Tag Archives: finding an expert cosmetic dentist

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.

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.

Porcelain Veneers are Too Shiny

I have the weirdest problem with my porcelain veneers. They look at bit off and I think it is because they are too shiny. It’s more of an unnatural shine. I wish I had gotten to see them before they were bonded on because maybe I would have noticed it. My dentist says they’re fine and I’m just used to stained teeth. However, I do know the difference between color and shine. Is there anyway to take away some of the shine?

Amanda

Dear Amanda,

Based on some things you said, I think the biggest thing that went wrong with your case has more to do with the skill of the dentist you choose. Most patients don’t realize that cosmetic dentistry isn’t a recognized specialty. Unfortunately, smile makeovers aren’t really taught in dental school so it is up to the dentist to invest in the training that will enable them to create stunning smiles.

Teeth with a natural shine

If you look at the teeth above, you can see that they are not uniform in either color or texture. There are ridges and bumps, as well as difference in opacity from the top to tip.

Your description makes me think your dentist did not add that texture that is necessary to make it look natural. The result will be flat teeth that look excessively shiny.

The only way to remove the shine is to have your hygienist use something like a power prophy jet or acidulated fluoride on your porcelain veneers. However, I am not going to recommend that. It damages the protective glaze on the veneers. This does more than give your veneers their shine. It also protects them from picking up stains.

Once that glaze is removed, your teeth will quickly start to pick up stains. Teeth whitening won’t work on this.

My suggestion is to ask your dentist to re-do the veneers. You paid for a beautiful smile and didn’t get one. An expert cosmetic dentist will not be satisfied if you are not.

When he re-does the veneers, make certain he uses a temporary try-in paste so you can see them in your mouth in several different lights. If you don’t love them, they need to go back to the lab. He should not permanently bond them on until you are thrilled with them.

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

Covering Tetracycline Stains Attractively

My sister and I both have tetracycline stains. Years ago, she had hers covered by porcelain veneers. At the time, the only way to cover the stains was to make the veneers more opaque. I am hoping that there have been some developments in the technology which will enable the porcelian veneers to look more natural. Is that a possibility?

Dinah

Dear Dinah,

The ability to make porcelain veneers look natural has been around for many years, even when your sister had hers done. The problem lay in the dentist who did the work for her.

Porcelain veneers are an advanced cosmetic dentistry procedure which takes extensive post-doctoral training to do well. Combine that with tetracycline stains, which are among the hardest types of stains to cover and you have a recipe for disaster if you don’t use a truly trained dentist.

Unfortunately, there isn’t a recognized specialty in cosmetic dentistry, This means any general dentist can call themselves a cosmetic dentist. When an inexperienced cosmetic dentist try to do a tetracycline case, they usually make one of three mistakes. Some are so concerned that they can’t cover the stains that they insist on doing porcelain crowns, which unnecessarily grinds down healthy tooth structure. Even then, they don’t get a beautiful result.

A second issue is they do what happened to your sister and make them too opaque in an effort to cover the stains. Finally, some dentists just do the veneers as they always have and the stains show through.

Without a specialized degree, it hard for patients to know which dentists have the requisite training and which do not. That is where the American Academy of Cosmetic Dentistry (AACD) created a way to help patients with this conundrum.

They began an accreditation program whereby dentists can prove they have what it takes to do the best work possible. In addition to taking stringent exams, the candidates also have to provide visual evidence for a large number of cases they have personally done in order to demonstrate their artistry. AACD accredited dentists are the best cosmetic dentists in the country.

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

A SErious Case of TMJ Disorder

I need some advice. In my late 20s I had all my teeth crowned because of severe teeth grinding. I don’t think it was done properly because those ended up ground down as well. In addition, my teeth are now on a slant and I have massive jaw pain. I became desperate and sought out a neuromuscular dental specialist. I didn’t know that wasn’t a real specialty and now worry I’ve been duped.

He had me in an orthotic for 2 years that opened up my bite too much. I’m worse off than I was at the beginning. I need to get this fixed. Here’s my questions. First, if there isn’t a specialty, how do I know who to go to for treatment? Second, do I have to choose between form and function? By that I mean is it possible to get someone who can give me a properly functioning smile that also looks good?

