Porcelain Veneers - Case 1
This patient is lives and works in Fort Lauderdale. Her chief complaint was "My last dentist told me I needed braces to fix my spaces but I don't just want the spaces closed. I want them to look nicer too but not too white".
We did a diagnostic wax up of her case to show her exactly how we could close the spaces and make the teeth look nicer with porcelain veneers all while controlling the color so that they did not look too enhanced or artificial. We discussed shape form as well so we could get a good idea of what shape she wanted her teeth to be. Her veneers were fabricated of EmpressCAD from Ivoclar Vivedent in one appointment and she was very happy with the result.
Porcelain Veneers - Case 2
This patient is a firefighter who lives and works in Fort Lauderdale. His chief complaint was "I am getting married soon and I really want to improve my smile. These bondings keep chipping." So this patient had traumatized his front teeth at a young age and they were fixed with bonding which is short for resin bonded composite or RBC. Now, RBC’s are very useful in dentistry when used in the proper indication. However, refacing the entire front of a front tooth is not really a proper long-term indication for several reasons that we will not cover here.
So, after a lengthy consultation we decided to perform a whitening treatment and then four porcelain veneers to match the new whitened shade. The veneers were made from EmpressCAD fro Ivoclar Vivedent and as you can see from the pictures, it is practically impossible to discern which four teeth are porcelain. The patient was very happy with this result and so was his bride who is also our patient.
Porcelain Veneers - Case 3
This case is not what it appears to be at first glance. You can see that obviously this patient walked in with veneers on her top teeth and then got veneers on her top and bottom teeth but if you look closely you will see more. This patient is a business owner originally from Atlanta but now lives in Florida. Her career was really taking off and she was about to start appearing on different television programs and was very self-conscious about her teeth. You might be able to see that when she started with us, she was missing a tooth on either side. It was important to replace these with implants to stabilize her bite. Furthermore, her overall bite needed to be corrected. Her upper front teeth were way in front of her lower front teeth. Most people would refer to this as an overbite but it is actually called an over jet. She had worn braces THREE times to try to correct this and was unsuccessful. The larger upper arch demanded larger veneers which is why her upper veneers are oversized and way too prominent. We told her it could be corrected with Invisalign by Align technologies. So her treatment consisted of placing two dental implants, then less than a year of Invisalign and finally replacing the upper porcelain veneers and placing porcelain veneers on the bottom. Once the position of her teeth was corrected, the veneers could be redone to the correct size and proportion. The porcelain veneers and the porcelain crowns on her dental implants were all designed and fabricated using the CEREC by Sirona system. The before picture is purposely taken with indirect light to show how prominent the over jet was. Notice how the bite and cosmetic concerns are all corrected. This was patient was very happy with the result.
Porcelain Veneers - Case 4
This patient had been a patient in our practice for several years. He had veneers done many years ago and had a very poor experience getting them because he said that the temporaries that he had to wear for 3 weeks kept coming off and he was constantly missing work to go in to the office and have them put back on until the permanent veneers came in. Then one by one, they started to fall off or break. So, he had a prior dentist in Fort Lauderdale patch them up because he was so averse to have them done again and go through the nightmare of temporaries. When we told him we now had new technology that allowed us to do the veneers in one visit with no temporaries, he was very excited and so were we to venture into this new technique together. We took all of the old bonding and broken veneers off, designed and fabricated new porcelain veneers with the CEREC by Sirona system using EmpressCAD by Ivolar vivedent and bonded them on his teeth the same morning. We were all very happy with this result and we are happy to report that since this case was done in 2007, not a single veneer has chipped or come off due to the superior strength of CAD materials and superior bond strength of same-day dentistry.
Porcelain Veneers - Case 5
This patient is a teacher in Fort Lauderdale and had asked her prior dentist about improving her smile but she reported that he wanted to do no less than eight upper crowns. After analyzing her bite and cosmetic proportion, we determined that we could make a significant change to her smile with only four veneers. In a single session, we designed and fabricated the four veneers using the E4D by D4D Technologies system out of EmpressCAD by Ivoclar Vivedent material. She was very happy with this result.
