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Lumineers® Indirect bonding without shots.

lumlensThe 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.

The advantages to this type of esthetic restoration are as follows:

Since in most situations, Lumineers® 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 or all ceramic 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.

For a thorough understanding of glass and porcelain, Students and dental professionals should consult  my five page course “Dental Ceramics for the beginner

What can be accomplished with Lumineers?

Discolored teeth

tetracycline

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

unattractive

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.

maxillartveneers

Closing spaces

closingspaces

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 also whitened his otherwise yellow teeth.

Hollywood smiles–Making a reasonably good smile perfect.

hollywoodsmiles

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.

Fixing generally unattractive smiles

unattractivesmiles

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.

unattractivesmiles2

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.

lumineers3

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.
Covering tetracycline stain

tetracycline2

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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