Who am I and why am I interested in Lumineers.
I am simply a dental patient with badly ground down teeth looking to fix that problem. I ground my teeth down somewhere between the age of 18 and 22. I don't really know when it happened. One day, I looked in my rear view mirror in my car and was horrified to realize how much of my teeth was missing. That was 22 years ago. I have been waiting for a reasonable solution ever since. Are Lumineers that fix? I am not a dentist - what you read below is what I have learned by researching the web and talking to my dentist. It is by no means meant to be an authoratative investigation into Lumineers.
What are Lumineers?
Lumineers are a proprietary brand of dental veneers made from a ceramic called Cerinate which is a product of the Den-Mat company. Den-Mat appears to be well regarded in the dental field. Lumineers are dental veneers, like all other brands of dental veneers, but with some unique features. Cerinate is a compressed ceramic that can be made very thin - 0.2mm according to the marketing literature, 0.3-0.4mm according to everything else. A human fingernail is a little less than 0.5mm in thickness for comparison. These very thin veneers are very strong, especially once bonded to the teeth. Also, Cerinate can be feathered to extremely thin edges so that the margin around the Lumineer veneer can be nicely finished. Den-mat guarantees Lumineers for 5 years, and they have experience with them lasting for 20 years or more. Like other types of dental work, consider them a success if you get 10-15 years out of them.
What are the advantages of Lumineers?
Den-Mat promote Lumineers as being the no-fear porcelain veneer. According to their marketing, you can get your veneers done in only 2 one hour visits without any drilling. Given that other brands of veneers can require a substantial amount of tooth reduction, these claims have a lot of appeal.
What are the disadvantages of Lumineers?
Ask any cosmetic dentist that does not offer Lumineers why they don't and you will get the same two reasons: 1) Lumineers are too bulky. 2) Lumineers lack realistic transparency.
The first reason is easy to explain. Think about fake fingernails or fingernail extensions. Acrylic fingernails are pasted onto your natural fingernails to give you longer more beautiful fingernails. But it is obvious that the fake fingernail has been added as the contour of the fingernail bulges outwards. Without any tooth reduction, the same thingis true with Lumineers. 0.3-0.4mm might not seem like much, but your teeth are pretty small to begin with.
The second problem is translucency, Teeth are not naturally opaque. You can see into the enamel, giving them a glassy depth rather than a pure paper white look. It is very difficult to achieve that glassy depth when all you have to work with is 0.4 mm or less.
What is the truth?
Lets look at all of Den-Mats claims and all the criticisms.
1) Number of visits: While Den-Mat promote just 2 visits, the reality is 4-5 visits. The first visit is a free consultation. My dentist explained to me what Lumineers are, what the advantages and disadvantages are, what the cost is, and then did a "mock-up" of what my teeth could look like with Lumineers. The mock-up was done by simply applying bonding material to my teeth to form the look I was seeking without doing the final curing step - so that the bonding could be taken off after a few minutes. For me, the results were stunning. I found myself looking at a mouth I hadn't seen in 25 years. I was sold immediately. I don't believe that all dentists will do a mock up like this as placing bonding material onyour teeth temporarily is not cheap, but a good dentist should do this in my opinion.
As I was sold immediately, the second step was done right away. If I had gone home to ponder the cost, I would have had an additional visit for this step. The second step was to take photographs of my face and teeth and to make impressions of my teeth and my bite. These were then sent to the lab (I believe directly at Den-mat) for analysis. I know that in my case the lab called my dentist to discuss my tooth grinding - I will need to wear a night guard in the future to not damage my Lumineers. This first visit lasted 3 hours,but a lot of the time was spent doing other things - I hadn't visited a dentist in many years and I needed to start a lot of other work as well.
The lab then created prep guides which they sent back to my dentist. These prep guides are simply two molds of my teeth. The first mold is of my teeth as they existed when the initial impression was made. The second mold had modifications made to accomodate the Lumineers. These modification are highlighted in red on the model and simply tell the dentist where tooth reductions need to be made so that the Lumineers can be made perfect. On the third visit, these modifications were made and new impressions were made to be sent to the lab so that they could craft my new Lumineers. I will talk about tooth reduction in the next section. This visit lasted over 2 hours - but it included replacing a couple old fillings in the teeth being prepared - a good idea before putting expensive Lumineers over them.
The final visit is for the installation the Lumineers. I was nervous about this visit wondering how the Lumineers were going to turn out. This visit lasted a little over three hours. First my teeth were flossed and cleaned in preparation for the final installation. Then the teeth were etched to take the Lumineers. A try-in paste was then used to temporarily install the Lumineers. Part of the process is selecting the final shade you want. I was given two choices and each side of my mouth was done with the other shade.I chose the less white shade as it more closely matched my lower teeth which don't have Lumineers. My dentist was pushing for the whiter shade. Its a matter of preference. I wanted something more realistic. But the difference between the two shades was pretty small, the teeth are quite white.
