One of the most common questions I get when I have a patient who is seeking cosmetic dentistry is “how much of my tooth do you have to cut?” The answer to that question is really dependent on a multitude of factors. The goal of any dentistry should always to be as conservative as possible and preserve as much natural tooth structure as I can. However the main factor that I have to consider is…What does the patient want the esthetic goal to be? If a patient has long teeth and they desire to have shorter teeth then I have to do some tooth reduction. However, if a patient has smaller teeth and they desire bigger teeth then I may be able to just do an additive procedure. Another example would be someone who inherently has darker colored teeth (even after whitening) and desires a very white shade result. In order to mask the dark teeth the porcelain would need to be a certain thickness because if it were contact lens thin it would not allow a dramatic color shift and you would see the underlying dark tooth color. Thicker porcelain may dictate more reduction of tooth structure in some instances depending on choice of porcelain systems. It is also critical that the esthetic goal fulfill the functional goal. I may be able to do minimal to no-preparation of tooth structure to achieve the esthetic goal but will it function properly in the patient’s bite?
With so many variables it can be confusing to the patient so I always start with a series of photos. The patient and I look at these photos and discuss what it is they desire to change and then we go through a co-discovery process together, considering all the aspects of esthetics and function. It is important to know that doing minimal to no-preparation veneers requires a lot of skill on both the dentist and the lab technician. It is a much more difficult process from start to finish for the dentist and technician. Everything from the thin temporaries to the making of the contact lens thin porcelain veneer to the cementation of the veneers is a delicate and time consuming process. The ability to deliver this type of restoration to the patient and preserve their natural tooth structure is a benefit well worth the additional time and patience.
Here is another example of another minimal to no-preparation veneer case.