Tag Archives: AACD accredited dentist

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.
Click here to read about Dr. Burba’s Beautiful Smile Guarantee.

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.

Why didn’t My Bonding Whiten?

I had dental bonding done several years ago. They started picking up stains. The dentist who did my work retired and sold his practice to someone just out of dental school. The dentist suggested we whiten them but that didn’t work. They actually look worse. Now he is talking about re-doing the bonding. I know this sounds petty, but I’m worried if he can’t get teeth whitening right he won’t get the bonding right. What do you recommend I do?

Patty

Dear Patty,

You are right to be concerned. I am not going to recommend that you have this dentist re-do your dental bonding. However, it wasn’t as much that he did the teeth whitening incorrectly as it is that he doesn’t understand how teeth whitening works.

The reason your dental bonding looked worse after he did the teeth whitening is the gel will only work on natural tooth structure. That means your natural teeth whitened, but your dental bonding did not. This is a basic principle of teeth whitening.

So, while your dentist did not do the teeth whitening wrong. he doesn’t understand the easiest of cosmetic principles. Dental bonding on the other hand is one of the most advanced cosmetic procedures a dentist has to do.

He’ll have to blend different textures, colors, and translucencies. He likely doesn’t even have enough of these in supply to do the job well. In addition, it will all have to be done freehand.

Here is my suggestion. I’d like you to look for an AACD accredited dentist. These are the top 1-3% of cosmetic dentists in the country. They will have the training, skill, and artistry to do this not just well, but beautifully.

They would have suggested you whiten first, if you want to whiten at all. This is because (as you’ve learned) the bonding color is permanent so it is better to whiten first so you can match the bonding to the color you want to stick with. You’ve already whitened, so that is one step completed.

Next, you will get the bonding done by someone who knows what they are doing.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.
Click here to learn about Porcelain Veneers.

Disastrous Dental Implant Case

I need some help. Close to three years ago, I had a full mouth reconstruction done that cost me $38,500. One by one, crowns and implants starting falling apart. I mostly have a mouth filled with implant screws sticking out of my mouth. I’ve contacted the office for a while and kept getting the run-around. Now I find out the dentist has fled the country and is currently in Egypt with no plans to come back. What do I do?

Kelly

Dear Kelly,

Illustration of dnetal implants being placed in three stages.

This is a tough position to be in. If this dentist has fled the country, it is nearly impossible for you to get your money back. Instead, what you will need to focus on is finding a dentist who has the skills to fix these dental implants.

Just having dental school training is not enough. You really need someone with advanced post doctoral training.  For example, Dr. Burba completed Dawson Academy in Florida which teaches full mouth rehabilitation, complex restorative dentistry, and occlusion.

Before you see anyone, ask them what training they have in dental implants. Don’t just go based on fees. Cheap is not affordable. Cutting corners in dental implants tends to lead to disastrous failures in the case.

Which leads me to a second issue. Make sure your second dentist is very thorough with your diagnostics. I would insist on a CT scan. Dental implants are a 3-dimensional procedure and you really need 3-dimensional x-rays. Without them, your dentist could risk placing an implant on a nerve or perforating your sinus cavity.

Finally, check the online reviews. You want to make certain their follow-through matches their credentials and that patients have had a good experience with them.

Because you want someone with artistry as well as technical expertise in order to make sure they can create a gorgeous result, it will help if they are AACD accredited as well.

On that note, please leave a review both about the dentist who did this to you and then fled the country and the practice he was with that is refusing to refund your money. This will protect other potential patients from experiencing the same lack of adequate dental care you went through.

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

Botched Tetracycline Case

I’ve had tetracycline stains most of my life. Originally, I had some work done by having dental bonding done over them, but it was time to replace them. I’d since moved to another city and couldn’t see the original dentist. My new dentist suggested we do six dental crowns because it would “hide the stains better.” I did not do adequate research and just trusted what the dentist told me. Now I regret it. The crowns show the stains underneath, especially in fluorescent lighting. Plus, you can tell these are crowns because they look so different from the adjacent teeth.

What do I do here? He’s offered to send them back to the lab, but I’m not sure the results will get any better. Is it okay to ask for a refund?

Lannette

Dear Lannette,

Tetracycline stains are among the most difficlut cosmetic procedures to do. The stains are so dark and so deep, it takes real skill to get the repair opaque enough to cover the stains while still having that natural translucent look. Your dentist likely had good intentions but was in over his head.

Warning Signs He Didn’t Know What He Was Doing

First, he suggested porcelain crowns instead of porcelain veneers. This automatically shows he is not comfortable with cosmetic dentistry. Dental crowns, for this type of procedure, means unnecessarily grinding down healthy tooth structure.

Second, he suggested only six teeth. When we study in dental school we learn about front and back teeth. The first six are considered the front teeth. However, dentists who study cosmetic dentistry, do not divide things into anterior and posterior teeth. Instead, we talk about the aesthetic zone. This is the number of teeth visible when you smile. For most patients, that is eight to ten teeth. Not six.

