During a veneer consultation, one of my first questions is how much shade change the patient is seeking. Ignoring this can lead to disappointing results if the desired amount of shade change exceeds what a chosen veneer type can deliver. No-prep veneers, for instance, can facilitate a change of only one to two shades. The thinness of this type of veneer is analogous to a contact lens, meaning no-prep veneers are going to underperform if a patient has dramatically stained teeth and wants to transition to a bleached shade; the veneers are going to be too thin to mask the chroma and value of the underlying stained teeth. Greater shade alteration can be secured with minimal-prep veneers, which enable changes of up to three shades. Minimal-prep veneers also can conceal fluorosis stains.

Other common considerations include tooth alignment, spacing and occlusion. For slight misalignments, minor chipping, and elimination of spaces, no-prep veneers are usually still feasible. More significant issues often require an additional phase of care, such as orthodontic treatment, to correct the problems. The patient’s bite must be assessed as well, to prevent occlusion at the margin of the tooth-veneer interface.

The health of the patient’s teeth is another subject for immediate evaluation. Are there any existing composite restorations on any of the teeth that will receive veneers? Research demonstrates complications associated with ending a veneer’s margin within an existing composite restoration.¹ If interproximal decay is present, a minimal-prep or even conventional-prep veneer will be needed, as the decay must be removed, the tooth built up with composite, and the prep extended to end on tooth structure, rather than on the composite.

With these patient-specific factors determined, my choice between no-prep and conventional-prep veneers might still depend on other factors. A no-prep design allows the tooth to remain intact, offering the strongest bond because the veneer remains completely within enamel. However, it’s difficult to know where the veneer’s margin ends, making a no-prep veneer extremely demanding of time and technique. Periodontal issues can be avoided by having the finish line be supragingival or equigingival, but the restoration may seem to be at risk of slipping around on the tooth during placement. Overcontouring is another concern. And a result of no-prep veneers is a bigger smile with more tooth display, which might or might not serve the patient’s expectations; before treatment planning, the patient needs to be informed of how this veneer type will add to the tooth’s bulk and length.