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dentistry

What Materials Should I Get for My Dental Implants?

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I am getting a smile makeover, but that will also include a dental implant. I know I’m getting porcelain veneers for most of the teeth, but I need some advice about the implant. Which brand is the best implant? Should I get a porcelain crown or a zirconia crown? What color would look best for someone who is fair skinned and in her 50s?

Cassie

Dear Cassie,

An image of metal and zirconia dental implants

I love that you are trying to do research and have some preparation going into your appointment. What I want to do, however, is shift your thinking. There is no way you are going to be able to learn enough about the nuances of both restorative and cosmetic dentistry to get these questions settled yourself. In fact, you could pick the best of all of these materials and still end up with a subpar smile makeover. That is because the success of your dental implant, as well as your smile makeover, will depend on the skill and artistry of the dentist doing it.

Think about it like art. If you gave both Michelangelo and me the same brand of clay and told us to create a sculpture of a woman’s face, I guarantee you that one of them would be better than the other…and it wouldn’t be mine.

What you need is a dentist who has invested in post doctoral training for both smile makeovers and dental implants. Both of these are advanced procedures. I would start by looking for an AACD accredited dentist. These are the top cosmetic dentists in the country. Once you have a list of those, look for one who also invested in dental implant training. For instance, Dr. Weiss studied at the Dawson Academy. Some other reputable implant training centers are the Las Vegas Institute for Advanced Dental Studies and the Spear Institute. There are others as well, but these three are a good start.

As for the color and type of crown for your skin tone, a great cosmetic dentist will work with you by first understanding the type of smile you want to portray to the world, then they will know the right coloring and materials to give you the smile of your dreams. So, pick the artist and let them pick the materials they’ll use to create the beauty.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Are 3N Veneers Better Than Lumineers?

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I have read some of your information about Lumineers, and other expert cosmetic dentists seem in alignment with your thoughts. My question is about 3N Veneers. I live in Europe and quite a few cosmetic dentists here say that 3N is better than Lumineers. What are your thoughts on them?

Marie

Dear Marie,

An image of a porcelain veneer being held up to a tooth.

I’m glad you wrote. I want to redirect your line of thinking. While great that you are trying to do research before investing in your smile makeover, I think you are looking at the wrong thing. Let’s look at it from an art point of view, and cosmetic dentistry is definitely an art. If you were trying to commission a sculpture to be done, would you look into the brands of clay or marble the sculptors use or the artistry of the sculptor? My guess is the artistry of the sculptor. That is how you need to approach this.

Why? Because while 3N porcelain veneers could be better than Lumineers, that would completely depend on the skill and artistry of the dentist placing them. An expert cosmetic dentist could provide you with a stunning smile no matter what brand they used. An average cosmetic dentist will give you an average smile no matter how great the brand. Plus, each brand has different strengths and qualities. A dentist who does a lot of smile makeovers will know the pros and cons of each brand.

I would focus your attention in finding the best cosmetic dentist you can. I am going to recommend that you look for a dentist accredited by the American Academy of Cosmetic Dentistry (AACD). Accreditation with the AACD is different than just membership. These dentists have passed stringent exams and demonstrated their artistry before an examination board. They’re in the top 1-3% of cosmetic dentists in the country.

One thing you can do to protect yourself is to make sure the dentist is willing to do a provisional try-in for your porcelain veneers. That means he or she will put them on with a temporary try-in paste. Then, you get to look at them in several different type of lightings. If you don’t absolutely love them, then your dentist should be willing to send them back to the lab as many times as is necessary to give you the beautiful result YOU want. They should not get permanently bonded until you are thrilled with them.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Stain on the Edge of a Porcelain Veneer

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I have four porcelain veneers. They have stayed very white and I have been pleased with them. However, there was a change after my most recent dental cleaning. There is a small gray stain at the top of one of the veneers at the margin. I am not sure if it is damaged, but do find the timing suspect. Is there a way to fix this?

