A cosmetic dentist explains what to expect when getting veneers

Media item: press segment on veneers, published June 2023

This page records the media item. Third-party content is the property of its publisher and is not reproduced here.

A note on the title before anything else: ‘cosmetic dentist’ is not a recognised dental specialty in Australia. The Dental Board recognises thirteen specialties, and cosmetic dentistry is not among them. The term describes an area of interest, and any dentist with general registration may provide this treatment. Check any practitioner on the register at ahpra.gov.au.

What follows is general information on veneers, written to include the parts that are usually left out.

What a veneer is

A thin facing bonded to the front surface of a tooth to change its colour, shape, size or alignment. Two broad types:

Composite veneers. Tooth-coloured resin placed and shaped directly in the mouth, usually in one appointment. Often additive with minimal or no tooth removal, repairable, and less expensive. They stain and chip more readily and generally have a shorter service life.

Porcelain veneers. Made in a laboratory or milled from ceramic, then bonded. Better colour stability and surface, greater longevity — and they normally require preparation of the tooth, which is the fact this page exists to emphasise.

The irreversible part

Preparing a tooth for a porcelain veneer removes enamel, and enamel does not grow back. Typically a fraction of a millimetre from the front surface, sometimes more where teeth are rotated, crowded or being lengthened.

Once prepared, the tooth is committed. It will need a veneer, or a crown, for the rest of your life. Every replacement removes a little more, and each cycle takes the restoration closer to the nerve.

‘No-prep’ and ‘minimal-prep’ veneers exist and are genuinely conservative in the right case — typically where teeth are small, worn or set back. They are not suitable for teeth that already sit forward or are crowded, because adding material to a prominent tooth makes it more prominent. A no-prep veneer marketed as universally appropriate is marketing, not dentistry.

What the process actually involves

1. Assessment. Examination, radiographs, photographs, and a discussion of what is actually bothering you. Existing decay and gum disease must be treated first — veneers bonded to compromised tissue fail.

2. Planning and mock-up. A wax-up on models, or a digital design, transferred into the mouth as a temporary trial. Ask for this. Insist on it. Seeing the proposed shape and length in your own face, speaking and smiling with it for a few days, is the single best protection against a result you dislike — and it is the stage most often skipped.

3. Preparation, under local anaesthetic, with the amount removed guided by the mock-up rather than by eye.

4. Impression or scan, shade selection with the laboratory, and temporary veneers — which are also a design test, not just a cover. The same-day alternative is set out separately.

5. Try-in and bonding. Fitted with trial paste first, checked for shade, shape and how they look with your lip at rest and smiling. This is the last point at which changes are easy. Look properly, in daylight, and say if something is wrong.

6. Review and adjustment of the bite, and a discussion of maintenance.

The material risks

A practitioner is required to disclose the risks a reasonable person in your position would want to know. For veneers those include:

• Irreversible loss of enamel.
• Sensitivity, usually temporary but occasionally persistent.
• Pulp damage. A small proportion of prepared teeth eventually require root canal treatment.
• Chipping and fracture, particularly on edges and in people who grind.
• Debonding, requiring re-bonding or remaking.
• Margin staining at the join over time.
• Gum response. Margins placed under the gum, or over-contoured, cause inflammation and recession — and a receding gum eventually exposes the margin.
• Colour mismatch over time, because porcelain does not change while your natural teeth do. Whitening is done before veneers, not after, since veneers will not whiten.
• Replacement. Veneers are not permanent. Plan on them being a lifelong maintenance commitment, with replacement at intervals that vary widely between individuals.

Longevity figures quoted in marketing should be treated with caution. Outcomes depend on the case, the bite, grinding, oral hygiene and the technician as much as on the material.

The alternatives that get skipped

Honestly, and in the order they should be considered:

• Cleaning and stain removal, which resolves a proportion of complaints on its own.
• Whitening, which removes no tooth structure.
• Orthodontics. If the problem is alignment, moving the teeth is almost always more conservative than cutting them down. It takes longer and it is frequently not offered.
• Composite bonding, additive and repairable, and a reasonable way to trial a shape before committing.
• Enameloplasty — minor reshaping of an edge, which can make a surprising difference.
• Replacing old, discoloured composite fillings, which is sometimes the whole answer.
• Doing nothing. Always an option, and sometimes the right one.

