This Veneer came off after 3 years… Here is the reason

Having carried out hundreds of smile design treatments, I can say that it’s pretty rare that a veneer comes off. 

Apart from that time that my lab decided to make everything in Zirconia… Those veneers kept falling off. 

That’s a story for another day. 

But normally, most are made from Emax, and this bonds to tooth quite well, so as long as the occlusion is good, the veneer (or porcelain restoration) will be stable over the long term.

Here is the case, when we fitted the restorations in 2020.

The before photo is in occlusion, so there is an anterior open bite. 

I know that this would have been an ortho case, in ideals circumstances – but after a 2hr consultation, he chose a smile design.

Spoiler alert, the UR5 came off due to occlusal issues (my fault), but lets look at this in a little more detail. 

In the pre-op photo, you can see that the only occlusion is on the molar teeth; and this has been absolutely fine for him for all his life. 

The reason he had a smile design was that he did not like the look of his smile, and front teeth looked short. And wonky. 

So like every smile design we do, we made everything in temps, and then the lab copies the temps to make the finals. 

I left a bit of an open bite in the temps, as any kind of overlap from the anterior teeth would cause an interference

In cases like this, and in class 3 cases, the lower jaw is used to having infinite freedom, so you can assume that there is very shallow guidance, or envelope of function. 

You do not want to create a restriction, otherwise something (probably your new veneers) will break. 

So I respected this, but there was still an interference – one that I did not pick up. 

It was a non working side interference. 

You can see that the restorations have been built up on the right side, with the palatal cusps almost longer than the buccal. 

When there is a normal guidance angle, this palatal cusp hardly every causes a problem, but in situations where the guidance is shallow (cow bite), then there is a higher chance of getting a non working side interference. 

So to remind you, if the patient moves their jaw to the left (in occlusion), if there is canine guidance, then the canines will remain in contact, while all the other teeth come out of contact. 

The left side is the working side

A Non Working side interference is a contact on the right side, as the patient moves their jaw to the left. 

I check for these all the time, and they are pretty rare. 

They are more common in:

  • Shallow bite cases
  • Cases where there has been a lot of ortho arch expansion (this causes the palatal cusps to drop down)

The simple solution in this case is to adjust the palatal cusp of the UR5. Immediately on doing this, the patient noticed his jaw felt better. 

Note: he thought it was okay for the last 3 years anyway! 

Eventually, bite issues will cause wear and fractures but having a good understanding of what is going on will help you to solve the patients problem quickly and easily. 

I will often go through these concepts and cases with the dentists I mentor, and help them to really understand occlusion, aesthetics, and how to carry out complex restorative cases (and how to get them in the first place!)

If you would like to arrange a call to see if mentoring is for you, you can click this link to arrange a free video call with me

If you found this useful – please tell your friends, you can forward the email you got or share this page. 

Here are some other photos of this case – the before, and retracted from last weeks appointment. 

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