August 24, 2016

Most porcelain veneer emergencies are related to:

Fracture - Breaking, cracking, crazing, chipping, etc...
Debonding - The veneer has come off, generally intact.

So, if you've notice that something is different about your tooth the first thing to do is determine which of the two has occurred.

1) Check to see if your veneer is still intact.

Carefully remove whatever parts of your restoration are in your mouth without damaging them further.

If you only find one piece and it's fairly sizable, then your laminate may not have broken but instead debonded (come off whole without breaking). If it has, your dentist may possibly be able to reattach it.
If it's broken, your dentist's only option will be to make you a new one.

[See below for more information about both scenarios.]

a) What to look for.

To get an idea if it's whole or not, take a look at your veneer's overall shape.

Intact veneers usually have an outline form that's rounded and fairly symmetrical.
When you look down on it's convex (shiniest) surface, it should look exactly like a tooth.

You can also evaluate the tooth it came off. You may see broken segments still attached. (If you do, be careful. Shards of porcelain like these can be rough or sharp to your tongue and/or lips.)

b) Store it carefully.

If you do have the whole thing as one piece, and if you can get it to your dentist's office safely, having it may save you the cost of a new one. So, wrap it up in some bathroom tissue and then place it in a hard protective container, like a medicine bottle.

If it's broken, you can save the parts to show to your dentist, but most likely they'll only be a curiosity to them.

2) Let your dentist know you have a problem.

You will, of course, need to contact your dentist's office and report to them what has occurred. And they'll need to arrange an appointment for you so they can evaluate exactly what has happened.

3) What to expect in the mean time.

a) Your tooth will probably be just fine.

In most cases, when your veneer was originally placed only a minimal amount of your tooth's front surface was trimmed away. If that's the case, then it's unlikely that your tooth will experience any significant problems between now and when you get in to see your dentist.

If you need more reassuring -

With many veneer cases, no temporaries are placed. The patient's teeth are left uncovered (like your tooth that's lost its veneer is now) for the entire one to two weeks while their laminates are being made.

b) What you're likely to notice.

Since your tooth has lost some or all of its front covering ...

It may have increased sensitivity to hot or cold foods and beverages.
You may find that it's rough or irritating to your lips and tongue. (Especially in the case that a part of a broken veneer is still attached to your tooth.)

... So be careful.

c) Temporary solutions for these problems.

If you do experience trouble with thermal sensitivity, or especially surface roughness, placing a protective layer of wax over your tooth can help to provide relief.

Most drugstores sell white dental wax. (It's frequently needed by orthodontic patients to cover over sharp brackets and wires.)
Just squish a small, flattened piece of it over your tooth. Letting it work its way in between your teeth somewhat will help to hold it in place.

4) Your dental appointment.

When you do get in to see your dentist, if there are any sharp or irritating parts of your veneer still remaining on your tooth, they can trim them off or buff them down. Doing so should be painless and just take a few moments.

a) Can your porcelain veneer be reattached?

If your laminate has debonded (has come off your tooth but is still in one piece), your dentist may be able to reattach it.

The success of the repair will be influenced by:

The type of debonding that took place. Possible scenarios: a) The veneer + cement (together as a unit) separated from the tooth. b) The veneer debonded alone (the cement remained attached to the tooth).
How successfully the dentist can prepare the tooth, and especially the veneer's internal surface, for the re-bonding process.

Success may be limited.

From a practical and cost standpoint, reattachment is worth a try. But it's likely that perfectly ideal conditions won't be met and the bond created will be subpar. (The more predictable, although more expensive and time consuming, solution is to make plans to have the veneer remade.)

b) Can a broken porcelain veneer be repaired?

If just a very small portion of your veneer has come off, it may be possible for your dentist to create a patch. However, this is not a first choice but simply one that's used as a practical solution.

Generally, there are two main problems that tend to come into play with this type of plan.

Your laminate is made out of porcelain but the only material your dentist has to make a repair with is plastic (dental bonding/dental composite).
That means that even if the repair looks satisfactory initially (which it very well may), over the long haul (months and years) the less durable bonding will deteriorate (pick up stain, fleck off at the junction with the porcelain) and a distinction between it and the veneer will become obvious.
With repairs located in areas where substantial forces are involved (like the biting edges of teeth), the bond between the veneer's porcelain and the dental composite patch may (likely will) prove to be troublesome.