Miranda

Dear Miranda,

a porcelain veneer being placed on teeth

I am at a disadavantage here of not being able to examine your porcelain veneers. However, I can give you some generalities. Porcelain veneers are both very stain resistant as well as color stable. When they do stain, it is only because of a handful of reasons. In some cases, a porcelain veneer will pick up stains on the edges where the bonding is. These can be polished out and should be considered a regular part of maintenance. Your dentist can do it quickly with special polishing strips at your checkups about once a year or so. This does not sound like what you are talking about.

Another reason for stains on porcelain veneers is on the surface if the glaze that protects the veneers is damaged. This can happen if your hygienist uses something like a power prophy jet or acidulated fluoride during your appointment. This can also happen if you use over the counter whitening toothpaste for an extended period of time. Most people don’t realize that these type of toothpastes use abrasives to whiten the teeth. If this were the type of stains you were having, it would stain over the entire surface of the tooth. If you want a whitening toothpaste that is safe for porcelain veneers, I recommend Supersmile Toothpaste.

If your porcelain veneers are older, say about ten or twenty years, you could be dealing with microleakage. In this case, stain starts right at the edge of the porcelain veneer and involves one to two millimeters of the veneer. It would confine itself to the edge of the porcelain veneer. It this is not addressed it can turn into decay. Unfortunately, the way of repairing this is to replace the porcelain veneer.

In your place, I would go to an expert cosmetic dentist who is experienced in smile makeovers, like someone who is AACD accredited, and have them look at the stain to give you a precise diagnosis.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Treating a Single Dark Tooth

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I have a pretty good smile. However, over the last few years one of my front teeth is turning darker. I went to see my dentist and he said the tooth has died and needs a root canal treatment and a dental crown. This seems a bit extreme to me, especially because there is no infection. Also, what would cause a tooth to die if I’ve had no pain?

Carrie

Dear Carrie,

before and after dental bonding

An example of dental bonding on a chipped tooth.

If there is no tooth infection, there is no reason for you to need a root canal treatment. I am not sure why your dentist suggested that. A crown is a bit of an over treqtment as well. If the tooth has turned dark without an infection, then it is likely that you bumped it lightly at some point. When that happens, it will develop a thicker dentist down the road, which gives it a dark appearance. However, the tooth will remain perfectly healthy.

With a healthy tooth, you have two osmetic solutions: a porcelain veneer or dental bonding. Both of these remove significantly less tooth structure than a dental crown.

Some highly artistic dentists will prefer dental bonding because they can gauge the color right there. Others will prefer a single porcelain veneer. Here’s the rub. Only about 2% of cosmetic dentists will be able to match a front tooth in a situation such as you are in. Please do not go to just any dentist.

My suggestion is you look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven technique and artistry and will be able to do a good job for you in this situation.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Should Porcelain Veneers Have a Hump at the Gumline?

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I wanted to fix the appearance of my two front teeth. At first, my dentist covered them with dental bonding. This ended up looking terrible. When I told her how awful they looked, she agreed to switch to porcelain veneers. My question is should they have a hump at the top by the gumline? The rest of them look okay. They certainly look better than the bonding, but this hump makes them uncomfortable. Maybe it is just because I know it is there, but I swear I can feel it all the time. This is my first time having porcelain veneers, but some of the pictures I have seen seem smoother at the top. Should I ask her to re-do them? I am starting to feel like a difficult patient.

Haven

Dear Haven,

a porcelain veneer being placed on teeth

I am very glad you wrote, if only to tell you that you are not a difficult patient. You paid for a beautiful result and you should get one. In fact, I think you’ve been overly patient. Let’s start with the dental bonding. Why did you have to tell her they were terrible? She should have realized that. A true cosmetic dentist would not be satisfied with anything but a gorgeous result for a thrilled patient.

Then, she’s tried her hand at porcelain veneers and struggled to do those right as well. This hump is not correct and can actually lead to both decay and gum disease. So, yes, these porcelain veneers need to be redone. By the way, you shouldn’t settle for veneers that are just okay. You should find them stunning.

