The Cosmetic Dentistry Blog

August 10, 2012

Do cosmetic dentists have to be artists if they outsource their porcelain work?

Dear Dr. Hall, How does one find a good cosmetic dentist that can do good bonding work? Most cosmetic dentist outsource their veneers and crowns to labs, but bonding is in the hand of a dentist. How do we filter the good and the bad? Does your list of referred dentist look at bonding work, in addition to veneers and crowns?
James from San Francisco

James,
Yes, the excellent cosmetic dentists that I recommend, for the most part, will also do beautiful direct dental bonding work. I say “for the most part,” because even some excellent cosmetic dentists don’t like doing direct bonding, but I would say that 90% of them do.

But I’d also like to address this question about “outsourcing” of their porcelain veneers and porcelain crowns to labs, because some people have the mistaken notion that if it’s a great esthetically inclined dental lab, it doesn’t really matter who the dentist is because it’s the lab that creates the porcelain work. I guess they think of it like buying artwork from a gallery – it doesn’t matter which gallery you bought it from, it only matters who the artist is.

But there are a couple of reasons that this isn’t true.

First of all, a great dental ceramist cannot really work around a poor dentist to produce a beautiful final result. The dentist starts by preparing the teeth and planning out the case. How the tooth is prepared and the quality of the tooth preparation as well as the quality of the impression that is sent to the laboratory is critical to the success of the case. Then the dentist is the one who writes the prescription, giving detailed instructions about the shade map of the final result, the surface texture, the degree of translucency, a mock-up of the final result desired, and a lot of other details. And then when the work comes back from the lab, it’s the dentist who approves the work and decides whether the case is ready to be bonded onto the patient or needs to be sent back to the technician. No, while a great laboratory technician is required for a great final result, there is too much that the dentist does for the case for an artistic laboratory technician to be able to produce a beautiful result in spite of the dentist.

Second, a dentist without a great artistic eye will not use the services of a great ceramist. Those services cost more, and it just doesn’t happen that you would get a “great ceramist – poor dentist” matchup. Oh, there are some dentists who are not very good cosmetic dentists who will use a name brand laboratory like DaVinci or Microdental in California to impress their patients, but those are large dental laboratories with large numbers of ceramists of varying levels of ability, and they will not assign their best ceramists to work with dentists whose work they perceive to be of lower quality. I’m sure it’s not something they talk about, but it doesn’t happen that way.

So pick the artistic cosmetic dentist, and that dentist will assume responsibility for the quality of the final result. That is the way for a patient to get beautiful cosmetic dentistry.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

January 22, 2011

How long do resin veneers last?

Filed under: Tooth bonding,Toothpaste — Tags: , , , — mesasmiles @ 7:09 pm

Dear Dr Hall Hope you don’t mind a question from across the other side of the world! I came across your website and thought I should order some of the supersmile toothpast that you recommend. My question is, have you heard of resin veneers lasting a very long time, i.e. 10 years and counting? I’m worried that they might all start to deteriorate at the same time! Many thanks for your time – much appreciated.
- Ruth from Adelaide

Ruth,
Do not mind questions from you Aussies. This makes two from Australia this month.
It isn’t unusual to see porcelain veneers lasting ten, even twenty years. I had some patients I watched for about 15 years after doing their porcelain veneers and never saw them “wear out.”  

Resin veneers require much more care. Their surfaces can get dull very easily, and I have seen some start to get dingy within a year or two. But you do extend their life by taking care of them well, and gentle yet powerful Supersmile toothpaste gets stains off without abrasives. Whenever any of my patients had extensive composite resin work, I gave them a free starter tube of Supersmile, and I encouraged them to use that as their only toothpaste.

And I would watch that your dental hygienist doesn’t use anything abrasive in your cleanings. They typically use pumice to polish your teeth, but this will scratch the resin veneers. Aluminum oxide polishes can help restore their luster.

Thanks,
Dr. Hall

Links: read more about care of porcelain veneers. Read about post-operative instructions for care of dental bonding and resin veneers.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

November 8, 2010

Can I whiten my dental bonding?

Filed under: Tooth bonding,Tooth whitening — Tags: , , — mesasmiles @ 6:51 pm

Dr Hall,
I have bonding on my two front teeth. The bonding is about 14 years old and should be replaced but I dont have the money at the moment. I understand that bonding doesnt change color with bleaching. My questions is can I atleast bleach the bonding back to its orginal color? Will the white strips change the color at all?
- Robert from Philadelphia

Robert,

No teeth bleaching will get your dental bonding any whiter. It will only make it look worse because it will whiten your natural teeth and won’t affect the color of the bonding.