With those adjacent teeth showing with the dark stains, it makes it obvious your front teeth are crowns.

I agree with you that this dentist is not going to be able to make it any better. I suggest you just ask for a refund. Then go to an experienced cosmetic dentist to do this. The best cosmetic dentists are AACD accredited, so I would look there. Unfortunately, once you have dental crowns placed you are stuck wtih crowns. The good news is an excellent cosmetic dentist can make them look natural and beautiful.

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

Porcelain Veneers With an Overbite

I am finally in a position where I can get a beautiful smile. I’ve had tetracycline stains on my teeth for years, which always left me self-conscious about my smile. I wanted to get porcelain veneers but my dentist said my overbite will prevent that because my top teeth pretty much completely cover my bottom teeth. Instead, he is suggesting four porcelain crowns. I have some questions though. First, have you heard of my type of bite being an issue with porcelain veneers. Second, Do I whiten my bottom teeth to come close to matching the top?

Melissa M.

Dear Melissa,

Porcelain Veneers require real expertise.

I am glad you wrote before going through with this procedure. I have some concerns about your dentist’s qualifications to give you a beautiful result. Let’s start with his choice of treatment–porcelain crowns. When dentists suggest porcelain crowns when a patient asks for porcelain veneers, it is most often because they are not comfortable doing porcelain veneers but don’t want to admit that to their patient.

I will give your dentist credit for his creative excuse, even if it is totally invalid. When you have an overbite, porcelain veneers actually make more sense. Veneers only cover the front of your teeth and hug the sides a smidge. Dental crowns have to go around the whole tooth. If your top teeth are covering your bottom teeth, that will be a challenge.

A second issue is your dentist suggesting four dental crowns. Unless you have an unusally narrow smile, this means your adjacent teeth, with their tetraycycline stains, will be visible when you smile. Most smiles need somewhere between eight to ten veneers to get all their visible teeth.

For the bottom arch, it is possible to have some teeth whitneing done, but tetracycline stains can be pretty resistant to most whitening methods. Kor Whitening has had the best results with these type of stains.

The Key to a Beautiful Smile Makeover

The one constant in beautiful results will be tied to the dentist you choose to do your porcelain veneers. Smile makeovers are not taught in dental school. On top of that, cosmetic dentistry is not a recognized specialty. A dentist has to decide to get the post-doctoral training necessary to produce beautiful results.

In your place, you need an expecially well-trained dentist. Tetracycline stains are one of the most challenging cases. Your dentist will have to get the veneers opaque enough to cover the stains but still look translucent to give it that natural reflective shine. To get this result, I would look for an AACD accredited dentist. These are the top 1 % of cosmetic dentists in the country.

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

She Needs to Leave This “Cosmetic” Dentist

I went to see a dentist who advertises as a cosmetic dentist. I mostly wanted them whiter and brighter. I also have a slightly crooked front tooth, but it really isn’t that crooked, certainly not enough to pay for braces. I wanted to get some porcelain veneers on my upper arch. But, the cosmetic dentist I saw wants me to do Invisalign first and then get the porcelain veneers. If the tooth is only a little crooked, is that really necessary?

Madeline

Dear Madeline,

Invisalign Aligner

I want you to find a different dentist to work on your smile makeover. While I am sure he calls himself a cosmetic dentist, there are a couple of things that bother me here. You should be aware that cosmetic dentistry is not a recognized specialty. Any general dentist can call themselves a cosmetic dentist regardless of the amount training they have invested in.

I have a strong feeling your dentist doesn’t have much training. Under normal circumstances, you would either need porcelain veneers OR orthodontics, not both. Porcelain veneers, done skillfully, can make crooked teeth look straight. He obviously does not know how to do this, so he is setting up the ideal situation for himself. This does not inspire confidence in me with his abilities.

Doing smile makeovers are not taught in dental school. In order to learn how to do them well, a dentist would have to invest in significant post-doctoral training.

If you want a smile makeover done well. You want a dentist with the highest skills.

However, there is something else for you to consider. If the only thing wrong with your teeth is you need them whiter and brighter, plus there is one crooked tooth you could save a significant amount of money by instead doing Invisalign with tooth whitening. In fact, the Invisalign aligners can double as the teeth whitening trays thereby saving you even more money. Unless there is something else you want to change about your smile, that is what I would recommend.

However, if you decide you still want to have porcelain veneers done, perhaps because you want the fastest solution, then I would look for a dentist with more expertise. In fact, I would only go to a dentist who is AACD accredited. These are the best cosmetic dentists because they have the proven skills and artistry.

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

Staining on Porcelain Veneers only one year later

I had porcelain veneers done just a year ago. I was told these would last for many years. I’m actually still paying them off. Yet, they’ve already started staining. Should I be worried?

Carol

Dear Carol,

I wish I had a picture of your porcelain veneers. That would help me have a more precise idea of what went wrong. Without that, I can give you some generalities which should be helpful.

