Dear Dr. Hall,

I had a left central incisor that underwent root canal treatment in 2004. It subsequently turned grey and I underwent internal bleaching last year.

The tooth still looks grey under certain lighting conditions and does not match my right central incisor. I am hesitant to get a porcelain veneer or crown as I would like to be as conservative with tooth structure as possible.

Also, I am aware of people who have problems with their porcelain veneers/crowns – poor colour matching, cracks, dislodgement, that result in repeated adjustments and more damage to the enamel each time.

Hence, I am considering composite veneers on either one or both central incisors to match them – if I need to change the composite veneers due to staining 5-7 years later, will I end up grinding off more enamel each time the composite veneer is changed? Is it possible to only drill off part of the old composite and bond a new composite veneer on the old composite itself(i.e. composite-composite bond)? If a composite-composite bond is feasible, then I could replace the veneers as required without harming any more natural tooth structure each time.

As composite veneers only last 5-7 years, I am worried that repeated replacements will eventually damage all my remaining enamel if more enamel has to be drilled each time (I am in my late 20s).

Please kindly advise if composite veneers would be a feasible long-term solution. I do not mind repeated costs, or having to visit the dentist every few months for touch up. My main concern is being conservative to the enamel, and finding a sustainable solution in the long run.

Also, will well-maintained and well done composite veneers look natural and blend well with the rest of my teeth?

Thank you Dr. Hall
– James, from an undisclosed location

James,
You’re not going to have to worry about possible damage from having this work re-done repeatedly if you get it done right. But if you don’t have it done right, yes, I have seen a minor correction to make two front teeth match escalate into two full crowns for the front teeth, where each tooth gets whittled down to a stub.

The key is going to be getting the right dentist. It is a small minority of dentists who will be able to get your tooth matched. And it is a slightly smaller minority who will do that in an ultra-conservative way, which sounds like what you want. But even if the dentist isn’t ultra-conservative, as long as it is done right you shouldn’t have to worry about repeated assaults on your tooth.

So your situation is one slightly discolored front tooth, and you’re apparently happy with the rest of your smile. The way I liked to treat cases like this was with direct dental bonding. I would shave off some of the front surface of the tooth to make room for the bonding material and so that the result would be no thicker than the companion front tooth. And then, with a combination of opaquers, tints, and composites of varying shades and translucencies, I would build up the discolored tooth to match its companion. I preferred using composite to doing a porcelain veneer because I could monkey with the color right there and get a perfect match without trips back and forth to the lab and having to communicate what I was seeing to the lab technician.

The same result could be accomplished with a single porcelain veneer. Some dentists will be very aggressive in their tooth preparation for a porcelain veneer and will grind away a lot of the tooth. But most expert cosmetic dentists will be pretty conservative, removing only a fraction of a millimeter of tooth structure. I would think that would meet your requirements of conservatism. And with a porcelain veneer, if the cosmetic dentist has done a lot of these, he or she will want to charge a premium fee, as I did, because there are going to be many trips this veneer will make back and forth to the lab with multiple try-ins to get the color perfect.

Lifespan of dental bonding

As far as the lifespan of the work, I will explain why I don’t think that should be a problem. With the bonding, it is the surface that deteriorates after maybe 3-5 years (longer if you use a gentle toothpaste like Supersmile), and the maintenance would simply be re-surfacing the composite. It wouldn’t have to be totally ground off and start over. With the porcelain veneer, if it is done right it could last many years. There isn’t a fixed lifespan there. If you take good care of it so that you don’t get decay on the edges or fracture it, it could possibly last twenty years. It’s not like a tire that wears out, but more like a piece of fine furniture that could fall prey to abuse, but if it is well cared-for could last indefinitely. And then a good cosmetic dentist would have tools to be able to remove the porcelain and bonding composite without significantly affecting the tooth.

If you get a dentist who wants to treat both your front teeth so as to guarantee a perfect match, take that as a red flag. The dentist doesn’t have confidence in his or her color skills to be able to match the adjacent tooth.

If you do want to share your location, I could help you further by possibly steering you to a cosmetic dentist who would be up to this task.
– Dr. Hall

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