It’s possible that the bonding could be made to look better with a little polishing. If the discoloration of the bonding is from external stains and is not internal to the bonding material, it’s possible that the discoloration could be polished away by an expert cosmetic dentist.

Otherwise, it would have to be replaced.

If you’re short of money, it would be smart to wait. Don’t go looking for bargains in cosmetic dentistry, especially with dental bonding. It requires artistic talent to do that right, and most dentists don’t even have the materials on hand to do that right. We list several excellent cosmetic dentists in the Philadelphia area, and I would go to one of them if it matters to you how this looks.

Dr. Hall

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

August 28, 2010

A small chip in a front tooth

Filed under: Porcelain veneers,Tooth bonding — iowasmiles @ 6:55 pm

Dear Dr. Hall,
I have few questions and I hope that I will get answers to them as soon as practicable. I really have healthly, white and nice looking teeth but last week i hurt my front upper tooth with glass (club was crowded and somebody push me). Breakage is really small, i don’t think it’s more than 2mm wide and 1mm long. breakage is virtually impossible to detect by someone else but i can see it and that bothers me. I consider porcelain veneer and i have few questions about veneer.

1.How natural veneer can be? I don’t want that veneer looks unnatural, is it possible that veneer have the exact shape like my natural tooth? 2. Color of the veneer can be perfectly like my other teeth? I don’t want and I don’t need any smile makeover I just wanna close that fracture. At the end, do i really need veneer for that small gap? (your opinion) I hope you wiil respond to this mail, Thank you in advance!
- Luka from Croatia

Luka,
A porcelain veneer, if done by an expert cosmetic dentist, looks very natural. But if done by your average family dentist it can look very fake. In your case, where your chip isn’t too noticeable, you could end up looking worse than if you had done nothing.

If you have a small chip in a front tooth, the best way to repair that is with composite bonding. The dentist just roughens the surface near where you tooth chipped, and applies a composite material that is bonded to the tooth. It can last a long time–years. If the repair is small, it doesn’t take a lot of artistic talent to get it to look good. Larger repairs require some artistic ability to get them to blend in with the tooth and look natural.

I hope this is helpful.

Dr. Hall

About David A. Hall

August 3, 2010

I have one tooth turning dark

Filed under: Porcelain veneers,Tooth bonding — iowasmiles @ 6:31 pm

When I was young I fell while skating and chipped my front tooth. I have a small filling in the left corner that has been there for many years. As I have gotten older (57) my front tooth is getting darker. I have talked to my regular dentist and he feels is could be risky to do a crown as the tooth is dead and the canal has calcified. I felt Lumineers was a great solution to this is problem but he said I would be unhappy with this procedure, and there have been problems with this. My tooth is getting darker and it makes me not want to smile. Any suggestions?
- Sally from California

Sally,
Lumineers is just a particular brand of porcelain veneers, so I will answer your question by talking about porcelain veneers in general.

I am getting the feeling from what you’re telling me that your dentist is uncomfortable with these cosmetic procedures. Porcelain veneers are usually not taught in dental school, and, while they work great for dentists who know how to do them, they can be intimidating for dentists who don’t. I think this is where your dentist is coming from.

One firm rule I always tell people is to not ever push your dentist out of his or her comfort zone. I have received so many e-mails from people who have really gotten burned trying to do this. Dentists are trained not to let you know when they are uncomfortable because it makes patients nervous. You’re lucky that your dentist is giving you these clues. He feels you would be unhappy with the result, and in his hands, you may well be unhappy. But porcelain veneers are a very beautiful restoration when done right.

So my advice is to stay with your regular dentist for your cleanings, checkups, and general dental work, but to find an expert cosmetic dentist to solve this particular problem.

If you otherwise love your smile and the only problem is this one dark tooth, then if it were me doing it, I would just do either direct bonding or one porcelain veneer over this tooth. If there are other things you don’t like about other teeth, then a full set of porcelain veneers may be in order. But find a true dentist/artist for this. Go to our list of recommended Northern California cosmetic dentists. If you’re not convinced you need an expert, please, for your own sake, take the time to read through some of the cosmetic dentistry horror stories that people have told me, and then you’ll be convinced that the average dentist on the corner is no place to go for this appearance-related work.
- Dr. Hall

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About David A. Hall

May 22, 2010

Want to save money on a new smile by doing bonding instead of veneers.

