Which should I choose: crowns, porcelain veneers or composite veneers?

Crowns and veneers are both equally good solutions to improve your smile. Both give excellent aesthetic results and allow the patient to eat things like crispy snacks and apples normally. Deciding which to have depends on several factors.

What is the difference between porcelain and composite veneers?

Porcelain veneers and crowns (which are usually also porcelain), are very similar: both are made in a laboratory and the dentist simply puts them in place, cementing them with the appropriate adhesive. Composite veneers, on the other hand, are totally different because they are made directly on the tooth by the dentist himself.

Crowns and veneers: what are the advantages and disadvantages?

CROWNS (OR COVERS)

Crowns completely cover the tooth. To fit a crown, the tooth has to be carved and filed to form a stump. The crown is made to measure in a laboratory and is fitted to the tooth stump with cement. They are usually made from porcelain, and with or without a metal frame.
 

Advantages:
 

• Crowns are a tried and tested solution that has been used for more than a century.
• Porcelain never changes colour and is very resistant to wear.
• They are very strong, and very rarely break.
• The dentist does not need to be a specialist in aesthetics, since the final appearance of the crown depends on the work of the laboratory, and the clinician simply cements it in place.
   

Disadvantages:
 

• The technique is more aggressive, as the tooth is permanently and irreversibly carved to enable the crown to be fitted.
• The aesthetic aspect is reliant on the quality of the laboratory’s work. If, the crown does not fit, or meet the expectations of the dentist or patient, reworking and revisions are required, which multiplies the number of sessions the patient needs.
• A porcelain crown cannot be repaired or renovated. Any deterioration or fracture, or modification is not possible and the only option is a new replacement crown.
   

PORCELAIN VENEERS

Unlike crowns which are designed to replicate the whole tooth, a veneer covers just the front face. It is an anaesthetic improvement in the look of the tooth. Like crowns however, the tooth needs to be prepared (carved and shaped) for the veneers – which are made in a laboratory - to be applied and fixed with cement.
 

Advantages:
 

• Less filing of the tooth is required for veneers than for crowns.
• Porcelain does not change colour and is very resistant to wear, although the veneers are more fragile than the crowns and fractures are possible.
• The dentist does not have to be an expert in aesthetics since the result depends on the quality of the veneers from the laboratory. However, the cementing of veneers is a thorough technique that requires a competent dentist.

Disadvantages:
 

Veneers are a less aggressive technique than crowns, but carving the tooth is still necessary, and is irreversible. Even the latest "veneers without carving" still require mutilation of the tooth to some extent.
 

• A veneer can peel. A peeling veneer can usually be re-cemented.
• Over time the edges of the veneer can change colour affecting the aesthetic.
• As the porcelain cannot be repaired or renovated, any repair or modification necessarily involves removing the veneer and ordering another.

COMPOSITE VENEERS

Composite veneers are made from powdered porcelain bonded with a synthetic resin. They adhere to the tooth without needing to make any alteration to the tooth. The dentist models and applies the material, which comes in the form of paste, in different layers until the desired shape, colour and form are obtained.

Advantages:

• The main advantage of composite veneers is that the tooth doesn’t have to be altered and does not lose any integrity. In most cases, anaesthesia is not required. The veneer is simply adhered to the tooth, which, under the composite, remains as it was before the procedure.
• Unlike porcelain, composite veneers can be retouched or repaired, directly in the mouth and without having to redo all the work. Any deterioration, defect or modification can be solved, usually, in a short time, and in a simple way.
• With proper maintenance and occasional retouching, composite restorations can last in good condition indefinitely – generally it has been seen that composite veneers last beyond 30 years.

Disadvantages:

•  The colour stability of the composites is less than that of porcelain and, over the years, may tend to darken.
• Also, like porcelain veneers, they can suffer a fracture but this can be solved without having to completely redo the restoration.
• As the veneers are not made by a laboratory, the dentist must have solid dental aesthetic training and artistry, as the result depends entirely on their skills.

WHAT IS THE BEST CHOICE?

Crowns: Because of their resistance, crowns are advised for people with aggressive oral habits: people who grind their teeth, people who chew pens, sportsmen etc. They are also the best option when teeth have been destroyed or severely broken.

Porcelain veneers: They are a good solution for those who want a low maintenance restoration option. The average duration of porcelain veneers is ten to fifteen years. After that time, margin degradation, possible fractures, changes in gum position and other factors often make it necessary to replace them.

Composite veneers: Composite veneers are the best solution for those:

• Who want to improve their smile without having to have their teeth altered.
• For patients who are undecided about modification.
• For young patients who are still growing and need a semi-permanent solution.
• For those who prefer a reversible treatment, that allows a change of mind in the future.