Broken Veneers Q&A
All patients become surprised and shocked when their porcelain veneer either breaks, cracks or chips. It is possible that a veneer can come off in one piece or it may break or chip with the remaining piece or fragment still attached to the tooth. It’s never good when a porcelain dental veneer especially on a front tooth, comes off or breaks or cracks or chips but the best-case scenario is if it does come off, it does so in one piece with the entire veneer intact.
In this article, we will look at what you should do if the veneer comes off in one piece or in the worst case when the veneer partly breaks, cracks or chips.
Introduction
A porcelain veneer is a thin layer of hard porcelain that is glued or bonded onto the front surface of your natural tooth. Most of the reasons why you must have had a porcelain veneer placed in the first instance are mainly cosmetic. The tooth underneath the may have been decayed, had an unsightly filling, or had been damaged and a porcelain veneer was decided is the best option for you.
Although the literature says that veneers last a similar length of time to full dental crowns, in reality, veneers are not as strong as dental crowns and therefore, in my opinion, they do not tend to last as long. Nevertheless, I have patients who I placed veneers on more than 25 years ago and the veneers are still going strong.
However, on average, a veneer should last you between 10 to 15 years. After this time, it may need replacing or a different option such as a full Crown may be considered. A veneer may need replacing sooner if circumstances in your mouth change. A typical Circumstance is when you have a veneer on a tooth and you have decided to have your teeth whitened or have further veneers placed on the remaining teeth. The original veneer will, therefore, have a different colour if you want to have whiter teeth so it will need replacing to match your remaining teeth with a lighter colour.
Another scenario is where your original veneer keeps breaking or has chipped due to changes in your bite.
Porcelain tooth veneer has come off altogether.
As stated above a porcelain tooth veneer can come off in one piece or it can partly chip, break or crack.
If the porcelain veneer has come off in one piece, it is extremely important that you try to keep it safe and secure. There is a very good reason for this. Porcelain veneers by themselves are quite fragile. However, porcelain veneers get their strength from the fact that they are glued or bonded onto your tooth. It’s very similar to a sheet of glass.
A sheet of glass is inherently weak and fragile but if that sheet of glass is placed on a perfectly flat hard surface, you can actually walk on it as it gains its strength by being glued onto the hard surface. A tooth veneer works on the same principle.
So if a porcelain tooth veneer has come off altogether, you must try to preserve it with your life. It’s usually not a good idea to put it in a piece of tissue because I’ve had so many times where a patient has come in with a lost veneer and they have lost the piece of tissue as well. In these circumstances, there is not much else you can do unless the patient can start rummaging through all their bins.
The best way to keep the veneer is in a little box. This could be a small matchbox, a very small box to keep a piece of jewellery in or even a very small pencil case. Make sure the box is secure and attach sellotape if you have to. Then you have to make sure that you keep the box in a safe place where it won’t be dropped until you go and see your dentist to have the veneer fitted back on again.
The worst thing you can do when a veneer comes off is to try to glue it back by yourself. You might be tempted to do this for example if you need it to go out on a social occasion and you cannot get to see your dentist. The most common substance that patients use to glue it back yourself is superglue. Always remember that if you are going to try this trick, then you may end up putting the veneer on in the wrong place resulting in the veneer being malpositioned to where it originally was.
Even if you do place the veneer correctly, you will not be able to remove the excess glue and this will damage your gums and excess glue will even attach onto your adjacent teeth accidentally. This excess Super Glue will need to be drilled off by a dentist. It also means you have now lost the veneer and you will definitely need to have a new veneer made.
Another hazard of trying to put the veneer on yourself with superglue is that you will almost certainly leave gaps under the veneer and this is where bacteria, plaque and decay will eventually rot your tooth underneath away.
Some patients don’t use superglue but try a temporary sort of glue such as denture adhesive or a temporary glue found in dental emergency kits that you can buy over the counter.
Once again, I would not recommend this because the veneer can easily come off again without warning and when it does come off again, there is a significant risk that you will either lose the veneer or it will break rendering it useless.
When a veneer comes off in one piece, this is your best chance of having it put back again but you have to keep it in a safe place and give it back to the dentist.
A dentist will try to find out why the veneer came off and will try to bond it back onto your tooth again. Unfortunately, when a veneer has come off, it is more likely to come off again and it just won’t have the same bond strength as when it was first put in. If that’s the case then you would be needed to send the veneer to The Laboratory to have it cleaned. This means you may be without your veneer for a couple of days. If a veneer made out of porcelain keeps coming off regularly, you need to find out why it is doing this so that an appropriate alternative solution can be found.
