Dr. Hall,
If my top two front teeth were initially ground down for crowns and there is no crown on the teeth will veneers work on the teeth now?
– Tina from Kentucky

Tina,
Once a tooth has been prepared for a crown, a crown is the only restoration that will work for that tooth – it will always need a crown.

The difference between a crown and a porcelain veneer is that the veneer covers just the front of the tooth and not the back, whereas a crown covers the entire tooth. But the distinction is not cut and dried. Some veneers can also involve the sides of the tooth. And some dentists will talk about placing porcelain veneers and then prepare the teeth for crowns. I disagree with this practice, and most expert cosmetic dentists would feel the same way, but it happens. To make it more confusing, many dentists will charge the same fee for a veneer as for a crown. So if the dentist covers the entire front of the tooth, both sides, and half of the back of the tooth, is that a crown or a veneer? I would call it a crown, but some dentists would call it a veneer.

Removing a lot of tooth structure is aggressive dentistry. However, I like the philosophy of minimally invasive dentistry, meaning that the dentist removes the least possible tooth structure to accomplish the desired outcome. This is the practice of the great majority of excellent cosmetic dentists – the type of dentists we recommend on this website. So if you need a new smile, we would shave about half a millimeter of enamel from the front of the tooth, which is about the thickness of a fingernail. There would still be enamel covering the tooth – it would just be a little thinner. That allows for half a millimeter of porcelain, which is adequate for changing the look of the tooth – the shape and the color. If a tooth is out of alignment – say it protrudes out in front of the others – then more would need to be removed to leave it in line with the others. Likewise, if it is turned inward, there may need to be little or no enamel removed at all to give an attractive result.

A crown will strengthen a back tooth against tooth fracture in almost every situation in which it is used. However, on front teeth, since they are subject more to horizontal stresses, a crown can weaken an otherwise healthy tooth, making it more susceptible to lateral shearing forces. That is why I like to be as conservative as possible in treatments to front teeth. A well-placed, conservative porcelain veneer will not weaken a tooth.
– Dr. Hall