Here’s the problem you are facing. Cosmetic dentistry is not a recognized specialty. That means any general dentist can “try their hand” at it. Unfortunately, it takes a significant amount of post-doctoral training to have the technical skill and artistry necessary to produce a beautiful and correct result. I sincerely doubt that your dentist has this training.

The best thing for you to do for the health of your teeth and gums, as well as get a truly attractive smile, is to not ask this dentist to do something beyond her ability. Instead, ask for a refund, then have this redone by a dentist who has the training necessary to do it correctly.

The easiest way to find a dentist with the artistry and skill to do your smile makeover, is to go to the American Academy of Cosmetic Dentistry (AACD) Website— aacd.com. They have a “find a cosmetic dentist” link. Make sure you check that you are looking for an accredited dentist. AACD accredited dentists have passed stringent exams and demonstrated artistry on a large number of cases before an examination board. They are in the top 3% of cosmetic dentists in the country.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Why Is This Porcelain Veneer Popping Off?

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I had some porcelain veneers placed a few months ago. Shortly after, one of the veneers on a canine tooth popped off while I was eating toast. My tooth instantly became unbearably sensitive. I went back to the dentist and he said the problem is that my bite is off. He did some shortening of the porcelain veneer and the tooth. When I asked if I needed to be numbed first, he told me it wasn’t necessary. That was a mistake. The procedure was very painful. Now, that same tooth has fallen off again. I had to go back, again because of the sensitivity. He told me the issue was still my bite and that now he needs to switch it to a dental crown. I’m a bit confused here. I was told these were supposed to last me ten years. I don’t want to destroy a tooth that is healthy. I did ask this dentist about his qualifications before going forward with the procedure. He told me he had a year training in cosmetic dentistry. What do you recommend here?

Patricia

* Note to readers. I asked who the dentist was so I could check up on this training.

Dear Patricia,

a porcelain veneer being placed on teeth

After looking up some information on this dentist, I see no post-doctoral training in cosmetic dentistry. My guess is that he is considering his one-year residency his training. This would not be adequate cosmetic training for smile makeovers even with the most liberal of definitions.

I also do not think your bite is the problem here. I think he does not know how to bond it properly. If it were your bite, then the repair he did to the bite should have fixed the problem. Plus, if a porcelain veneer is properly bonded, then if something is wrong with the bite the porcelain veneer will chip instead of fall off.

Please do not allow this dentist to put a crown on your tooth. He does not know what he is doing. Plus, your porcelain veneer can be bonded back on properly so that it will stay on. Go to either mynewsmile.com or aacd.com. These are two safe ways to get a recommended cosmetic dentist. Anyone on the mynewsmile recommendation list can bond this on properly for you. If you use the aacd site, make sure that you check the box saying that you are looking for an accredited cosmetic dentist. These are the only ones with the right credentials.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Full Mouth Reconstruction Going Badly

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I needed a full-mouth reconstruction because of how bad my smile looked. My dentist provided crowns on all my teeth, with the exception of one tooth which he extracted and placed a dental implant. When he did the temporaries for the crowns, everything seemed fine to me. However, now that the permanent ones are in things are off. Some of my teeth are not lining up properly. Because of this, it hurts when I eat. When I spoke to my dentist he said he met all the checkpoints and just to give it time. I went to get a second opinion and the other dentist said, “Oh, Dr. —- [name withdrawn] is a great dentist.” I got the feeling that he didn’t want to disagree with this dentist because they must know each other. In the meantime, I am stuck with this bite that is killing me. Is there any advice you can give me?

Laurie

Dear Laurie,

woman holding her her jaw in pain

I want to make sure I understand that your dentist gave you a full mouth reconstruction simply for cosmetic reasons. Is that right? If so, that is a massive overtreatment. A smile makeover is typically done with porcelain veneers and even then you would not put them on each and every tooth. You would only place them on the teeth that are visible when you smile. Generally, that is the eight to ten upper teeth, depending on the smile.

