Ceramic veneers: everything worth knowing before deciding

Ceramic veneers are among the most requested elective treatments in aesthetic dentistry. Before proceeding, it is advisable to understand their indications, limitations and alternatives.

Ceramic veneers are thin layers of ceramic, in some cases composite, cemented to the vestibular surface of anterior teeth to modify their colour, shape, proportions or to correct minor positional defects. They are among the most frequently requested aesthetic dental treatments and, when correctly indicated and executed, produce results that are stable over time.

Before proceeding, it is useful for the patient to have a clear picture of what this treatment involves, its clinical limitations and the available alternatives.

When are ceramic veneers indicated?

Veneers are indicated in the presence of:

• Enamel discolourations refractory to whitening (fluorosis, tetracycline staining, post-traumatic discolouration).
• Teeth with shape or proportions that are not harmonious relative to the face and the arch.
• Diastemas (spaces between teeth) of limited extent, not requiring orthodontic treatment.
• Minor positional irregularities (rotations, slight malpositions) that do not significantly alter the occlusion.
• Enamel wear limited to the vestibular surface.

When veneers are not indicated

Veneers are not the right solution in the presence of:

• Untreated bruxism: parafunctional forces are incompatible with the longevity of veneers.
• Active caries or untreated periodontal disease: any aesthetic restoration must be preceded by resolution of the biological situation.
• Deep bite (marked overbite) that leaves insufficient space for vestibular lamination.
• Excessive enamel loss: when the residual enamel layer is insufficient, the bond of the veneer is compromised and the risk of sensitivity and failure increases significantly.
• Expectations of outcome not aligned with what is clinically achievable.

Enamel sacrifice

This is the most important variable the patient must understand before proceeding. Preparation for a veneer requires, in the majority of cases, the removal of a layer of vestibular enamel (generally 0.3 to 0.7 mm). This preparation is irreversible: the prepared tooth cannot return to its original condition.

The extent of enamel sacrifice depends on the starting situation, the type of result expected and the clinician’s technique. No-prep or minimal-prep veneers exist in selected cases, but cannot be applied indiscriminately.

It is essential, before definitive preparation, to create a mock-up (a dry trial of the expected aesthetic result) and a provisional prosthesis that allows the patient to verify shape, proportions and function before definitive cementation.

Longevity and maintenance

Feldspathic or lithium disilicate ceramic veneers, correctly made and cemented on adequate enamel, have a documented clinical longevity exceeding 15 to 20 years. Longevity depends significantly on: the quality of the substrate (residual enamel), the quality of the cement and cementation procedure, bruxism control, the patient’s oral hygiene, and the craftsmanship quality of the ceramic.

Veneer removal

A frequent question concerns the possibility of removing veneers where aesthetically unsatisfactory or for other clinical needs. Ceramic veneers are removed with an erbium laser and high-precision rotary instruments, under local anaesthetic, in a short appointment. The erbium laser has a specific clinical indication for this purpose.

After removal, the condition of the underlying tooth determines the available options: if the enamel is adequately preserved, it is possible to proceed with a new veneer; if the original enamel sacrifice was significant, a crown may be required. A preventive clinical assessment is necessary, but is often not fully reliable before actual removal.

The correct process

A correct pathway for ceramic veneer restorations involves: complete aesthetic and functional analysis (facial proportions, occlusal analysis, periodontal status), diagnostic mock-up, provisionals, aesthetic and functional verification of the provisional, definitive preparation and cementation. Skipping the provisional phase is a time saving that the patient pays for in terms of outcome.