Tooth Whitening in the Presence of a Porcelain Veneer
I have a patient who is interested in tooth whiteningÑboth in office and at-home. However, she has one porcelain laminate veneer on an anterior tooth. What should I recommend?
The first question is whether the veneer is a color match to the adjacent teeth. Restorations do not change color in response to bleaching. If the veneer matches now, it may not match after bleaching adjacent teeth. If the veneer is lighter than the natural teeth, the color match may be improved by bleaching the natural teeth to match the veneer. This approach should be slow, however, with only daytime wear of the tray with 10% carbamide peroxide recommended to avoid overlightening of the natural teeth. Interestingly, a tooth can be bleached underneath a veneer, which may make it look lighter, depending on the veneer’s translucency. If a veneered tooth matches or is slightly darker than adjacent teeth, I would try bleaching the veneered tooth substructure using a single tooth-bleaching tray to apply the whitening material to only the veneered tooth (Figure 1 and Figure 2).
When the veneer is darker than the adjacent teeth, in-office whitening is not an option because of the lengthy treatment time required to bleach a tooth under a veneer. The process may require up to 8 weeks of nightly tray bleaching using 10% carbamide peroxide (the approximate equivalent of four in-office treatments). Once the veneered tooth has reached its maximum whiteness, the treatment should be stopped for 2 weeks to ensure shade stabilization. Then, if the veneer appears lighter than the adjacent teeth, a full tray can replace the single-tooth bleaching tray for daytime wear, so the natural teeth can be bleached to match the color of the veneered tooth.
FIGURE 1. A single-tooth bleaching tray removes the tooth molds on either side of the dark tooth, so that only the dark tooth is treated and the color of the adjacent teeth remains unchanged.
FIGURE 2. Nonscalloped with no reservoirs, a single-tooth bleaching tray is designed for 10% carbamide peroxide. The tray extends further onto the tissue on the lingual side than a conventional tray and the edges are hidden behind the rugae.
If all teeth, including the veneer, are bleached at the same time with an inoffice or full-tray technique, patients may be dissatisfied with the results because they will have a single dark tooth rather than a uniform smile.