A full mouth reconstruction is for much more serious conditions and removes a LOT of your tooth structure. A couple of reasons for a reconstruction would be serious TMJ Disorder which does not respond to less invasive treatments; or to cover teeth that are worn down to nubs by bruxism (teeth grinding). Without a clinical reason for crowning all your teeth I would say this was unnecessary. Now, there may have been a good reason that just didn’t get mentioned because it was not relevant to your question. I just wanted to make sure.

Not that it is funny, but I chuckled a little at your dentist’s comment that he met all the checkpoints and you just need to get used to it. That is often dental speak for, “I want you to leave me alone. This is hard and I don’t know how to fix it.” Plus, I’m pretty sure any dentist should consider “My patient is not in pain” as a checkpoint. Just saying…

Occlusion, the term for how your teeth meet together, is an advanced subject. It takes post-doctoral training to understand this properly. It is very possible that your dentist does not have enough training in this area.

Getting a Real Second Opinion

I’m not surprised you didn’t have much luck with your second opinion. One of the cardinal rules in getting an unbiased second opinion is to not tell them who your dentist is. Just ask them about the way the crowns are meeting together and explain you’re in pain. If they ask before giving you their diagnosis, tell them you want an unbiased opinion so don’t want to tell them. They should understand that. When you get that second opinion, make sure you go to a dentist with the training you need. Unfortunately, there is not a recognized specialty in this type of work so you will just need to look for the right training. Two great post-doctoral institutes that instruct on TMJ and occlusion are the Dawson Academy and the Pankey Institute. Any dentist who has studied there, will be able to give you a truly educated diagnosis.

This blog is brought to you by Philadelphia Dentist Dr. Michael Weiss.

Can I Bleach My Non-Veneered Teeth?

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I have four porcelain veneers placed on my teeth. I asked for them to be really white, which they are, but wasn’t thinking about how dark the teeth next to them would look. Is there a way for me to whiten them with something like Crest Whitestrips?

Evie

Dear Evie,

teeth whitening trays

Professional Teeth Whitening Trays

I have a solution for you but I want to address your smile makeover first. Most smiles are eight to ten teeth wide, so four porcelain veneers will make your non-veneered teeth quite obvious. Because of the difference in color, it can even make the veneered teeth look fake. Don’t beat yourself up about not knowing this. It was your dentist’s job to point this out. When a patient cannot get enough teeth to cover their smile, teeth whitening is recommended before the veneers are placed. That is too late for you now, but that doesn’t mean this can be worked around.

Though, Crest Whitestrips will whiten teeth, I do not recommend them in this situation. First, the gel that they use are much weaker because they are over-the-counter. Second, they are only designed to cover your front four to six teeth, depending on the size of your teeth. Those are the veneered teeth and not what you want to whiten. It won’t damage them, but it is pretty useless.

My suggestion is that you go to your dentist and have him custom design teeth whitening trays to fit around your porcelain veneers. This will allow you to whiten your teeth much more quickly while protecting your gums and avoiding your veneers.

I hope this helps.
This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

30K Cosmetic Dentistry Disaster

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Can you help me find a different dentist. I just had a total smile makeover that included both dental crowns and porcelain veneers. This was done to fix both the damage done from my teeth grinding as well as cover my tetracycline stains. They look really opaque, which does give them a fake appearance. However, the thing I’m worried about is my jaw has been hurting. It didn’t hurt like this before the crowns and veneers were placed. I did have some low level aching because of the teeth grinding. However, now my jaw really hurts all the time. So much so that it is distracting. My dentist insists not only does everything look great but that he has passed all the check marks for proper placement. I’m at my wits end and have already spent $30,000 on this.

