1. EXPERIENCE

I graduated from Tufts in Boston - one of the top dental schools in the country. When I left Tufts to begin my specialty training in the Army, I had completed exactly zero veneers during my 4-year education. Most dentists in fact have either no experience or very limited experience with veneers coming out of dental school. This treatment option, albeit minimally invasive, is very technique sensitive and takes years to master: if too much enamel is removed, the veneer won’t bond to the tooth. If not enough enamel is removed, the veneer will look thick, bulky, and may cause inflammation and irritation of the gingiva (gums). The tolerances that separate success from failure are razor thin and ideally should be left to the subject matter experts.

2. LABORATORY

Collaboration with a highly-skilled ceramist to produce veneers is equally as important as the experience of the clinician. All of the preparation and time spent with the patient in the chair is meaningless if the dental laboratory technician isn’t also highly experienced in the art of fabricating laminate veneers. The highest-end results are almost universally achieved when the dentist and ceramist have a long-standing professional relationship and history of working together. Additionally, if the dentist has never seen the laboratory or met the ceramist face-to-face, this should be a red flag.

3. PORTFOLIO

The goal with porcelain veneers is to mimic natural human dentition - in both function and aesthetics. The process involved with fabricating veneers mandates exceptional photographic skill with a digital camera in order to communicate with the ceramist. A large part of this communication includes sharing the final results with the ceramist - both as a cooperative courtesy and as a means for self-improvement. Any dentist who has significant experience treating patients with veneers, therefore, should possess a large portfolio of before and after cases to share. When evaluating images, look to see if the gingiva (gums) around the veneer is red and inflamed, does the veneer just look better than what the patient had to start or does it disappear in the mouth, and lastly, make certain that the photographs are authentic and not stock images.

4. MATERIALS

There are very few topics in the field of dentistry that are universally agreed upon. One issue that does have a general consensus amongst professionals is the inherent aesthetics of veneering ceramics. Many patients find it surprising that not all veneers are manufactured from the same material or process. The following list places the options for veneers in order of most pleasing to look at to those that are the least desirable (spoiler alert, we utilize feldspathic porcelain for nearly every case). We promise to NEVER use zirconia for our veneers at Nuance.

1. Feldspathic Porcelain (made using either a refractory die or platinum foil technique).

2. Leucite Reinforced Ceramic (a beautiful ceramic, but still lacking compared to feldspathic porcelain).

3. Lithium Disilicate (often called e.max, this ceramic is has a reaction layer, turns gray, and generally lacks beauty if it is not layered).

4. Zirconia (this ceramic can not bond to tooth, may damage opposing teeth, and is quite unattractive).

5. EDUCATION

With so many fantastic cosmetic dentists available, it’s difficult to know which one to select for your veneers. Many patients look for the clinicians that attend expensive, hands-on courses, and log 100’s of hours of continuing education. Our patients choose us because they prefer to be treated by the Prosthodontist that teaches the cosmetic dentists how to do veneers at the continuing education courses. The techniques that Nuance utilizes is in such high demand that we are invited to teach our protocols to clinicians around the world every year. Click the link below to see our international lecture schedule (patients are always welcome to attend).