Why We Decline Cases
We turn down cases every week. Here's exactly what doesn't qualify — and why.
The willingness to decline a case is one of the cleaner indicators of a clinician who is operating to a standard rather than a revenue target. At ACE DNTL, we decline cases regularly — for clinical reasons, for aesthetic reasons, and occasionally for reasons of expectation alignment. This article explains how we think about it, what the criteria are, and why the selection process ultimately protects the patient.
Clinical criteria for porcelain veneer candidacy
Porcelain veneers require a specific clinical foundation. Without it, the restoration will fail — either immediately or within a timeframe that renders the investment unwise. The following criteria are non-negotiable at ACE DNTL:
Periodontal health. Active gum disease — gingivitis or periodontitis — disqualifies a patient from veneer placement until the condition is treated and stabilised. Veneers placed on periodontally compromised teeth face two risks: progressive gum recession that will expose the veneer margins prematurely, and potential tooth mobility that undermines the structural stability of the restoration. We will not place veneers on a foundation that is actively deteriorating.
This does not mean periodontal disease permanently excludes a patient from treatment. It means the periodontal condition must be addressed first — through scaling, root planing, and in some cases surgical intervention — and the gum tissue must demonstrate stability over a monitoring period before cosmetic treatment proceeds. This may add three to six months to the timeline. We consider this appropriate.
Enamel volume. Porcelain veneers bond most reliably to enamel — the hard, crystalline outer layer of the tooth. When enamel has been lost — through erosion, abrasion, previous preparation, or developmental deficiency — the bonding surface is compromised. Dentine, the softer layer beneath enamel, accepts adhesive bonding less predictably than enamel. A veneer bonded primarily to dentine has a lower survival rate and a higher risk of debonding.
We assess enamel thickness at the preparation stage using clinical examination and, where necessary, radiographic evaluation. If the available enamel is insufficient to support a predictable bond, we discuss alternatives — including indirect composite, orthodontic alignment (which may reduce the need for preparation), or a decision to defer treatment until the conditions are more favourable.
Occlusal stability. Patients with unmanaged bruxism — habitual clenching or grinding of the teeth — subject their dental restorations to forces significantly greater than normal function. Porcelain is strong under compression but brittle under tensile and shearing forces. A bruxist patient wearing porcelain veneers without occlusal management will fracture them. This is not a possibility — it is a predictability.
We do not exclude bruxist patients from treatment categorically. But we require that the parafunctional habit be managed — typically with a custom-made night guard — before veneers are placed, and that the patient commits to ongoing use of the guard after treatment. Without this commitment, we will not proceed.
Caries control. Active decay — untreated cavities — must be resolved before any cosmetic treatment. Placing a veneer over or adjacent to an active carious lesion creates a clinical time bomb: the decay progresses beneath or around the restoration, eventually undermining it. The veneer fails, and the tooth beneath it is in worse condition than before treatment began.
Expectation misalignment
The fourth criterion — expectation alignment — is less clinical but equally important. It addresses the gap between what the patient wants and what ACE DNTL's clinical philosophy can produce.
Occasionally a patient presents with a clear vision of a result that our philosophy cannot deliver. The most common example is a patient who wants the whitest possible shade — a "Hollywood white" that exceeds the natural range of human dental colour. This shade exists in the material catalogue. It can be produced in the laboratory. We will not place it.
Our position is that an excessively bright shade produces a result that will look impressive in photographs and regrettable in person within two to three years, as the patient's aesthetic sensibility evolves and the cultural moment that made extreme brightness fashionable moves on. We have seen this pattern repeatedly in correction cases — patients who arrive wanting us to replace the very brightness they requested from a previous clinician.
In cases of expectation misalignment, we explain our position clearly. We describe what we can produce and why we believe it will serve the patient better in the long term than what they have described. We show references. We discuss the distinction between a result that impresses immediately and one that satisfies indefinitely.
Some patients adjust their expectations in light of this discussion. Many do. They recognise that the clinician's reluctance to deliver exactly what they asked for is a signal of clinical integrity rather than inflexibility.
Some do not adjust. In those cases, we are not the right clinic for them, and we say so clearly and without judgment. There are clinicians who will produce the result they are seeking. We are simply not among them.
What qualifying actually means
When a patient passes the ACE DNTL candidacy assessment, they are not simply being cleared for treatment. They are being confirmed as someone whose case we can approach with confidence — clinical confidence in the foundation, aesthetic confidence in the outcome, and philosophical confidence that the result will serve them well for the next decade or more.
This selectivity is not elitism. It is quality control — the same quality control that applies to the materials we use, the laboratory processes we employ, and the clinical protocols we follow. A case that should not proceed is a case that will not produce the standard of outcome our practice is built around. Accepting it would compromise not only the patient's result but the clinical standard that every other patient is relying on us to maintain.
The patients who qualify are the patients we can serve at the level they deserve. That is the only metric that matters.
Direct Answers
- What are the clinical requirements for porcelain veneers at ACE DNTL?
- Periodontal health (healthy, stable gums), adequate enamel volume for reliable bonding, occlusal stability (managed bruxism if present), and controlled caries (no active decay). Each is assessed during the consultation.
- What happens if I have gum disease — can I still get veneers?
- Not immediately. Periodontal disease must be treated and stabilised first — through professional cleaning, possible surgical intervention, and a monitoring period to confirm stability. Once gum health is established, cosmetic treatment can proceed.
- Does ACE DNTL treat patients with bruxism?
- Yes, provided the bruxism is managed with a custom night guard before treatment and the patient commits to ongoing guard use. Unmanaged bruxism will fracture porcelain veneers — this is a predictability, not a possibility.
- What if my expectations don't match what ACE DNTL offers?
- We explain our clinical position, show references, and discuss why we believe a more integrated result will serve you better long-term. Some patients adjust their expectations; those who don't are directed to clinicians whose approach better matches their vision.