Marcy

Dear Marcy,

woman holding her jaw in pain

You’ve already learned some hard lessons. I’m sorry about that for you. I wish your dentist in your twenties would have recognized your teeth grinding and been proactive instead of allowing them to be ground down so far that it required you to get a full-mouth reconstruction. He or she gave you very poor care.

Now onto your questions. I am actually going to answer the second one first. You absolutely do NOT have to choose between form and function. It will take finding the right dentist, but there are dentists who are qualified in both treating TMJ Disorder and skilled in creating beautiful smiles. How you go about that will answer your first question.

Who Should Treat Your TMJ Issues

You want a dentist who has done post-doctoral training. The training that is given in dental school isn’t enough. Here are some of the top post-doctoral training centers for TMJ Disorder:

  • Spear Institute
  • The Dawson Academy
  • The Las Vegas Institute of Advanced Dental Studies

Once you’ve found a list of qualified TMJ dentists, you’ll want to see what type of cosmetic dentistry training they have. Ideally, you want a dentist who has achieved accreditation with the American Academy of Cosmetic Dentistry. AACD accredited dentists are in the top 1% of cosmetic dentists in the country.

It isn’t always easy to find a dentist with both of those qualifications in every area. If you’re having trouble finding a TMJ dentist who also is AACD accredited, you can also look on the mynewsmile.com website.

They have a “find a cosmetic dentist” link. This site is run by a retired cosmetic dentist and he pre-screens all the dentists who want to be listed for both their technical training as well as their artistry. They can’t just pay to be listed, they have to be qualified. On the list are many AACD accredited dentists as well as those who are on their way to accredidation, which takes years, and equally qualified.

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

Gum Inflammation after Porcelain Veneers

I recently had a smile makeover done. The results improved my smile, so I’ve been very careful to be diligent with my oral health care. Since then, my gums have become inflamed. I went back to the dentist after a month and the hygienist tried to blame me for not brushing enough. When the dentist came in he did remove some excess cement which helped a bit. Should I ask for a recommendation for a periodontist?

Liza

Dear Liza,

It is infuriating when dentists blame the patient. We have always found when we do a smile makeover with porcelain veneers, the patients love their new smiles so much they are even more diligent with their care than they were before. It is much more likely that the dentist did something wrong. In fact, I know yours did.

Inflammed gums with porcelain veneers would fail an AACD accreditation review.

If a dentist is trying to obtain accreditation through the American Academy of Cosmetic Dentistry, one of the things the review committee will look for, in addition to the beauty of the results, is the health of the gums. For instance, if the picture above would have been submitted, it would have failed because the two lateral incisors are inflamed.

You mentioned that your dentist removed some dental cement at a one-month follow-up appointment. This should have been done at the initial appointment. A skilled cosmetic dentist will cure the cement in the center of the porcelain veneers and then remove the excess cement while it is still soft and cannot irritate the patient’s gums.

One issue, if your gums are still irritated after he removed some cement, that means there is still some there that needs to be removed. If that isn’t the issue, it could be that the margins of the veneers are off. This means the veneers aren’t flush the way they should be.

When the margins aren’t properly set, then things can get trapped there causing both irritation to the gums as well as decay underneath the veneers.

Getting to the Bottom of the Problem

You mentioned going to a periodontist. While they are gum disease specialists, they will be unlikely to be able to tell you what is the root cause of the problem. If it is the margins, the porcelain veneers will need to be re-done in order to protect your teeth.

I’m going to suggest that you have an expert cosmetic dentist look at this. Either go to an AACD accredited dentist or one recommended by mynewsmile.com. These dentists are all pre-screened for their technical knowledge as well as their artistry. They will know exactly what is wrong with the veneers and can advise you on what your next step should be.

If it turns out the margins are the problem and the dentist needs to re-do them, it should be done at your dentist’s expense, not yours.

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

Did Dentist Damaged My Porcelain Veneers

I had six porcelain veneers made. I liked them but noticed a small scratch on one. I called the office and he had me come in the next day. He did something to get the scratch out of it. It looked fine at first, but then I noticed the next day (why is it always the next day instead of in the office?) that the spot where he removed the scratch is a bit less dull than the rest of the tooth. I’m worried this part is somehow damaged. Will this be a problem?

