Veneers, whitening or orthodontics: which should you choose?

What bothers you: the colour, the position or the shape?

This is the first question the examination asks. Teeth that are yellow but well shaped, teeth that are a good colour but crowded, teeth that are small or worn: three situations, three answers. Many smiles combine several concerns, and the analysis separates them.

When is whitening enough?

When what bothers you is the colour of natural teeth, and there is nothing wrong with their shape. Teeth whitening removes nothing from the tooth.

In Europe, whitening products containing more than 0.1% and up to 6% hydrogen peroxide may be sold only to dentists. The first application of each course of treatment is carried out by the dentist or under their direct supervision, and these products are not to be used on anyone under 18.

Temporary sensitivity is common, whatever the technique; it is managed by adjusting the pace of treatment.

Its limits: existing crowns, veneers and composites do not change colour, and some deep discolouration responds poorly to it.

When should you think about orthodontics?

When the teeth are out of position: crowded, set back, too far forward, separated by gaps. Veneers can mask a slight misalignment, but a veneer does not move a tooth: on a tooth that sits forward, masking means removing more enamel.

Aligning first often means less preparation, and sometimes no need for veneers at all. Dr Haccoun does not carry out orthodontic treatment himself: when alignment is indicated, it is entrusted to an orthodontist.

It is not always the option chosen: orthodontics takes time. In one of the practice’s cases, alignment had been suggested before eight veneers were made; the patient did not want it, and the plan was built around the existing position of the teeth.

When do veneers become the right answer?

When the shape or shade cannot be corrected any other way: a tooth that is too short or too narrow, a worn edge, discolouration that whitening is not enough to correct, old restorations that need redoing. For a small addition of volume, composite may be enough, without preparation.

In what order, if several steps are needed?

Align, then whiten, then restore: this is the most common order, because each step changes what the next one requires.

After whitening, the shade continues to change for a while, and bonding to freshly whitened enamel is less effective, as laboratory studies show. That is why the shade of a restoration is chosen, and the restoration bonded, only after a waiting period.

A case presented on the ceramic veneers page follows this logic: three weeks of whitening first improved the overall shade; the canines then blended in well enough not to need treatment, and four veneers were enough.