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Leading dentists question widespread use of porcelain crowns and veneers

04 July 2011

Some dental patients are having unnecessary, expensive and aggressive restorative treatment for minor cosmetic problems because porcelain crowns and veneers are being overused, warns a leading dentist in July’s edition of the Faculty Dental Journal (FDJ). The article highlights concerns felt within the dental profession about these popular treatments, reporting that patients can suffer with long term problems including dead teeth, after these invasive, supposedly “cosmetic” treatments.

Tooth preparation for porcelain or ceramic veneers removes between 3 and 30% of tooth structure while 62-73% of structure is removed when teeth are treated with ceramic crowns.

The opinion piece, Porcelain Pornography, asserts that the destruction of relatively sound tooth structure (enamel and dentine) to prepare teeth for veneers or crowns can rarely be justified for minor cosmetic or wear problems. There is limited evidence of long-term benefits in these circumstances of brittle porcelain veneers. Available research suggests that after 10 years about 50% of veneers are either no longer present, have had further treatment or are no longer in a satisfactory condition.

Senior dentists are concerned that fitting porcelain veneers or crowns, on mainly sound teeth, has become so widespread that it is sometimes considered a ‘normal’ treatment for those patients who might benefit from more conservative restorative treatments like bleaching and bonding. They add that pressure from patients and the media as well as the opportunity for financial gain, should not cloud a dentist’s decision to recommend treatment which could have a detrimental effect on a patient’s long-term dental health.

Mr Martin Kelleher, Consultant in Restorative Dentistry and author of FDJ opinion piece, said:

“All clinicians should place the long-term health of their patients first. Porcelain veneers have their place in responsible restorative dentistry when provided by suitably trained and qualified individuals but I believe that other safe and proven cosmetic treatments, like bleaching and bonding, should be considered before the destructive ones. Patients must understand that extensive porcelain veneer or crown treatment is not a risk free shortcut to a perfect smile.”

Miss Kathryn Harley, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons, said:

“It’s alarming that there has been a significant rise in complaints about dental veneers over the past five years; that fact alone suggests that patients do not fully understand the risks, outcome and long-term maintenance of porcelain veneers. We would welcome more in-depth research into this area so that current and future dentists are armed with the best evidence in order to recommend the appropriate treatment.”

Read the full article Porcelain Pornography in July’s edition of the FDJ (available Tuesday 5 July). Please see attached pdf for full article under embargo until 0001hrs Tuesday 5 July.


- Ends –
Notes to Editor

 

  1. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk.
  2. The Faculty of Dental Surgery at the Royal College of Surgeons of England is committed to achieving and maintaining the highest standards of clinical practice and patient care across the dental specialities. For more information please visit www.rcseng.ac.uk/fds.
  3. The FDJ of the Faculty of Dental Surgery of the Royal College of Surgeons of England is the official journal of the Faculty of Dental Surgery and is published four times a year in January, March, June, and October. The principal aim of the FDJ is to provide expert opinion to inform the whole dental community on contemporary issues across the spectrum of dentistry and dental practice. For more information please visit www.rcseng.ac.uk/publications/fdj.

    If you have any queries please contact:

    - Matthew Worrall – Email: mworrall@rcseng.ac.uk; T: 020 7869 6047
    - Elaine Towell – Email: etowell@rcseng.ac.uk; T: 020 7869 6045
    - Heather Casey - Email: hcasey@rcseng.ac.uk; T: 020 7869 60
    - Out-of-hours: 07966 486 832
  4. References:
  • Edelhoff D, Sorensen JA. Tooth structure removal associated with various preparation designs for anterior teeth. J Prosthet Dent 2002; 87: 503-509.
  • Kelleher MGD The “daughter test” in elective aesthetic (”esthetic) or cosmetic dentistry Dental Update 2010 ;37:5-11
  • Burke FJ, Lucarotti PS Ten year outcome of porcelain laminate veneers placed within the general dental services in England and Wales J Dent 2009 37(1) 31-38