Questions about Cosmetic Work

I want to get porcelain veneers, but have some questions. I can’t afford to get them on all my teeth, so can I just whiten them? If so, do I do it before or after the veneers? Another question I have is about Invisalign. I have a slightly crooked front tooth. When I talked to my dentist, he hinted that I may want to do Invisalign before getting the veneers. I may be wrong about this, but I thought that porcelain veneers could make teeth look straight. Was I wrong about that?

Simone

Dear Simone,

Porcelain veneer being placed on a tooth.

I am a bit concerned about the dentist you are using for this. I will say that up front. We’ll get into that more in a moment. First, let me answer your questions.

You should almost always whiten your teeth when you are getting porcelain veneers, even if it is just for your bottom teeth. Teeth whitening is even more important if you are not getting enough veneers to cover all the visible top teeth when you smile. This should definitely be done before getting any porcelain veneers. It is much easier to match porcelain veneers to the whitened teeth exactly. It’s almost impossible to stop the whitening at the perfect time.

Invisalign and Porcelain Veneers

Invisalign aligner

As for Invisalign, I haven’t seen your case, but in many cases Invisalign can make your teeth look straight when done by a skilled, artistic cosmetic dentist. The way you described your situation I would think porcelain veneers would do a fine job.

My guess is your dentist is not comfortable with that portion of the makeover, so he’s trying to convince you to pay for Invisalign to make his job easier.

How to Get a Beautiful Smile Makeover

You are not going to get the smile makeover you want with this dentist. I get the feeling he has not invested in much post-doctoral training in cosmetic work. Here is the problem you are facing. Cosmetic dentistry is not a recognized specialty. That means any dentist can call themselves a cosmetic dentist.

Even worse, doing smile makeovers is not taught in dental school. It is completely up to the dentist how much training they invest in. So, how will you go about finding a dentist skilled enough to provide you with a beautiful smile?

The easiest way is to find an AACD accredited dentist. This is a program that was started by the American Academy of Cosmetic Dentistry to give patients a way of knowing which dentists have the skills and artistry to provide you with a stunning smile. Dentists who pass accreditation are the best cosmetic dentists in the country.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.
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Dental Bonding Doesn’t Match

I had a chipped tooth and had it repaired by my dentist but the color does not match at all. You can tell he added something onto the tooth for repair. I have a few questions. One, should I go back to the same dentist to have him re-do it? Two, if I do use the same dentist, should he charge me for the color? Finally, would I just be better off finding a different dentist who can make this look right?

Susan

Dear Susan,

Before and After Dental Bonding-

As you can see from the image above, dental bonding can look completely natural and you should not settle for anything less. Here is my advice. First, I would suggest giving your dentist one more chance at this. It may be a skill he’s been learning and we all have to develop new skills.

Dental bonding in particular is a difficult skill. It has to be done freehand. When you have him re-do it make sure he understands that if it doesn’t match this time, you would like a refund but you wanted to give him a chance to get it right.

As to your second question, no, you should not have to pay to have him repair the color. Part of what you paid for originally was dental bonding that blended with your natural tooth structure. He should understand that.

Finally, if it doesn’t work out or he does not even want to try again, that is when you should get your refund and go to a more experienced cosmetic dentist.

The best cosmetic dentists are AACD accredited. Though, not every state will necessarily have an accredited dentist nearby. If you can’t find one, the dentists listed on mynewsmile.com are excellent as well.

By the way, if you want to whiten your teeth, the time to do it is now before you have the repair redone. I’d talk to your dentist about that as well. This way the bonding can match the whiter color. It will not whiten after it is bonded.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dentist Said My Tooth Moved with My Porcelain Veneer