Karlie

Dear Karlie,

porcelain veneer being placed on a tooth

Yes, this is a problem. It sounds like your dentist removed the scratch by simply grinding down the veneer and removing the glaze with it. This is quite an amateur move on his part and it leaves your porcelain veneer susceptible to staining in that one spot.

The glaze is what protects your porcelain veneers from picking up stains. This needs to be repaired. Your dentist has two choices at this point:

  • His first option is he can polish the veneer where he damaged the glaze in order to restore it. However, this requires some equipment he may not have. We’ll talk about how he can do this in a moment if this is what he chooses.
  • His second option is simply replacing the damaged porcelain veneers at his expense. This is costly, so my guess is he’ll choose the polishing option.

Polishing a Damaged Porcelain Veneer

What I recommend he gets if he doesn’t already have the equipment is Brasseler’s Dialite porcelain polishing system. He will start off with a polishing paste, but then will need to end with the ultra-fine diamond polishing paste.

Often family dentists just dabble in cosmetic dentistry so they have some basic skills and not the expertise needed to do a fantastic job.

It sounds like you are at least happy with the look of your porcelain veneers before he damaged them. Others aren’t so fortunate. We’ve had quite a few new patients in our office who came in simply because their dentist provided them a disastrous smile makeover and they needed the entire thing re-done by a more experienced dentist. Even worse, it is totally up to the dentist whether or not they are willing to provide a refund.

If you have a friend who is also wanting a smile makeover, you would be a great friend to them by recommending they go to an AACD accredited cosmetic dentist to have theirs done. I guarantee the results will be stunning. These are the dentists who have invested in a lot of cosmetic training and have developed their artistry and technique.

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

My $30K smile Makeover Makes Me Look Like Wallace & Grommit

I am devastated. I had teeth that were a bit small and hard to notice when I smiled. I wanted to get porcelain veneers, but my dentist said getting porcelain crowns instead could make my smile look bigger. As that was what I was going for, I agreed. He placed a dental crown on every tooth . The best way I can describe it is I look like Wallace from Wallace & Grommit. I can’t even close my mouth anymore and it is making my mouth so dry it is painful. Is there anything that can be done? I spent my life savings on this.

Lizzie

Dear Lizzie,

Wallace & Grommit

I placed an image of Wallace and Grommit here for the benefit of those who may not be aware of who they are. I can see why you are so devastated. Based on some things you said, I have a strong suspicion your dentist was in over his head.

The Bad News

The porcelain veneers you originally requested would have done the job of making your teeth look bigger without having to damage so much healthy tooth structure.

Many inexperienced cosmetic dentists will discourage a patient from porcelain veneers and suggest porcelain crowns instead because it is a procedure they are used to doing. Unfortunately, even doing something familiar, like porcelain crowns, requires extra training to do beautifully.

Even worse (for patients especially), doing smile makeovers isn’t something taught in dental school. Instead, a dentist has to invest in a significant amount or post-doctoral training. It doesn’t sound like your dentist invested in this.

In addition to his lack of training, he didn’t just try a smile makeover. Crowning every tooth is known as a full mouth reconstruction. It is one of the most advanced things a dentist can attempt. Getting the bite to come together properly (known as occlusion) requires bringing together a lot of factors. He seems to have missed the boat.

The Good News

If the only thing wrong with your smile makeover was the appearance and the function of your smile was okay, you would be completely out of luck. I hate to say it, but the fact that you can’t quite close your mouth and are now suffering from severe dry mouth works in your favor.

Your teeth depend on the saliva in your mouth to keep them healthy. It is a little known fact that there are minerals in our saliva that help to fight decay. When you have dry mouth, it puts your teeth at risk. Because your dry mouth is a direct result of your full-mouth reconstruction, it will have to be re-done.

Getting Your Smile Makeover Re-Done

Your current dentist is in over his head. This leads me to believe he is unable to fix this properly. Instead of asking for him to re-do it or even a refund, I want you to have him pay for it to be re-done by the dentist of your choosing.

The downside is, you are stuck with dental crowns. There is no way to grow back that tooth structure he removed for the crowns so you can have porcelain veneers. However, a skilled and artistic cosmetic dentist can create a stunning smile with porcelain crowns.

