Porcelain Veneers or Braces
I am often asked by patients, “Should I get braces or porcelain veneers?” In their minds they are debating what they have heard or read about and they are not sure of the credibility of the information. As we all know there is a lot of good information and a lot of misinformation and it is hard to know which is which. The real answer is it depends on what you start with and what you want the end result to look like. In general the younger you are and more ideal the shape and color of your teeth the better result you will get with braces. Almost all 8-12 years olds can benefit from braces from a health point of view. What I mean by this is their bite and alignment will be improved resulting in teeth where the forces of chewing and clenching are more evenly distributed and they are much more easily cleaned resulting in less gum disease. Since clinching and grinding forces and gum disease are the most common causes of tooth lose this is a great benefit to all young people. I encourage all my patients to have their children seen by an orthodontist as I believe this is an invaluable gift they can give towards their children’s futures.
Traditional braces will align the roots and arrange the teeth. If the patients has an attractive color, size and symmetry of teeth, this can result in a nice smile which will make the average person very content. This treatment works best for youths or young adults who have attractive teeth but are misaligned. Unfortunately, young adults in the work force usually do not like to wear traditional visible braces. Most of the times they will choose invisible braces like Invisalign. Invisalign is undetectable but limited in the amount of movement it will create. It cannot move teeth like traditional braces but can be very effective when limited movement is needed. Thus for some young adults it can result in a wonderful result and in more complex cases it can only make improvements. It does a good job of straightening lower front teeth and usually a good job on the upper front teeth. Major movement is best left to traditional braces.
For patients wanting more than a two shade change to lighten their teeth that can be achieved with bleaching or desire a broader larger smile, veneers are the choice for this young adult group. If the patient has undamaged teeth, no preparation or minimum preparation veneers are an excellent choice. This means there is no altering the shape of the original teeth so the treatment is theoretically reversible although I have never seen anyone exercise this option. If the patient has existing fillings on their front teeth then the veneer should be extended to cover the fillings. For example fillings between the teeth is common, thus the veneer would extend between the teeth requiring more preparation.
For patients over forty or so it becomes progressively more difficult to get the result the patient wants with braces alone. Braces can offer improvements but cannot repair the damage and disfigurement to the teeth from clenching, grinding and cavities. As time goes on we find more vertical surface and deeper fractures and the more serious horizontal fracture lines in the teeth. The teeth get darker and shorter from wear with time making the esthetic results from braces alone often disappointing. This group also is unlikely to wear traditional braces; usually I use invisible retainers like invisalign or Essex to straighten lower teeth or in some cases to straighten teeth before veneers. Often we can straighten the lower teeth with Invisalign or Essex retainers, bleach the lower teeth and veneers the upper teeth which often dominate the smile and get a great esthetic result. Each case of course is different and must be diagnosed. If the patient shows a lot of their lower teeth on smiling this may not be possible. Often for adult patients who want very esthetic smiles by today’s standards invisible retainers are used to set up very conservative preparation treatment for veneers and limit the number of teeth that we need to veneer.
Twenty years ago braces where the standard in esthetic dentistry. We could not bond porcelain and composite to teeth with long term success like we can today. Today braces in many cases cannot produce the esthetic result of veneers nor restore the damage to teeth. Braces are excellent for young patients to help make their teeth healthy and easier to care for as well as minimize the number of veneers needed and the amount of preparation needed. Each case is different and sometimes braces can give an excellent result, but I am speaking in generalities.
The good news is patients have more choices now and can select the amount of esthetic enhancements they desire. The combination of bonded veneers and braces of different types helps fit the needs of most patients. Invisible retainers often only need to be on 3 to 12 months to straighten teeth depending on the complexity of straightening, whereas traditional braces often take 24-36 months. Treatment is different for each patient and a thorough evaluation and diagnosis is one of the most important services that I provide my patients.
