Recently I lectured for a day and a half to a study club outside Boston. As often happens, one dentist kept at me with questions. On the second day, I had spent a lot of time teaching how to successfully do veneers, inlays, and onlays. His hand went up again. He asked, “Why don’t you just keep going and spin that tooth down and do a full crown? The patient is probably going to need a crown eventually anyway.” I tried to answer his question but he was not having any of it. I saw that the audience wanted to move on, so I asked him if we could agree to disagree. I think I caught him by surprise, but he said “yes” and I was able to move on with neither one of us losing face.
Ask yourself these questions:
• If full crowns are so great and last so long, how come insurance companies approve a new crown after five years?
• Has dentistry come to such a place that full crowns only last five years? Perhaps we are doing something wrong.
• Is it the preparation?
• Is it the cement?
• Are there overhangs remaining on the crown because the lab cannot read the impression? I wonder.
So, why do I believe so strongly in veneers? My journey started back in the late 1970s when a few bold dentists were talking about some revolutionary ways to restore anterior teeth. These dentists were actually trying to make us believe that we could paste pieces of fired porcelain onto these teeth and they would stay there. Well, I was fascinated because I fractured the mesial corners of two upper centrals when I was 12 years old. My dentist, who also was our neighbor and instrumental in my going to dental school, told me that if I ever went to Hollywood, he would restore those centrals. All through dental school, my classmates wanted to crown those teeth. I just kept refusing.
I realized that veneers would provide a perfect solution to this problem. No PFM with a subsequent black line for me! So, in 1981 I had veneers placed on Nos. 8 and 9 and they looked great. My wife had centrals that lapped over each other. I had tried to do ortho on her when the children were young, but she was never that concerned about those teeth and she decided not to be treated. When veneers came along, here was a simple way to correct this situation. I prepped her centrals and laterals for veneers and they have looked great ever since. You would not believe how many people ask her about her teeth.
In the early days of veneers, two men stood out - Drs. Bob Ibsen and Bob Nixon. I listened to both of them. Dr. Ibsen’s course was free, and participants bought all the needed materials at the back of the room. Most of the dental companies did not have adhesives and cements. In those days, we were prepping only in enamel because we didn’t have any dentin adhesives. Veneers never came off! Dr. Nixon taught me a system of preparation and a system of cementation. Part of his course included a manual, which had all the steps to follow for successful veneers. He became my mentor, although he probably didn’t know it until much later.
In those early years, I had become very conscious of preserving as much tooth structure as I could. In the early 1980s, I quit doing amalgams because of the amount of tooth structure that had to be removed for the undercuts to hold the material in place. Minimally invasive dentistry seemed to be the way to go. I was doing a lot of veneers, inlays, and onlays using gold, porcelain, and lab-processed composite. It was exciting dentistry. Some of the restorative materials worked and others didn’t, but I learned things along the way and became the best I could possibly be.
We began to get our patients’ mouths back to good oral health. Our contract with our patients was to help them keep their teeth for the rest of their lives. Many of our patients could see and feel the connection between large amalgams with overhangs, teeth with broken down amalgams, and their oral health. They knew the reason for the irritated tissue around those teeth. The patients responded by having their teeth restored and then finding that their gingival tissues were healing.