Porcelain Veneers - Case 6
This case is great example of the difference between composite or "bonding" and ceramic. When patients ask us to repair a tooth with bonding and expect it to look very natural and undetectable, we have to explain the difference in the physical properties of the material that make this expectation unrealistic. This patient was a patient of ours first, then left the practice to have some posterior teeth by another dentist in town that they had heard good things about from a friend, then returned back to us for the front teeth after being less than satisfied with the work that was done in the back. Her chief complaint was "I want to replace all the bonding with porcelain and make them much whiter". We designed and fabricated twenty porcelain veneers using the CEREC system (Sirona Dental Systems) out of IPS EmpressCAD (Ivoclar Vivedent) in a BL3 shade which is just off the natural shade guide and on the bleaching shade guide.
Porcelain Veneers - Case 7
We often have patients come in who have been told by other practices that their desired cosmetic enhancement would require a entire mouthful of veneers or crowns to get the result they want and then when they come to us, they hear a much smaller number of teeth required. Why is that? It is much more difficult to analyze teeth one by one, decide which specific teeth are the detractors in the smile presentation and then only correct those making them fit within the rest of the remaining untouched teeth than it is to just do all visible teeth choosing whatever color and characteristics the doctor chooses. This patient came to us with a chief complaint of "I want to fix my smile but don't want to spend a ton of money." After careful examination, we determined that the front four teeth were the main detractors in the smile due to heavy wear and old large bondings. We used the CEREC system (Sirona Denal Systems) to fabricate four 3/4 crowns from Emax (Ivoclar Vivedent) and bonded them in about three hours after starting.
Porcelain Veneers - Case 8
This patient presented with a chief complaint of "I want to really improve my smile". After careful examination, we discussed different options with the patient ranging from Invisalign and Zoom whitening to porcelain laminate veneers. The patient expressed an interest in making his smile whiter, fuller, maintenance free and lengthen the teeth a little. Porcelain does not change color or darken over time and allows for the changes he requested so twenty laminates were done, ten upper and ten lower.
Porcelain Veneers - Case 9
This patient presented with a chief complaint of " My teeth have become very short and dark over the years". Upon examination, we determined that this patient had done lots of clenching and grinding, otherwise known as bruxing, to his teeth destroying lots of the enamel. We recommended twenty porcelain laminate veneers to lengthen, lighten and strengthen his teeth. These laminates were made from Empress press and fabricated by Killian Dental Ceramics.
Porcelain Veneers - Case 10
This patient presented with a chief complaint of "I'm always in pain. I go through at least 20 advil per day and I cannot remember the last time I smiled." After careful examination, we determined that all of her front teeth were fixable. We performed a few root canal treatments and then fabricated eight CAD ceramic units from Ivoclar Vivedent Empress Mutlilayered ceramic in shade A2 with custom colorization. All of this work was started and completed in one 7 hour visit and the patient's reaction was priceless.
Porcelain Veneers - Case 11
This patient presented with a chief complaint of "I don't like the black triangle between my front teeth and I want my front teeth to look nicer". i immediately noticed that the reset of this patients mouth had been restored with porcelain fused to metal, or PFM. The esthetic problem with PFM is that because they have a dark grey metallic base, a lot of material and attention has to be devoted to masking the dark grey so there is then little ability to create natural organic luster and vitality with the remaining porcelain over it. i discussed this with the patient and the two options we had which were to either make the front four match what he had or to make them look like real teeth which would contrast with the PFM but look nicer on their own. He chose the latter. I like this case because it really shows the difference in vitality and esthetics between PFM and CAD ceramics. As you can see in the afters, the front four really do look like natural teeth as opposed to his PFM which may be the shape and size of real teeth but unfortunately do not have the organic vitality and light refraction that the CAD ceramic does.
