Veneers are thin, custom-made shells, typically crafted from porcelain or composite resin, that a dentist bonds to the front surface of a tooth to improve its appearance. They are a cosmetic solution designed to correct issues like discoloration, minor misalignment, or small chips. Veneers cannot be placed over actively decaying or “rotten” teeth. Any form of dental decay, gum disease, or infection must be fully resolved and the underlying tooth structure stabilized before the procedure can be considered. This pre-treatment ensures the longevity and success of the restoration.
The Necessary Foundation for Veneers
A healthy tooth structure is mandatory because successful veneer placement relies entirely on a strong, reliable adhesive bond. This bond is primarily achieved between the veneer and the tooth’s outermost layer, the enamel. For porcelain veneers, the dentist prepares the tooth surface by removing a small amount of enamel (often between 0.3 mm and 1.5 mm) to create space for the shell.
The bonding process is a precise chemical and micromechanical procedure. The dentist prepares the enamel surface using a mild acid, typically phosphoric acid, to create microscopic pores. This allows the adhesive resin to penetrate and form a secure mechanical lock. If decay is present, it compromises the integrity of the enamel and underlying dentin, preventing the formation of a strong, durable bond.
Placing a veneer over active decay seals the decaying process beneath an impermeable layer. This sealed environment causes the decay to accelerate rapidly, shielding bacteria from saliva, brushing, and fluoride. The infection can quickly spread deeper, potentially reaching the pulp (the nerve and blood vessel center). This results in severe pain, infection, and complete tooth failure, so the tooth must be structurally sound and disease-free.
Mandatory Pre-Treatment for Decay
The initial step involves a comprehensive dental examination, including X-rays, to identify hidden decay or existing infections. Any signs of tooth decay or periodontal disease must be completely eliminated before the cosmetic phase can begin. This preparatory phase ensures the foundation is clean and stable enough to support a long-lasting restoration.
For minor decay, pre-treatment involves removing the decayed portion of the tooth and restoring the area with a composite filling. This filling material replaces the lost tooth structure, creating a stable surface for veneer bonding. The dentist carefully selects the filling material and placement to ensure the tooth contour is appropriate for subsequent veneer placement.
If decay is extensive and has infected the pulp, a root canal procedure is necessary to remove the infected tissue and save the tooth. Following a root canal, the tooth often requires a core build-up, where restorative material replaces the lost structure to provide a solid base. If gum disease is detected, it must be treated with procedures like periodontal scaling and root planing before proceeding with cosmetic work.
When Veneers Are No Longer the Appropriate Solution
If decay or structural damage is too severe, the tooth may no longer be a suitable candidate for a veneer, even after pre-treatment. Veneers are designed to cover the front surface and rely on the majority of the tooth structure being intact. If a significant portion of the tooth is compromised or has large existing fillings, a veneer will not provide the necessary structural reinforcement.
When the tooth is extensively damaged, a full-coverage crown is the recommended alternative. A crown is a prosthetic cap that encases the entire visible portion of the tooth, starting from the gum line. This full coverage provides greater strength and protection to a weakened tooth compared to a veneer.
In situations of irreparable damage, where the tooth cannot be saved even with a root canal and crown, extraction becomes the final option. Following extraction, the patient needs to consider restorative solutions, such as a fixed dental bridge or a dental implant, to replace the missing tooth. The choice between a veneer and a crown depends on the extent of the damage and the need for structural support versus cosmetic enhancement.