With the shade selected, the Lumineers were all cemented in place. That part of the process was quick and painless. However, a few steps remained. As with most dental additions,the bite had to be corrected - nothing major there as the Lumineers are on the outside. Then margins around the gums needed to be feathered smooth with a drill and then sealed.This is important if there is to be no leakage and then decay. It is a crucial step - but it is not painless. It was done without numbing, but eventually a topical anesthetic was applied to reduce my discomfort. It wasn't anything like getting a filling, but it wasn't painless either. Just remember that this is important if your Lumineers are to be trouble free. Finally, the teeth had to be separated so you can floss normally. All the cement used to bond the Lumineers to you teeth overflows out the sides and you teeth get stuck together with overflow. It takes quite a bit of work and pressure to clean this up. By far, this was the longest part of the process. But you want to be able to floss cleanly without snagging, so this must be done right.
The final visit is a checkup in a few days to check everything and to make sure that the margins are perfect. By then any gum irritation should have healed and the dentist can make sure that nothing will catch in your gum pockets.
2) Tooth reduction: Den-Mat promote Lumineers as being the no-pain no-drilling solution to veneers. This isn't totally true - nor should it be. If your teeth are too small or you have gaps you want to have filled, then chances are you won't need to have any tooth reduction. However, in most other cases some tooth reduction will be needed. This is especially that case if your teeth tilt outward or the edges between the teeth are too sharp or bulky to accomodate the Lumineer veneers over the top. When I saw how much toothreduction was needed, I was very concerned. Once that work had been done, I would have essentially crossed the bridge, there would be no turning back. Prepping my teeth took well over an hour. There was a lot of drilling. The good news is that the drilling was in the enamel and there was no need to numb my mouth and there was no pain. Once it was all done, I grabbed the mirror to see how much of my teeth remained. I was in for quite a shock. Instead of seeing small stumps of teeth, what I instead saw was a perfect mouth of teeth. All the irregularities were gone. The contours were natural and how I wanted them. In fact, the mouth I saw was pretty much what I had in mind with theLumineers. All except for the length - I wanted more length. That is what the Lumineers are for. I am still amazed that my smile could be so improved by simply grinding enamel away. I don't think that simply grinding enamel away is necessarily a good thing as it weakens the tooth, but the results were amazing. One thing I did notice later isthat the sides were ground down more than is apparent when looking at my teeth head on. This is to provide space for the Lumineers to wrap around the sides a little bit. Otherwise, the edges would be crowded and your new lumineers would look like a single band of teeth rather than individual teeth. Another benefit of the tooth reduction isthat the surface of your teeth are roughed up. You can feel that. The roughness will make for a better bond to the Lumineer. For me, there was no sensitivity after having the tooth reduction whatsoever.
To get an idea of what to expect, take a look at http://www.lumineers.com/reversible. What they show are the original teeth in 1988, after Lumineers were placed in 1988,after 19 years of service, after the Lumineers had been removed, and finally a new set. Compare the original teeth in 1988 with the teeth after the Lumineers has been removed. After your teeth have been prepped they will look quite similar to the photograph of the teeth after the Lumineers had been removed. It also seems that grindingyour teeth down reaches down into darker shades of your teeth - they lose some of the whiteness. Also, quite frankly, I think the original set of Lumineers look better than the new set that are too white, don't match the other teeth, and are very opaque. Maybe that is what the patient wanted.
3) Bulkiness: The bulkiness is the result of what you get when you don't do any tooth reduction in the cases it is needed. You are simply adding material without taking any away. If your goal is bigger teeth, then you have nothing to worry about. If your teeth are more normally sized, then you should expect some tooth reduction if you want to geta realistic result. The good news is that the tooth reduction is minimal and painless. Done right, the result should not be bulky. If you really don't want any tooth reduction or your dentist sticks with Den-Mats marketing, then you might not be happy.
4) Translucency: The translucency is a function of the natural tanslucency of the tooth material and its depth or thickness. Normal teeth are several millimeters thick and are quite translucent. Veneers don't match the translucency of natural teeth unless you have all the enamel removed and thicker veneers put on. But removing that much good tooth material seems like such a bad idea. So there is a trade-off. Take off a minimum of tooth and get minimal translucency or remove a lot of tooth and get maximum translucency. Fortunately, there are a few other variables though. A lot of the color you get with Lumineers is not exactly in the Cerinate porcelain, it is instead underneath in the material used to bond the Lumineer to the tooth. The dentist paints your existing teeth with a bonding agent that contains special materials called shade modifiers or opaquers just prior to attaching the Lumineer. You have some choices in what color this bonding agent is. If you have dark stains such as tetracycline stains on your teeth or you want your teeth to be unnaturally white (which is so in fashion these days), then your existing teeth are going to have to covered over with a very opaque white covering. In this case the amount of translucency you can achieve through the thin, but still quite translucent, Lumineer will be minimized. The dentist can however, depending on his or her artistic skills, simulate translucency by painting grey shadows onto your underlying tooth rather than just applying an opaque white. Another option, if your existing tooth color is reasonable and you want only minimally more whiteness, is for the dentist to instead apply a natural bonding agent for a more transparent color under the Lumineer and you can gain back some of the existing translucency in your underlying enamel. However, it won't be the same as your natural tooth. For this reason, if you are getting Lumineers, you should get all your visible upper teeth (and/or lower teeth) done together so that the result you achieve will be uniform. You will have some degree of translucency and it will look natural if all your teeth are similar. Compared to your natural teeth, a Lumineer or two would be obvious due to the differing translucent properties you would see.