Porcelain Veneers - Case 12
This patient went to a local cosmetic dentist with a chief complaint of "I want a whiter fuller smile". That dentist decided to perform six porcelain laminate veneers. The veneers were prepared and an impression was taken and temporary veneers were put in place for two to three weeks while the lab fabricated the permanent veneers as is this the traditional method and still the method that 95%+ of dentist still use. Unfortunately, the temporary veneers kept coming off and so the patient had to keep returning to the office to get them put back on causing her to miss a lot of work. Three weeks later when the permanent veneers came in, they did not fit properly so the dentist took another new impression and put the temporary veneers back on. After several attempts like this over a THREE MONTH period, she finally sought out our help and we prepped, scanned, fabricated, and delivered her veneers in a single 6 hour appointment. she was very pleased and able to get a refund from the first dentist. Note that we extended her case from six to eight veneers so that the canines were not overly dominant and the smile was fuller, which is what she wanted.
Porcelain Veneers - Case 13
This was an interesting and alarming case. This patient was a 16 year old girl whose mother had been patient in the practice since its inception. The family lived in Pompano beach so the daughter was treated by an orthodontist in that area but did not see a general dentist. As you can see from the before pictures, a tragic result ensued. Not only is her bite far from correct but the supervision of her hygiene while wearing braces was so poor that cavities started and grew around her orthodontic brackets without any intervention. The orthodontist removed the brackets and sent her home with her bite incorrect and large cavities on her front teeth. Both mother and daughter were fatigued by what happened and did not want to start orthodontic treatment again although they did acknowledge that at some point, they should continue her ortho with another provider to correct her bite. But their priority now was to manage the cavities that had grown. To correct these cavities with resin bonded composites would be a violation of the parameters of the material meaning that RBC is not designed to replace such large portions of teeth and thus, will not function predictably. So, we decided on porcelain laminates. We fabricated 6 porcelain veneers from VitaForte by Vident using the E4D by D4D technologies system. One of the benefits of CADCAM restorations are their superior material strength and bond strength so a patient with a less-than-ideal bite can have the confidence that they will not chip or fall off.
Porcelain Veneers - Case 14
This patient contacted us early on a Saturday morning with a chief complaint of "I fell at a concert last night and landed on black plastic chair face first. I went to the emergency room and they just gave me pain medication." We met her at the office Saturday morning and determined that she had traumatized her upper anterior teeth and alveolus (the bone that holds those teeth in). There was actually a small fracture in the bone and the teeth were loose and some had been relocated. We manually relocated the teeth back to where they belong, reset her alveolus and then stabilized everything with a surgical splint. There is no pre operative picture of her smile because her like were too traumatized to smile at all as her upper front teeth had gone through her lip. We waited the appropriate time for all the healing to take place and then we performed a few root canals on the teeth that needed them and then fabricated a combination of crowns and veneers out of Empress CAD from Ivoclar Vivedent using the CEREC system from Sirona. The second appointment took approximately four total hours to take her from the surgical splint to the finished four units.
Porcelain Veneers - Case 15
This patient is a business owner in Fort Lauderdale who had been on a few consultations with different cosmetic dentists to replace his twenty year old veneers on top and perform matching veneers on the bottom. His chief complaint was "I really want to replace my old veneers and get the bottom done but I simply do not have time to come a million times."
The treatment sequences he was quoted ranged from six to fourteen visits and totaled over $30,000. After our evaluation, we determined we could perform his case in two visits for a fee $10,000 less than he was quoted. The uppers were done in about six hours and the lowers a week later in a second six hour visit. They are made of EmpressCAD from Ivolar Vivedent.
Porcelain Veneers - Case 16
This patient is a grammy award winning country music star who lives in Tennessee most of the year but has a vacation home in Fort Lauderdale. She presented to the office for a Zoom! whitening but after discussing all the things she did not like about her teeth and smile, she understood that color was only one small component of what she wanted to improve. We decided on porcelain veneers on both top and bottom. These were performed in two sessions, 6 hours each. The CEREC by Sirona system was used to design and fabricate the porcelain veneers from EmpressCAD from Ivoclar Vivedent. The shade of these veneers is just off the natural shade guide and into what we call the bleach shades, not the lightest but one of the lightest available. The patient was ecstatic with this result.