In your place, I’d look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. These are the top 1% of cosmetic dentists in the country. You are pretty much guaranteed to get a smile you can’t wait to share. In fact, some of them even have a beautiful smile guarantee.

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

Worried This Dentist Can’t Do Porcelain Veneers

I had some dental bonding on my front teeth that needed to be replaced. I had since moved and am going to a new dentist. I thought the new bonding would look like the original, but they actually looked awful. The dentist felt she could do a prettier smile if we did porcelain veneers. I thought that would be okay. I’m in the temporaries right now. They have a hump on the top which worries me. Is it supposed to be like that? I saw a picture of some Dura-Thin veneers and they didn’t seem to have that hump. What do you think?

Olivia

Dear Olivia,

A single porcelain veneer being placed

I can understand your concern. To answer you question bluntly, no it is not good for your porcelain veneers to have a hump. It is not just visually unattractive , but it is hygienically dangerous. The hump will trap bacteria and plaque. That will lead to gum inflammation, decay, or even gum disease. Your dentist should know that.

Another thing which worries me is that she couldn’t get the dental bonding to look good. An artistic cosmetic dentist could get DuraThin, bonding, or any other brand of porcelain veneers to give you a gorgeous smile makeover.

You’ve got two choices here. You can tell her you’d like to transfer your case to another dentist and then have a cosmetic dentist with more expertise and artistry. Your second option to give her a chance to get it right.

If you decide to give her a chance, here is wha tyou need to make sure happens. First, she needs to let you see the permanent porcelain veneers in your mouth BEFORE permanently bonding them on. She can do that using a temporary try-in paste. If you don’t love them, and I mean really love them, then she shouldn’t bond them in.

Don’t let her try to tell you they will look better after they are bonded on. They won’t. Also, don’t let her tell you they can be adjusted after they are bonded on. They can’t. If she can’t get it right, then you really do need to switch.

Finding an Expert Cosmetic Dentist

There isn’t a recognized cosmetic dentistry specialty, which makes it hard for patients to know which dentists have done post-doctoral training and which haven’t. Additionally, not every dentist has the artistry necessary.

One way to be certain you can find a great cosmetic dentist is to look for one who is AACD accredited. These dentists have passed stringent exams as well as having to submit a large number of cases they’ve done for visual inspection of both their technical expertise and artistry.

Any dentist who passes accreditation has years of experience and can create stunning smiles. That’s who I would go to if you switched.

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

Dentist Feels I’m Too Picky

I had to get a dental implant on a front tooth. The implant itself has done fine but I’ve had the crown replaced three different times. My dentist hasn’t been able to get it to match the adjacent teeth. She said it’s because my teeth are between two shades and I’m being too picky. She also said if I keep having her remove it, I risk losing the implant itself. That scares me. Am I being too picky? Should I just accept that false teeth can’t match perfectly?

Lanie

Dear Lanie,

Woman covering her mouth
Your dental crowns can match

One thing I want to tell you right up front is that you are not being too picky and it is possible for your implant crown to match the adjacent teeth. That being said, it may be above the skill set of your current dentist.

Matching a single front tooth is challenging even for the most expert of cosmetic dentists. They often have to do several try-ins before they are satisfied it matches properly. Notice I said “try-ins”. There is a temporary try-in paste your dentist could have been using this entire time instead of permanently bonding it on and then having to pry it off.

Don’t buy into the fear your dentist hinted at. Your dental implant will be safe having the crown replaced. However, you may have to go somewhere else to have it done.

Matching Your Dental Implant Crown

It’s very possible the color of your teeth is between two standard shades. That happens a lot. However, the tooth can still be made to match. While using one of the standard shades is fine for a back tooth, front teeth need some artistry. Below is a color map a dentist would provide for a ceramist to show them what tints to place and where in order to shade the tooth properly and get it to match seamlessly with the teeth beside it.

color map for a cosmetic tooth
Color Map

Your best bet at this point is to ask for a refund on the crown portion of your dental implant procedure. Then, find an AACD accredited dentist. They’ll be able to provide you with a beautiful, natural-looking porcelain crown that matches perfectly.

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