I need some advice. I had a chipped tooth that had some dental bonding on it, but the bonding was old and discolored and needed to be replaced. I went to my family dentist and she said you can’t replace dental bonding that we’ll need to do a dental crown instead. I didn’t want to grind away an entire tooth, so I suggested she do a porcelain veneer instead. In anticipation that I would whiten my teeth afterward, we had the shade made a little whiter than my other teeth. When it came in, it looked fine and then she put it on my tooth. She said everything looked great, but I didn’t get to see it. When I got to the car, I looked in the mirror. I was a bit concerned because it looked like it was a millimeter or two too long and there is a gap between the back of the veneer and my actual tooth. I’m afraid that will get decay. I thought maybe it just looked that way because of the angle of my rearview mirror and went home to look at my bigger, magnified mirror. It was the same. When I called her she said that they can close up the gap, but nothing can be done about the length. She tried to say my tooth must have moved. Really? From the distance of her office to my car? I have a feeling I am not going to like the fix. What should I do?

Mazie

Dear Mazie,

It is sad how often we hear stories like this. Not many family dentists actually know what they are doing when it comes to cosmetic dentistry. One of the problems patients face is there is not a recognized specialty in cosmetic dentistry, so they are left guessing which dentists invested in the training and which did not. Yours obviously did not.

There were several mistakes made here. First, dental bonding can, in fact, be replaced. She likely just said that because she did not know how. Second, if you were anticipating doing teeth whitening, she should have had you do it before having the porcelain veneer done so you could get a more accurate match. Porcelain veneers are much more precise than teeth whitening. Finally, her bonding was off. In my opinion, she must have known that, otherwise why didn’t she show off the result to you when she finished? A dental office without mirrors? I doubt it.

It is much easier to seat a crown on a tooth. You just slip it on. A porcelain veneer has to be carefully positioned and then cured into place. Somewhere there, she messed up. Rather than admit it, she tells you it looks great. That is not cool. Not cool at all. An ethical dentist would have admitted their mistake. But, no, she was willing to let you go on with a protruded veneer that makes you look weird and puts you at risk of decay.

Now, every dentist has probably seated a veneer incorrectly at one point or another. The problem is not the mistake, it is how she responded to it. If the only thing wrong with the veneer was the length, then she could just have trimmed it. She didn’t even offer that, because she knew the problems here were more substantial and the entire veneer needed to be re-done.

In cases where a skilled, ethical cosmetic dentist has this problem, they would tell you what happened, show you the result, then schedule for you to come back at your earliest convenience to have it redone.

Getting this Porcelain Veneer Done Right

What you will need to do is go to an expert cosmetic dentist and have them document with photographs the problems with this tooth. Look for either an AACD accredited dentist or one recommended on the mynewsmile.com website. Both sets are expert cosmetic dentists. They can arm you with what you need to secure a refund. Then, have the true cosmetic dentist fix this tooth in a way that is beautiful.

This blog is brought to you by Boston Cosmetic Dentist Dr. Randall Burba.

Replacing Baby Teeth with Dental implants

I am 16 years old and none of my canine teeth have come out. I had the bottom ones removed but the adult teeth behind them grew pretty far behind and it looks weird. I don’t want that to happen with my upper teeth. They show when I smile and that would be too embarrassing. I was thinking maybe I could remove those teeth and put dental implants in their place. Would that work?

Avery

Dear Avery,

I am impressed by how you are handling this. Though, I will admit I’m sad that you are having to do this on your own. Any decent pediatric dentist would have dealt with this years ago.

How you proceed with this will depend on what is actually going on with the adult teeth. If they are there but just impacted, then your dentist can do something to open the area. However, dental implants will not be an option. These only work to replace missing teeth. If you have teeth there, then you need a different solution.

If they are in a position where they’d come in crooked like the bottom teeth were then I suggest you see an orthodontist who can help them erupt properly.

If you have congenitally missing teeth, meaning that the baby teeth never came in, then dental implants are a possibility. However, you will want to wait until your jaw is completely developed in order for it to be a successful treatment.

That doesn’t mean you will have to go with baby teeth or missing teeth until then. You will need time to get the remainder of your teeth moved a bit anyway in order to make room for your replacement teeth. In that case, I would get something like Invisalign. Then, you can use a dental flipper to temporarily replace the missing teeth until your jaw is ready for the implants.

The best thing you can do is get to a dentist who can help you work through this.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.