Filed under: Tooth bonding — iowasmiles @ 9:50 pm

Dr. Hall,
My mature daughter is thinking of having veneers applied to her two canine teeth which are ‘peg’ teeth, and her dentist wants to do all four front teeth at quite a price. From what I have read on your website, you do not recommend bonding (which she had done many, many years ago – about 25 years – and are no longer satisfactory). Question: Since she cannot afford to have the veneers done all at once, and since it appears that the two canines will need to be bonded anyway to accommodate the veneers, do you feel she would be better off to have all four teeth bonded now (at 1/5 the cost of veneers) and repeat the process every five years or so?
- Donna from Florida

Donna,
First of all, I probably wouldn’t recommend that she go to “her dentist” for this work. Somewhere around 98% to 99% of family dentists are not artistic enough to do a smile makeover. So I would start with a second opinion from an expert cosmetic dentist – unless she has lucked out and her dentist is a highly qualified cosmetic dentist.

Second, if this bonding is going to cost 1/5 the cost of veneers, I seriously question the quality of it. It takes as much time to do direct bonding that looks good as it takes to do porcelain veneers. Either this dentist is giving you a ridiculous sale price, or the dental bonding is not a very high quality. Beware.

I’m suspecting, if these teeth are “peg teeth,” that they are actually lateral incisors and not canines. That would explain about the four veneers being suggested – the two lateral incisors and the two central incisors. Why does she need the four veneers? Maybe the reason is that this dentist doesn’t have the confidence that he or she can match the two veneers to the existing teeth.

Pardon me if I’m off base on any assumptions I’m making. I would need more information to make an accurate recommendation. If I knew who the dentist was and what he or she expects to accomplish with the extra veneers, I could be more helpful. But if what I suspect is true is indeed true, that this dentist is only a family dentist who does some cosmetic dentistry, then I would recommend one of two options:

1. Go to an expert cosmetic dentist and get two porcelain veneers. If the dentist is good at cosmetic dentistry, most cases of peg lateral incisors can be corrected with two porcelain veneers and maybe some minor shaping of the adjacent teeth.
2. If you want to get by as cheaply as possible, for now have this dentist slap on some composite on these peg teeth and get by with this for a year or so and then later go somewhere and get it done right, so it really looks good.

I hope this is helpful.
Dr. Hall

Links:
Gentle dentistry Los Angeles from Dr. Robert Thein
Los Angeles teeth bleaching is also from Dr. Robert Thein

About David A. Hall

April 12, 2010

Solution for brown fluoride stains

Filed under: Tooth bonding,Tooth staining — Tags: , — iowasmiles @ 6:50 pm

Dr. Hall
My son has brown fluoride stains on his front teeth. We have had a local dentist bleach his teeth but the stains are still evident. She recommends veneers but I wonder what the difference in cost is between bonding and veneers? Also can you recommend a cosmetic dentist in Amarillo, TX. Amarillo is the closest city to our small hometown.
Doreen in Texas

Doreen,
Don’t have the dentist who did the bleaching do the veneers or the bonding. She doesn’t sound like she knows what she is doing. It sounds like you have figured that out.

Teeth bleaching doesn’t work for splotched teeth. I shake my head every time I hear one of these stories, that another dentist doesn’t know how to do this.

Depending on the extent of the stains (these fluoride stains are called fluorosis), yes, direct dental bonding may be the best thing – this would cover up the stains. And thank you for asking for our recommendation. But even Amarillo is a problem. I just looked there again and can’t find anyone I would recommend.
And, as I check a map, I see that you are clear out in a remote rural area of the Texas panhandle. I know it’s going to be a 4-5 hour trip, but if you want this done right, I would really suggest you go to Oklahoma City. Very few dentists are going to know how to do this right, and they tend to gravitate to larger cities. In Texas, they go to Dallas, Austin, San Antonio, Houston, and other parts of east and central texas. I have looked in West Texas and only last month did I finally find someone in Lubbock that I would refer patients to. And we can’t yet find anyone in Amarillo.

Dental bonding is an art. It has to be done freehand, and they simply don’t teach it in dental school. And dentists have to be passionate about appearance-related dentistry to know how to do it well and to stock the materials on hand to be able to do it right.