Managing minor chips.

If only a small bit of porcelain has flecked off, one solution is for your dentist to trim and buff your veneer until the chip's divot has been polished out.

This makes a very lasting solution. However, neighboring teeth may need to be recontoured in a similar fashion so the symmetry of your smile is maintained.

Cracks in veneers.

You may have encountered the situation where you've discovered a crack or craze lines in your veneer but otherwise it remains whole and in place on your tooth.

In this type of situation, it's impossible for your dentist to know how firmly the fractured parts are still bonded to your tooth. Additionally, over time the crack will tend to accumulate stain, ultimately spoiling the veneer's appearance.

There really isn't any type of repair that can be made in this type of situation. There's no way for your dentist to fill in the crack or bond the two pieces of porcelain back together. You'll simply need to make plans with your dentist to have your veneer remade.

5) What if your porcelain veneer can't be replaced?

Sometimes replacing a veneer either isn't possible or doesn't make a reasonable choice.

Proper case selection is a very important part of being able to create a successful veneering outcome. And it may be that now that problems have occurred (possibly more than once) that it's obvious that your situation really wasn't (or no longer is) a suitable application for this technique.

Misdiagnosing veneers.

That scenario isn't terribly uncommon. As we discuss here, a recent trend in dentistry has been one where dentists and manufacturers have pushed the use of veneers to remedy conditions that far exceed the original applications for this procedure. This includes: a) "Instant" orthodontics for severely misaligned teeth, b) Lightening very dark teeth.

If replacement isn't possible or prudent, then having a dental crown made is the next step for your tooth.

6) Learn from past events.

For future reference, it makes sense to take note of what activity broke, or immediately preceded the breaking of, your veneer. And then, obviously, do your best to minimize or eliminate it (stop biting your finger nails, clenching your teeth, etc...).

Discuss your circumstances with your dentist. They may be able to suggest some solutions.

Underlying causes of veneer fracture and debonding.

The type of veneer emergency that you've experienced can give your dentist a hint about what type of underlying problem lies at hand.

a) Debonding.

A porcelain veneer is a sandwiched affair, consisting of tooth, cement and ceramic. When one debonds (comes off its tooth, primarily in one piece), the separation may have taken place either at the ceramic/cement junction or else the tooth/cement one.

What usually happens.

Assuming that the original placement conditions were ideal, the most common failure point lies at the tooth and cement interface.
The most likely cause for this is that the tooth surface to which the veneer has been bonded involves a high percentage of dentin (the tooth layer underneath dental enamel).

Explanation.

Dental materials will create a bond with dentin. But the strength of this bond is far weaker than the one possible with dental enamel (use the link above for more details).

If a high percentage of the tooth's surface is exposed dentin, the strength of the tooth-to-cement interface will be comparatively weak.

Solutions.

As explained above, a dentist can attempt to re-bond the veneer. Unfortunately, the same underlying condition will still persist (not enough tooth enamel is present to create a secure bond) and therefore further episodes of debonding may be likely.

Especially in the case of repeated failure, making a dental crown for the tooth instead may be the only lasting solution.

b) Fracture.

Considering the thin, fragile nature of porcelain veneers, it may be surprising to most people that breakage or fracturing happens as seldom as it does.

These restorations work because when they're bonded onto enamel, it's the more rigid of the two and therefore tends to absorb most of the forces directed to the tooth.

Cracking.

When a veneer cracks, it suggests that the opposite is the case. The forces applied have been directed to it instead of tooth structure.

As an example, when a veneer is bonded to primarily tooth dentin (the problem discussed above) the laminate is the stiffer of the two. This tends to focus forces applied to the tooth to the veneer, thus leading to fracture.

Chipping.

In some cases, just a small chip may have broken off a porcelain veneer (like off of its biting edge).

This would simply be testament to the fact that the tooth/veneer complex has been able to successfully withstand the pressures applied to it. However, the forces applied exceeded the internal strength of the ceramic itself.

The activity that caused the chipping might be a one-time event, like unexpectedly biting into something hard. But often it's a parafunctional habit that is the problem and must be curtailed (clenching teeth, biting fingernails).

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