Crowns and veneers are primary options in restoring teeth, improving appearance and, in the case of crowns, protecting their structure and function. Dentists recommend crowns and veneers for several reasons, and will consider the tooth’s integrity, stability and appearance before making a decision. Which one is right for your teeth? A dentist can help you decide.
The difference between crowns and veneers
A veneer only covers the front side of the tooth and is thinner than a crown. While a crown is two millimeters thick, and may be even thicker, a veneer is rarely thicker than a single millimeter. In patients that receive veneers, the tongue side of the tooth is left untouched, while with a crown, most of the time the entire tooth is covered.
To accommodate crowns and veneers, some of the existing tooth must be trimmed away. The remaining tooth is shaped to make for an easy fit, and the crown is placed over it for complete restoration. While some trimming is usually necessary for a veneer as well, much more of the tooth is preserved.
When should I choose veneers?
Veneers are usually considered a cosmetic-focused restorative option. They should only be placed on teeth whose underlying structure is healthy, and on teeth where the enamel is mostly intact. Even damage that appears minor will often indicate crowns being the ideal option instead, especially if the dentin or deeper tissues are exposed. The tissues surrounding the tooth will also need to be in good health to allow for a veneer.
Veneers are ideal when minor changes to the tooth’s color or shape are desired. Issues like minor misalignment, gaps between the teeth and stains are best handled with veneers. A veneer will immediately improve the tooth’s appearance, so veneers are considered ideal for teeth that are easy to see upon smiling. This usually includes the incisors, cuspids and premolars.
Some people think of veneers as nonpermanent and crowns as permanent, but this is a misconception. Veneers are just as permanent as crowns.
This is what the veneer placing process looks like:
1. Trimming – The existing tooth is trimmed back, and the dentist will only trim to the same depth as the veneer’s thickness, so the tooth’s overall thickness won’t be changed following veneer placement. Trimming is essential for creating an even surface that is easy for the veneer to bond to.
2. Color matching – The dentist will pick a color for the veneer that closely resembles the color of adjacent teeth. If there are one or two teeth involved, multiple teeth are treated and the shade can be changed to blend in with surrounding teeth. Often times bleaching the other teeth is advised prior to choosing a color. The color picking process is done using a shade guide for reference, and in some cases, the dentist may need to pick several colors for a single veneer. The veneer’s translucency must also be considered, as this will affect its final appearance.
3. Impressions – The dentist will need an impression of the patient’s teeth to properly fabricate the veneers. This is typically done by loading a dental tray with a moldable putty, and placing the tray over the patient’s teeth. It only takes a few minutes for the putty to form around the teeth, and it will be used as a model to fabricate the veneers to the proper shape.
4. Fit and shape evaluation – Once the veneers come back from the lab, they are ready to be bonded. Before they are, though, the dentist will temporarily place the veneer and verify that it fits and is shaped properly. Although dental labs can fabricate veneers precisely, once they are on the teeth, minor changes may be required.
5. Bonding – When everything is ready for placement, the tooth’s enamel is etched using a slightly acidic gel. This is allowed to sit for about 20 seconds, after which it is washed off. Etching the tooth produces a rough surface that makes for easier bonding.
The bonding agent and cement are both applied, and the veneer is placed over them. The dentist will remove any excess cement present.
The dentist will schedule an appointment for a quick follow up, usually within a week. During the follow up, the dentist will check the patient’s gums for any inflammation and verify that the veneers are secure.
Caring for veneers is simple and is much like caring for natural teeth. Brushing and flossing are essential, and regular cleanings at the dentist will keep them in good shape. Patients that grind their teeth will probably need a mouth guard to protect the veneers from damage. Veneers are strong, but grinding forces can result in damage. For this reason, it’s also best for patients with veneers to avoid chewing on hard objects like ice.
When should I choose crowns?
Crowns are normally recommended when the patient’s teeth have sustained significant damage. While they also correct each tooth’s appearance, crowns are usually relied on to restore integrity and function. For this reason, crowns are the preferred approach when a tooth is cracked, broken or badly decayed, but damage to teeth can be much more subtle and still require a crown. If the enamel is etched through, for example, and the underlying dentin exposed, it will be difficult for a patient to see, and they may not have any symptoms. Dentin exposure, however, should always be corrected with a crown. This is one example of why annual dental examinations are a must.
Crowns are also more appropriate for patients that grind their teeth or clench their jaw. While veneers are susceptible to biting and grinding forces, crowns are designed to handle the day to day rigors of eating and chewing. For this reason, it is rare for a dentist to recommend veneers for molars.
Like veneers, once a tooth is fitted with a crown, it will always require one. Also like veneers, crowns last for years before they need to be replaced, so they are an effective, long-term solution.
It usually takes a couple of weeks, and a couple visits, to fabricate and place crowns. This is what the process looks like:
1. Trimming – Crowns cover the entire surface of the tooth and replace the remaining enamel. Because the crown produces a secure, tight fit, it will keep plaque from accessing the natural tooth, so the tooth can undergo considerable trimming.
The area is numbed to minimize discomfort. Following this, the dentist will carefully trim the existing tooth enamel down and shape the remaining tooth so that the crown will fit over it properly.
2. Impressions – Once the tooth is prepared, the dentist will take impressions of the patient’s mouth. Impressions are a model that the dentist or laboratory will use to shape the crown precisely, so that it offers a perfect fit.
Dental trays loaded with putty are placed over the patient’s top and bottom teeth, and the putty forms around them. The dentist may also use a small cord, called a gingival retraction cord, to gently push the gum away from the base of the prepared tooth so the impression reaches further down. A total picture of the tooth and root is essential to fabricating the crown.
3. Temporary crown fabrication – Although it will take a week or two to fabricate the final crown, the prepared tooth must be covered, so a temporary crown is placed over the tooth in the meantime. It will keep adjacent teeth from shifting, gums from overgrowing the prepped tooth, and keep the prepped tooth from hurting if it is still a live tooth.
The temporary crown is typically made from an acrylic resin and is placed using a dental tray. The resin forms around the prepared tooth and, once the tray is removed, the dentist will shape it so that it doesn’t have any rough or sharp edges. The temporary crown is cemented in place and the patient’s bite is checked to ensure it fits.
4. Placing the final crown – Once the final crown is fabricated, the patient is brought back and the temporary crown is removed. The prepared tooth is given a thorough cleaning and the final crown is positioned on it.
The dentist will make sure the crown fits just right. If there’s too much space between the crown and adjacent teeth, food will get trapped. If there’s too little space, it will be more difficult to keep the area clean. Adjustments are done accordingly to make sure there is a perfect fit.
When the dentist is satisfied with the fit, the crown is filled with cement and is secured on top of the tooth. Any excess cement is removed.
After a brief time to let the cement set, the patient’s bite is checked and the dentist makes a final inspection. If everything looks right, the dentist will give the patient their postoperative instructions and schedule any follow-ups.
Crowns are easy to take care of, and should be handled like a natural tooth in terms of oral hygiene. It is important to avoid certain foods, like nuts and hard candy, as these may damage the crown.
Crowns and veneers are popular, effective methods of tooth restoration. They can enhance aesthetics, protect teeth from further damage and maintain normal functioning of the mouth. While there is some overlap in what crowns and veneers can do, they each play a different role in restorative dentistry. Your dentist will help decide between crowns and veneers, and ensure the restoration fits and functions just like a natural tooth.