile, we chose to veneer ten top teeth instead of only
the front six, In order to place Lumineers on the lower
teeth, it was necessary to reduce the vertical size of the lower
teeth by a bit over one millimeter to allow enough room to
accommodate the bite. Note also that the lower teeth are
crooked in the before shot and have been straightened using the
lumineers.
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