A porcelain veneer primarily gets its strength from the Close fit it has with the underlying surface of the tooth but also how the adhesive resin bonds on to the tooth surface and the fitting surface of the veneer. The tooth surface and also the fit surface of the porcelain veneer are pretreated with etching agents which aid in the micromechanical retention of the veneer. Bonding agents are also used as an intermediary chemical to enhance retention between the resin adhesive and the surface of the tooth plus the surface of the veneer.
Broken, chipped or cracked veneer
Unfortunately, when this happens, it will be upsetting and it results in further problems.
The biggest problem is that the veneer will now look unsightly and will be sharp or rough to your tongue and the inside surface of your lip. You will need to go and see your dentist in order to have this polished so that at least temporarily it is not catching anymore.
When a veneer has broken, chipped or cracked, in 99 per cent of cases, it will be necessary to make a new veneer or come up with an alternative solution for your tooth.
This is because veneers cannot be readily repaired.
There are cases but they are very few when a broken, chipped or cracked veneer can be paired with a composite resin bonding material or luting agent.
Even though the results of this may look ok initially, discolouration of the junction between the composite resin filling material or luting agent will become apparent and you will want to see a better solution long-term.
If a veneer does come broken or partly chipped, it is important to keep hold of the dislodged fragment. The way you can keep hold of the dislodged fragment is the same as when a veneer comes off in its entirety and this has been discussed above.
There are many reasons why a dental veneer does become broken, chipped or cracked.
The most common reason why a porcelain veneer breaks, chips or cracks is that you accidentally have bitten into something that you shouldn’t have. Common scenarios are biting into granary bread seeds, biscuits, a stone in a fruit or a boiled sweet.
Veneers can chip, break or crack if you have accidentally hit your knife or spoon directly on the veneer whilst eating.
A porcelain veneer will certainly break if you have been hit in the face directly or indirectly.
Veneers will become chipped, break or crack if Decay has established itself under the veneer and it has gone unnoticed. Before this happens however you will have noticed that the tooth underneath the veneer is becoming discoloured and certainly your dentist will also notice it.
Porcelain dental veneers can chip, break or crack if the underlying tooth was never strong enough or adequate enough in the first place to accept a veneer
A dental veneer will chip, break or crack if the initial fit was less than perfect. As already mentioned above, a veneer must be perfect on to the tooth and it must have contact with the tooth surface.
It can sometimes happen that a porcelain veneer when it has come back from the Laboratory, has a small microfracture which cannot be readily seen by the eye. Then once the veneer is on, this microfracture propagates and becomes a larger fracture resulting in a chip, break or crack.
Another fairly common scenario is during cementing the veneer on in the first instance. This can cause the veneer to become cracked because the pressure used by the dentist in fitting was too much.
The technique for fitting a veneer is extremely critical and technically demanding. For instance, if there is any hint of moisture contamination from blood or saliva, the veneer will not bond on and will certainly not be successful.
In the past, a 2 paste bonding system of adhesives used to be used where two parts of the adhesive would come in as a base and catalyst. These were mixed and that’s how the adhesive became hard. Mistakes could be made in the mixing in that there could be unmixed base or catalyst and therefore the full 2-part of the adhesive has not fully set.
Nowadays, all-porcelain luting agents are one component and they are light-cured. The luting agent is hardened with a UV light but this can cause issues if the light is not strong enough or the light hasn’t fully penetrated the depth of the adhesive resin causing unset resin to remain. If the adhesive has not fully set, this can cause the veneer to come off, chip, break or crack.
Many causes of veneer chipping or cracking are due to something called occlusion. Occlusion in dentistry is the science of how your bite comes together but also how your bite functions when you are chewing and eating. If the occlusion is not balanced, or the exclusion is unnecessarily heavy on a veneer, the veneer would not be able to withstand these huge forces and will give way.
Related to occlusion is a term called parafunction. Parafunction in the dentition is when patients will clench or grind their teeth at night-time. Indeed, parafunction is a contraindication to providing veneers unless the parafunction has stopped or is prevented using a nightguard. However, in general terms, porcelain veneers are contraindicated for patients who have a heavy bite, clench or grind their teeth.
In summary, if a veneer has come off but is intact, it can be put back on again. If this happens repeatedly, there are other factors that need to be explored to see why this is happening.
If a veneer has broken, chipped or cracked, it is necessary to remove the remaining portion of veneer that is still attached to your tooth and have a new veneer made entirely. If this happens repeatedly, there are other factors that need to be explored to see why this is happening.