Which one do I need?
So, your dentist said you need a crown, or a veneer, but you have no idea what the difference is. Crowns and veneers are dental restorations that improve the look and function of your teeth. A veneer covers only the front part of your natural tooth and a crown covers the entire tooth.
Let’s look at this case I did a few years ago to discuss the differences and reasons why you may need one and not the other.
This was my 19 year old patient, who came to see me because she was embarrassed of having a “black tooth.”
Tooth #9 had a big cavity (it was even bigger on the back of the tooth) and a failing composite bonding right on the edge of the tooth (from an accident when she was little). Tooth #8 had a cavity too (not as large as on tooth #9 but it was clearly visible on the x-ray) – this is a classic example of why flossing is so important. Once you get a cavity on one tooth, the bacteria that causes decay will spread and cause a cavity on the adjacent tooth). In this case, the patient was happy with the way her tooth #8 looked (she liked the shape and that yellow discoloration right at the edge did not bother her at all (as far as esthetics go). We decided we will take care of the cavity on tooth #8 with a pretty, tooth-colored filling. Tooth #9 was a little bigger problem. The cavity on that tooth was so large, once I removed the old bonding and cleaned up the decay, there was not much tooth left (especially on the back of it). A crown was a better option for this patient because too much of her natural tooth was gone.
Crowns protect teeth and restore function. They are indicated on teeth that are heavily decayed, worn, broken, cracked or endodontically treated (teeth that have had a root canal). To finish off this case, I ended up smoothing the edge of tooth #8 (even though it didn’t bother the patient) to reduce some of that yellow discoloration and to round off some edges (I think most dentists are perfectionists and want everything to look pretty and symmetrical –I know I do haha).
I normally recommend veneers to patients who are unhappy with the shape and color of their teeth (enamel defects, intrinsic staining, etc.). Preparation of veneers is more conservative (we only have to reduce the tooth about .5mm off the surface, some people may be candidates for no-prep veneers if they wish to close up small spaces without doing braces. Veneers are usually not covered by insurance because they are considered a cosmetic procedure.
The preparation for a crown is a little more aggressive (we need about 1.5mm-2.0mm of reduction to make the crown fit and be strong enough to withstand the forces of biting and chewing). Veneers leave more exposed tooth structure, so there is more potential for recurrent decay around the margins. Also, nothing in dentistry is permanent, eventually all fillings, veneers, and crown will have to be replaced as they can still break, crack, come off, and get cavities around margins. Longevity of crowns and veneers depends on your oral hygiene, eating/drinking habits and proper care. On average they can last 10-15 years.
The photo below: Male patient, early 20s, wanted to have a more symmetrical front tooth. In his case, I did a veneer on #9 with a little bit of gum contouring using a diode laser.
Third example: Male patient, middle-aged, ready to have his front tooth fixed. Patient broke his front tooth when he was in his early 20s, had a root canal done on that tooth years ago, and a post to hold the big composite filling. In this case, I did a buildup and a full coverage crown on #8. Pt was not a candidate for a veneer because too much of his natural tooth structure was gone.
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