Laurie

Dear Laurie,

Woman Holding her jaw in pain

Under normal circumstances, it would be very hard for you to get this repaired without paying for the whole thing all over again. If the only problem is the appearance it is nearly impossible for you to get a refund. You’d think that wouldn’t be the case when you are talking about cosmetic work, but that is currently where it stands. However, you seem to be dealing with some functional issues. I don’t know how he thinks the markers for proper placement would not include your patient not being in pain.

It sounds like your bite may be thrown off a bit, which could be leading to complicating issues such as TMJ Disorder. This can work in your favor because it means that the case isn’t truly functional. We’ll go over how to get this diagnosed in a moment. First, I want to go over the difference between a general dentist and a true cosmetic dentist. Even though there is not a recognized specialty in cosmetic dentistry, there are some distinct differences.

One of those differences is the amount of training they get. Smile makeovers are not taught in dental school. In order for a dentist to truly learn the techniques and artistry required, they would need post doctoral training. Another important difference is how they treat the patient. A true cosmetic dentist would not be satisfied with the work if you weren’t. They would first do a temporary try in and allow you to look at it in several different lights and make sure you are completely thrilled with the results. Even a little hesitation would cause them to ask, “What do you wish was different?” and it would go back to the lab to make the changes.

The easiest way for you to find one of these dentists would be to go to the American Academy of Cosmetic Dentistry’s (AACD) website. They have a “find a cosmetic dentist” link. Make sure you check the box that says you want an Accredited Cosmetic Dentist. These are among the top 1% of cosmetic dentist’s in the country. Have one of them examine your case. It will be helpful if they also have TMJ training. They can tell you if your current dentist’s work threw off your bite. If that is the case, then they can help you secure a refund so you can get this done properly by a qualified dentist.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Why Do I Need Root Canals after Porcealin Veneers?

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My dentist gave me a complete smile makeover with veneer crowns. When the permanent ones were placed in, two of them had sharp pains. The dentist adjusted them about 3 times and eventually the pain went away. However, not long after those same teeth developed abscesses on the top of them. He did some x-rays and said that the nerves died and those teeth need a root canal treatment. I was a bit shocked because he never mentioned nerve damage as a possibility. He said he didn’t know why it happened and I’m just unlucky when it comes to this. Since then, three more teeth have needed root canal treatments and two more teeth are starting to hurt. I feel like each of these teeth are going to “fail” at some time. I also feel like I’ve been taken advantage of. Is there anything I can do about this?

Miranda

Dear Miranda,

Comparison of tooth preparation between dental crowns and porcelain veneers

I am going to start by clarifying some terms because there is something that has me concerned you were misled. You mentioned you received a smile makeover with veneer crowns. That is not a thing. There are porcelain crowns and there are porcelain veneers. The two of these are very different procedures. You can see that even from the type of tooth preparation necessary.

Notice in the image above, on the left side there is a LOT of tooth preparation. This is what happens when your teeth are given dental crowns. On the right, is the preparation for porcelain veneers. I believe you were given crowns for a couple of reasons. First, it is pretty much unheard of for someone to need a root canal treatment as a result of porcelain veneers. Second, you said something about the permanent ones. It is dental crowns which start with temporaries and then go to permanent. However, there are times you’re given a mock up of your porcelain veneers and allowed to try them in to see if that is what you were wanting for your smile makeover.

A smile makeover does not require the aggressive grinding down of the teeth. That is why porcelain veneers are the standard. With dental crowns, if there is too aggressive a tooth preparation the dentist risks exposing the pulp. This is what I think your dentist did. Many dentists who did not invest in post-doctoral training will do porcelain crowns instead of veneers because it is what they are more familiar with. If your dentist lied to you and hinted you were getting veneers, then you need to demand a refund as well as for him to cover the cost of the root canal treatments. If he didn’t say you were getting porcelain veneers and you just assumed that, you can still ask him to cover the root canal treatments because he is the one who ground down your teeth too aggressively.

I’m sorry you are dealing with this. For those reading this considering a smile makeover, it is always better to have a smile makeover done by someone with the right training. I would recommend you use a dentist who is AACD accredited.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.