I would recommend Dr. Michael Forth in Edmond, OK. That’s a northern suburb of Oklahoma City. He does beautiful work.
Good luck,
Dr. Hall

Read more about stained teeth.

About David A. Hall

March 20, 2010

A case of serious overtreatment?

Filed under: Crowns for front teeth,Second Opinions,Tooth bonding — iowasmiles @ 6:30 pm

Dr. Hall,
I had bonding placed on my 6 front top teeth for whitening purposes. Since then it has chipped off. I relocated to South Carolina and went to a dentist here. He told me that my teeth are stained inside and that I either needed internal bleaching or porcelain crowns. What options do I have?
- Deanna from South Carolina

Deanna,
I get so aggravated hearing of situations like yours. This sounds to me like a dentist who doesn’t know what he or she is talking about, and I strongly suggest getting a second opinion from an expert cosmetic dentist. I’m on a plane answering this question, so I don’t have access to any maps, but hopefully Summerville is near one of the cosmetic dentists we recommend in South Carolina. Even if it isn’t, it would be worth several hours’ drive to get this done right.

Maybe I don’t fully understand your situation. Do you have root canal treatments on your front teeth? From what you’re telling me, the only problem is the color. If that is true, crowns are overkill, and internal bleaching isn’t possible. I don’t understand where this dentist gets this idea. For crowns, your front teeth have to be ground down to stubs. And if this dentist knows as little about cosmetic dentistry as your e-mail makes it sound, I have grave concerns about how these crowns would look when he or she is done with you. Don’t let him or her grind your teeth down.

And six teeth aren’t a smile. Don’t be surprised if a real cosmetic dentist suggests doing eight or ten teeth. When the teeth are dark and the front six teeth are made considerably lighter, the result looks really weird.

Depending on what your teeth look like, the amount of discoloration, and their general health, you either need simple teeth bleaching or conservative porcelain veneers bonded onto the fronts of your front eight or ten teeth. Anything more is overtreatment.

Good luck.

Dr. Hall

About David A. Hall

November 13, 2009

Composite and Alcohol

Filed under: Tooth bonding — iowasmiles @ 9:34 am

Where do you get your information that alcohol can dissolve resin veneer cement? A patient told me about this article on your website.
- Dr. Young

(see Care of Cosmetic Dental Work)

Dr. Young,
It’s not that the alcohol dissolves it—it softens the resin. I don’t remember where I first heard it, but I’ve known it almost since I started doing any bonding. It was a frequent source of discussion in American Academy of Cosmetic Dentistry circles, and we advised patients with extensive direct dental bonding to even avoid alcohol-containing mouthwashes.

I also saw the effects in my patients. If they used excessive amounts of alcohol frequently, the composite work would come back looking seriously pitted and worn after only a year or two. It’s not so noticeable if it’s smaller bonding work, but they can ruin a complete composite veneer, for example.

Dr. Hall

Other links:
Read about DURAthin porcelain veneers.
Dr. Abraham Abaie is a Scottsdale dentist.

About David A. Hall

August 15, 2009

Treatment for a single dark tooth

Filed under: Porcelain veneers,Tooth bonding — iowasmiles @ 8:00 pm

My smile is good except my right front tooth is turning brown. It may have gotten bumped when I was a child but I do not recall. It is not painful. It is solid and fine…just slowly dying. What would be the best procedure to take care of this problem do you think? I don’t smile as much due to the fact it has gotten darker. Dentists here want to do a root canal and cap but that seems a bit extreme. It’s not infected and does not hurt.

Thank you for your time,
- Vicki from California

Vicki,
If your tooth is fine and not infected, then there is no reason to have a root canal treatment. When a tooth is bumped hard enough, it can sever its blood supply, and it will die, develop an abscess, and turn dark. It will need a root canal. But if it’s bumped lightly, often it will later develop thicker dentin and will look dark but will be perfectly healthy.

If the tooth is healthy, it just needs some type of veneer to change the color. But the degree of color manipulation required for a single tooth is difficult for about 98% of dentists. If the dentist is artistic enough, often he or she will prefer to use direct dental bonding, because that way you can see the color as you go. Or, a single porcelain veneer works excellently for this situation also, with the porcelain veneer made by a dental laboratory.

But don’t go to the dentist on the corner for this – the color matching required is too difficult. I’d recommend one of the cosmetic dentists on our list, because they are screened for artistic ability.

I’d expect to pay $1300 to $2000 to get this done right.
- Dr. Hall

About David A. Hall

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