INTRODUCTION
The ability to predictably bond thin pieces of tooth-colored restorative material to teeth and expect excellent long term aesthetic/functional results has created a new arena in the practice of dentistry—that of elective cosmetic treatment. Not to say that these procedures “appeared over night;” they did not. However, over the last 20 or so years, the materials and technologies have continued to improve. Now, many procedures in which longevity was felt to be compromised by the “old school” critics have proven to be excellent and clinically viable treatment options. Teeth can now be “resurfaced” with tooth-colored restorative materials requiring very little, if any, tooth preparation.
Adhesive bonding technology allows the dentist to place a brittle restorative material of minimal thickness to the surface of the tooth that will not break under normal masticatory function. Hence, patients who are not happy with the smile “mother nature” provided can elect to have a “smile makeover” correcting aesthetic problems associated with tooth shape, position, and color. For many years, patients had to live with aesthetic problems that were tooth related. Orthodontics could straighten teeth, but could do nothing for malformation or problems associated with tooth color. The psychological ramifications to the patient with an unaesthetic smile are only beginning to be understood and validated. Some dentists still believe that it is a “violation of the Hippocratic Oath” to disturb “healthy” tooth structure, even if the patient is unhappy with the aesthetics; and that we should talk the patient out of elective treatment. In this day and age, such backward thinking is preposterous. For many patients, elective cosmetic dentistry can be a life-altering experience, giving those who weren’t lucky enough to be born with a “perfect” smile what they always wanted.
NO-PREP VERSUS MINIMAL-PREP PORCELAIN VENEERS
It has always been my belief that some preparation is required for porcelain veneer cases to achieve optimal aesthetic and biologically functional outcomes. Crowded cases need not only the facial surface positions corrected, but also the palatal surfaces as well (360° veneers) to functionally align these teeth and make home care and periodontal maintenance possible. Many of the restorations from no-prep cases that I have seen in my 27 years of practice have appeared to me as “unaesthetic, opaque, monochromatic chiclets” (Figure 1). Crowded “no prep” cases, in many instances, the previous dentists have aligned the crowded facial surfaces only to leave the functional (palatal) surfaces uncorrected, making maintenance or restoration difficult, or even impossible (Figure 2). I believe the key to unlocking the major problems with the no-prep technique lies in selecting the proper case (small teeth with spaces, with slight lingual alignment being the most ideal), and having an all-ceramic material that can be made extremely thin and aesthetic, yet strong. This also means that the cervical margins need to be extremely thin (knife edge), and be able to be finished by the dental laboratory technician. It is my opinion that it is nearly impossible to finish and polish ceramic margins in the mouth to the same degree as can be accomplished in the laboratory by the ceramist.
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