Common questions

How long does a porcelain veneer last?

A systematic review in the MDPI Journal of Clinical Medicine, pooling 25 studies and 6,500 porcelain laminate veneers with a minimum three-year follow-up, put the 10-year estimated cumulative survival rate at 95.5% — counting fracture, debonding, secondary decay and the need for root canal treatment as failure. Read the exclusion, because the authors state it plainly: slight marginal defects and slight marginal discolorations were not counted as failures, “since they have more to do with the appearance of the PLV, and can be easily repolished or repaired”. Surviving is not the same as still looking right.

A second systematic review is blunter about the spread: studies with 10 to 12 years of follow-up report survival ranging from 53% to 94.4%. That range, rather than one headline number, is the honest answer. The same 25-study review also found fracture the most common complication, then debonding, “both more commonly happening within the first years after PLV cementation” — so the early period is the informative one.

Does it matter whether the veneer is bonded to enamel or to dentine?

It matters more than most of what gets discussed in the appointment. The review literature puts it directly: “the survival rate of LVs is negatively affected by veneer preparations extending into dentin”, because enamel gives the adhesive its best bond.

The uncomfortable part is how hard that is to judge by eye. In a laboratory study of 20 extracted upper central incisors, prepared to 0.6 mm with a 0.3 mm cervical chamfer, three operators of different experience examined the same teeth under magnification and reported very different amounts of exposed dentine on window preparations — 58.05% by the general practitioner against 10.55% by the prosthodontist. The authors concluded that “proper training may be paramount in discriminating between prepared enamel and exposed dentin”, and that magnification helps. Twenty teeth, in vitro, one operator per level of experience: treat those percentages as an illustration, not a rate. The point survives the caveats — ‘we stayed in enamel’ is a judgement, not a measurement.

Should the veneer wrap over the biting edge?

The evidence genuinely contradicts itself here, and you should know that before anyone presents one answer as settled. The 25-study systematic review reports that veneers with incisal coverage had lower failure rates than those without. Another review states the opposite — “the incisal-covered preparation designs for LVs show an increased risk of failure compared to those without incisal coverage.” Both are in the published literature. Less contested: among incisal-covered designs, a butt-joint preparation affects tooth strength less than a palatal chamfer, and the palatal chamfer is more prone to ceramic fracture. So the useful question is not whether it wraps over, but which design, and why that one for this tooth.

What does ‘no-prep’ actually mean in millimetres?

A specific and small number. The review literature describes minimal-preparation and no-preparation laminate veneers as a ceramic thickness of 0.3–0.5 mm, for situations such as “closure of diastemas, limited reshaping of front teeth, treatment of microcracks, enamel defects, and minor discolorations.” That is the honest scope: small gaps, small reshaping, small defects. A 0.3 mm facing cannot mask a dark tooth, and a tooth that already sits forward is outside the indication however the product is named.

I have been quoted a far lower price overseas. What does the ADA actually say?

Its position is unambiguous: “Australian residents should only seek elective dental treatment in Australia to ensure Australian standards are met, complications are managed promptly, and good oral health is maintained.” The stated reasons are practical — inability to maintain supportive maintenance visits, communication difficulties that “may impact on informed consent”, possible lack of insurance cover for complications, lack of recourse, and lack of access to treatment records.

One thing cuts the other way, and it is fair to say so: that document is a policy position, not evidence. It carries no complication rates, and no Australian dataset quantifying how often overseas veneer work goes wrong. Anyone quoting you a percentage on this is quoting something the profession has not published. The case rests on what happens afterwards — that this is not, in the ADA's words, a “single episode or short course of treatment” — rather than on a failure rate.

Related reading

• What is the difference between composite veneers and porcelain veneers?
• What is the difference between porcelain crowns and veneers?
• Turkey Teeth: the real risks of getting veneers overseas
• I want a smile makeover. Where should I start?
• Edge Work composite bonding and the before and after gallery
• 3 myths surrounding veneers, debunked and more coverage in Our Media
• What a full smile makeover actually involves

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Every practitioner's registration and any specialist entry can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a media item; third-party content is not reproduced. The material above is general information, not clinical advice — suitability, risks and outcomes vary between individuals and can only be assessed by examination. Veneer preparation is irreversible. No particular result is promised or implied.

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