Porcelain Veneers - Case 17
This patient presented with a chief compliant of "My teeth are too short, small and dark." Upon examination, we determined that the patient had lost lots of enamel from bruxism (clenching or grinding). Lots of dentists will not do veneers on patients that brux but if the patient's bite is corrected properly and damage from future bruxing prevented through the use of a night guard, veneers are a good option. We performed twenty veneers on this patient in two half-day sessions. We used the CEREC system (Sirona Dental Systems) to fabricate the veneers out of Empress CAD (Ivoclar Vivedent) and made the nigh guard the same day as well in the office from INTERRA in a design that covers only the upper front four teeth so it is very comfortable and not too intrusive to sleep with thereby improving compliance. After all, it only works if the patient wears it.
Porcelain Veneers - Case 18
This patient presented with a chief complaint of "I hate the color and age of my smile." Upon examination, we determined that the patient's upper anterior teeth were discolored, worn, out of position and contained multiple failing bonded fillings. we agreed that porcelain veneers were the best long term choice to meet the patient's demands. We fabricated eight veneers from Empress CAD from Ivoclar Vivedent fabricated with the CEREC system from Sirona Dental Systems.
Porcelain Veneers - Case 19
This patient presented with a chief complaint of "My veneers are broken." While her veneers were old, the age was not the primary reason they were failing. They failed because she had been grinding on them at night for decades and of course any ceramic will eventually fail if it is ground on night after night for decades. We replaced her broken veneers with CAD/CAM designed veneers made of EMaxCAD designed and fabricated with a CEREC. We of course also fabricated her a small night guard for the front four teeth that she will wear at night and these veneers should be the last set she ever needs.
Porcelain Veneers - Case 20
Porcelain Veneers - Case 21
This was an emergency case. Patient had a basketball injury and came in with two broken and two chipped teeth in the middle of a busy day for us. We found time to make him two new permanent veneers and bonded the two teeth on the side at his initial emergency visit rather than making him walk around like this or make some type of unstable temporary. Due to his heavy bite in the front, any temporary would have been under heavy stress and likely would not have lasted long at all.
Porcelain Veneers - Case 22
This patient presented with a case of fluorosis that was previously treated with other methods that did not yield a satisfactory result for the patient. She wanted a significant esthetic change in her teeth without "destroying them". We opted for minimal prep veneers. With minimal prep veneers, the teeth are barely modified, just enough to allow for proper fit of the porcelain. These eight veneers were started and completed on the same day in about a five hour session which required no impressions, temporary veneers or second session of needles. The patient received her veneers just in time for her wedding day.
Porcelain Veneers - Case 23
This patient presented with two failing crowns, one failing veneer and diastemas (gaps) between the teeth. We recommended two all ceramic crowns and two veneers to close the spaces and reconfigure the symmetry and proportion of her front four teeth. These four units were started and completed in one two and a half hour session with no temps and no impressions.
Porcelain Veneers - Case 24
This patient suffered lots of excessive wear and cracking from years of unprotected grinding of her teeth, a very common and rarely treated disorder. She came in asking for eight veneers because we had done an eight veneer case on her friend that she was very impressed by but after consultation, we determined that a significant esthetic change could be accomplished with four veneers and she would only need eight if she desired a more significant improvement in color. Color was not a big issue for her so she chose the four veneers and was very happy with the result. These four units were completed in around two and half hours with no temps and no impressions.
Porcelain Veneers - Case 25
This patient presented with large old composite bondings that were failing. They never looked like real teeth even when new and had only become worse over time as composite is not a good material selection for long term replacement of the majority of a tooth, especially in an esthetic location. We rehabilitated this smile with four ceramic veneers that were done in one two and half hour visit with no temps and no impressions.