If the staining seems to be over the surface of the entire veneer, there are two possibilities. The first is that the glazing on your veneers was removed. This can happen if your dental hygienist used something like a power prophy jet or acidulated fluoride during your appointment. Both of these will damage the glazing, which does not only give your veneers their shine but protects them from stains.

A second possibility is that there is a gap between your porcelain veneers. This allows food and other bacteria to get underneath. Not only does that make your veneers look darker because of all the stuff caught underneath, but it pretty much guarantees you’ll end up with the tooth underneath becoming severely decayed.

Both of these issues are the fault of your dentist, and they should take responsibility for repairing it, which will mean replacing them.

If the staining is not all over, but rather at the top or the sides these are completely separate issues. The first problem can occur if there is a gap at the top of your veneers between that and your gumline. Like the other gap, it will cause both staining and decay. Your dentist will need to replace them.

The staining around the sides is much easier to deal with and is generally part of regular maintenance. There is usually a minimal amount of composite bonding around the edges of your teeth. The composite needs to be periodically polished. This is easily done and I would plan on doing it once a year. This is especially true if you smoke or drink staining beverages such as coffee or tea.

If the problem is one of the more serious issues that require replacement, but your dentist is uncooperative you may have to get a second opinion dentist to help you.

Sometimes a dentist is more willing to listen to a peer than a patient. I would make certain you go to an expert cosmetic dentist to tell you what is wrong with them, though. See if you can find a nearby dentist who is AACD accredited. These are the best cosmetic dentists in the country.

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

Dentist Pulled My Implant Out

I had a dental implant placed on a front tooth. I wasn’t thrilled with how it ended up looking. It was obviously fake next to the other teeth. However, it was better than having a gaping hole in the front of my mouth. A week after the crown was placed, the implant felt loose. I called the office and they told me to come on it. The dentist said the crown was likely loose and he would just rebond it. He had a little trouble getting it off until he got a tool, but when he did, the implant came out with it. Does this normally happen? He said they can re-implant it but I’m nervous.

DeeAnn

Dear DeeAnn,

No, this does not normally happen. However, in your case I am going to call this a blessing in disguise. I am having a hard time fathoming the level of incompetence this rises to. First, when a dental crown is loose, it is easily removed. He would not need a special tool at all.

It was obviously the dental implant that was loose the entire time. Because this implant was defective and unattractive, it is fortunate that your dentist accidentally pulled it out. Now you have the right to demand he pay to have it repaired properly.

Do not just ask for a refund. Instead, I want you to insist he pay to have it replaced by the dentist of your choice. This is because it will be more complicatted to replace the implant and dental crown. You lost bone when he ripped it out. That bone is necessary in order to retain your implant. In order to place it, you will need bone grafting done to build the area back up.

Finding the Right Implant Dentist

Dental implants aren’t really taught in dental school so you need a dentist who has invested in post-doctoral training. You also want to make sure that they have a high success rate with their dental implant procedures.

At the time I’m writing this dental implant failure and the consequences of poor placement is one of the leading dental malpractice suits. Ask about their success rate. I’d like you to see someone with a 95% or higher rate.

In addition to their implant training, you need to consider how skilled they are in cosmetic dentistry. You are replacing a front tooth. As you’ve discovered, getting a perfect match is essential for a beautiful, natural-looking smile. In your place, I would want an AACD accredited dentist to work on my implant crown.

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

How Do I Touch Up My Whitening Before Getting a Dental Crown

I have to get a dental crown on a front tooth. Because I read the color is permanent, I’d like to touch up my teeth. I had them whitened a few years ago and they’ve been picking up stains again recently. I asked my dentist for some extra whitening gel, but he couldn’t give me an idea of how often and long to use the gel to get my teeth back where they were.. Are there any standards for this?

Meagan

Dear Meagan,

Teeth Bleaching Trays

I’m a little concerned your dentist could not advise you on this. The principles of teeth whitening are fairly simple. It is the easiest cosmetic procedure dentists do. Given his inability to answer this question, I have serious doubts he’ll be able to provide you with a dental crown on a front tooth that looks natural and matches the adjacent tooth.

Crowns of front teeth are much more difficult because of how directly the light hits them. It takes an expert cosmetic dentist to do them beautifully. If you want to stay with this dentist for your dental crown, make sure he uses a temporary try-in paste when your crown is ready and allows you to see it in several types of lighting. If you don’t like how it looks, he needs to re-do it. Don’t let him bond it on.

You may be better served by finding a different dentist to do your crown. The best cosmetic dentists are accredited with the American Academy of Cosmetic dentistry.

How Much Teeth Whitening?

As to how much teeth whitening, the principle is fairly easy. The longer you wear the whitening gel, the faster it will whiten. If you’re in a hurry, I suggest wearing it overnight. First, that allows it to stay on your teeth longer. Second, your saliva production goes down at night which means there will be less dilution.

If you prefer wearing it during the day, that’s fine too. Just wear it for as long as you comfortably can.

The one hard and fast rule here is once your reach the level of whitening you are happy with and you are done with the whitening gel , you want to give it a week for the color to settle before having the color of your crown matched to it.

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