Restoring a beautiful smile: tips on choosing crowns vs. veneers

Elana, daughter of Howard Steinberg, DMD, shows off her prepless veneer-enhanced smile. (Courtesy Howard Steinberg, DMD)

Tooth restoration is a great way to enhance your smile at any adult age. Veneers or crowns are two popular options. Both are dental restoration methods to improve the appearance of your smile, but they are very different procedures. Tooth preparation may be a determining factor in deciding which route to take.

“The primary reasons for having a crown or veneer placed is to repair broken/chipped/fractured/decayed teeth or for cosmetic reasons such as closing gaps, correcting for stained teeth that cannot be treated with traditional tooth whitening (ex: tetracycline staining), and creating an idealized esthetic look,” says Frank Son, DDS.

Veneers are wafer-thin, strong but brittle porcelain coverings that bond to the front surface of existing teeth. The porcelain is matched to your natural tooth color.  Because the veneer is brittle, repeated sharp impact can crack or dislodge the cover. Crowns are more durable compared to veneers but a well-placed veneer can last just as long, Son says.

Veneers, left, vs. crowns [Courtesy DDS Labs)

Veneers may be the best choice for minor or aesthetic improvements, such as stains, chipped or minor chips, and small gaps between teeth or mild misalignment. They only can be placed on the front of the tooth. Veneers used to correct tooth alignment may be treated more aggressively with trimming similar to crowns.

Veneers are the more conservative route than crowns and might be chosen initially, as less of the tooth is removed for placement. Only a thin layer of the tooth enamel is abraded to assure adherence. The core and back remain untouched.

Veneers are an irreversible, permanent solution. Once veneers are applied, the tooth will always require veneers in the future. However, upon replacement, the tooth can be further reduced to allow fitting of a crown.

“I have a 22-year-old daughter who is starting Georgetown law this fall. She did orthodontics for many years but her teeth were proportionally off. She just finished the orthodontics recently and I made prepless veneers (that means I did not touch her teeth but I just made super thin porcelain covers over her upper 10 front teeth and bonded them on). I never used novacaine or local anesthetic. She flew to Washington last week and she sent me a text, ‘Look at my teeth!!! Every day I cry because I am so happy…U changed my life,’” says Howard Steinberg, DMD, MDS.

Crowns, often called caps, are made of metal, porcelain or both combined. A crown encases the entire tooth. It is at least twice as thick as a veneer, making it durable and resistant to damage. Crowns are necessary when a tooth is damaged, badly broken, cracked, worn down from tooth grinding or following a root canal treatment. For the crown placement, 60 to 75 percent of the existing tooth is trimmed away.

“I always try to do the most conservative procedure for patients and a veneer is much more conservative,” Steinberg says. “However there are many occasions where a tooth is more broken down, or the bite needs to be changed, or the patient already has a crown; then I do a crown, or multiple crowns.  A primary reason for a crown is that a patient has either significant decay that goes on both the front and back of a tooth or they have had a traumatic accident like a car accident or domestic abuse where the teeth are broken off from front to back.”

The crown protects the tooth from further damage. Once it is cemented into place over the remaining tooth, it becomes the new tooth surface. Crowns can change the tooth color or shape. Once placed, the tooth will always require a crown or covering.

The cost of veneers and crowns is similar. Insurance companies may consider veneers strictly aesthetic and are less likely to cover the treatment. While crowns also may achieve aesthetic improvement, they usually are treating foundational issues and are more likely to be covered by dental insurance.

Either solution should last for a decade or more, with proper care. The porcelain in both processes is marginally stain resistant, but continued oral hygiene, including attentive brushing, flossing, and healthy eating habits, remains important. Gum care is critical to prevent periodontal disease. Caution when biting hard surfaces is advised to extend the lifespan of the sparkling new smile.

“Since children’s teeth are continuously developing and erupting, crowns and veneers are almost never placed until the teeth and occlusion have been stabilized,” Son says.