How much should lumineers cost and how do you choose a dentist?
I found surprising variability in the price of Lumineers - ranging from $397 a tooth to $1600. I paid $1050 per tooth with is right in the middle and seems to be about average.Keep in mind that you are paying for two things - the work done at the Den-Mat lab and the work done by your dentist. While the work down by the lab will largely be the same no matter where you go, that price component of that work is also the same no matter where you go. The real variability is in your dentist. Choose a cheap dentist and you might just discover that you get what you pay for. Lumineers are not a commodity. Your dentist needs training, experience, and a fair amount of artistic skill to achieve agreat result. Choose carefully.
What about putting Lumineers over existing crowns?
Den-mat promote this as an option. I don't understand it. In my case, I am having two crowns replaced to match my Lumineers rather than covering them. Given that crowns don't last forever, that their cost is comparable to a Lumineer, and that chances are you are covering them because they don't look good, then it seems to make more sense to simply replace them. Why spend all that money on a Lumineer if the underlying crown will fail in just a few years. Seems like a bad idea to me. In fact, when my two crowns were removed, both a dozen years old, decay under the buildup was found. It is good I had this fixed before I needed to have a root canal.
What about decay around the margins?
Whenever you have dentistry done, the seam between your tooth and the restoration has the potential for leaking or trapping food material, leading to further decay. Once you have crowns in particular, you should regularly see a dentist. All veneers have the potential for this type of failure. I have seen mention that the thin feathering that is possible with Lumineers should mean that it isn't necessary to create a large ridge under the gum linewhich would be a potential site for decay in the future. Other dentists have claimed that the bulkiness factor of Lumineers creates a ridge at the gum line that could fail. I am not sure what the truth is, I imagine that it is somewhere in between. The skill of your dentist in avoiding this problem is most important. If you aren't happy with the margin, speak to your dentist right away. I wish I had done that with my crown that has failed - it cost me a lot of money just four years ago.
What about all the bad reviews I see on the web?
First, given the widespread application of Lumineers, I am surprised at how hard it seems to be to find many complaints about Lumineers. What I have found mostly points to mistakes made by the dentist or to overly high patient expectations. I have seen a few cases of people upset by the bulkiness. In one case, where the guy provided pictures, I think the real problem was simply that he wasn't used to having normal-sized teeth. Once he got used to his new look, I am sure he would be thrilled with them. I found a complaint about the color, but here the problem seemed to be someone pushing for too much whiteness and not being happy with the resulting opaqueness. Another color case seemed to be a chemical reaction that might be occuring under the Lumineer - another error by the dentist. I saw a few cases of Lumineers falling off soon after installation. Again, this appeared to be an error on the part of the dentist as the bond should be really good. Finally, I found a number of other cases which seemed to be competitors grasping at straws to criticize Lumineers and promote their own product - most of which could be easily ignored as shady competitive marketing.
Does Den-Mat Marketing go too far?
Absolutely! And I see no reason for it. Lumineers are a great product. Why spoil them with shady marketing? They claim you only need two visits when their standard procedures yields a minimum of four. They claim no tooth reduction, yet this is seldom the case. They show examples of teeth done with Lumineers, which apparently comeout perfect every time and contrast this with traditional veneers which require dramatic tooth reduction and may come out flawed. Well, it isn't always necessary for ramatic tooth reduction with other veneers and there is just as much potential for flawed results with Lumineers than with other types of veneers. More facts, less hype would be better IMHO.
My Results
I am thrilled with my new smile. I am still getting used to it. My teeth are whiter than before. After two weeks of living with near perfect looking teeth after the tooth rduction, the Lumineers are somewhat larger - but that was my goal. My teeth are not bulky though, they look and feel quite natural. I don't have to force a smile to see any teeth. Finally, when I have pictures taken, I won't hear "smile more, I want to see some teeth". I hate all those pictures with me overly smiling to get my teeth to show. My teeth do look perfect, maybe too much so. I am 44, not 24. Maybe a 44 year old shouldn't have such perfect looking teeth. Or maybe I need to get other aspects ofmy face fixed now - oh no, what have I started!!!
Summary
Lumineers are a wonderful product. For me, they are a solution to a problem I have fretted over for a long time. Den-Mat's marketing goes too far though, and sets up an unreasonable expectation of Lumineers. Promoting a solution that involves just two visits and involves no tooth reduction seems incorrect. Especially as that isn't what theyactually do anyway. What they instead do is a bit more involved, but it is necessary for a great result.
So in the end, if you are willing to work within the constraints of the product and you find yourself a good competent dentist, you should be very happy with a new set of Lumineers.
-O-
