Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

July 7, 2016

I had bonding to close black triangles, and it looks awful


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Dr. Hall,
I had dental bonding done to close two tiny black triangles I had on the teeth next to my front teeth, and it looks awful. I went back today to see if he could fix it and it still looks bad.

I thought my dentist was a cosmetic dentist but come to find out he’s not certified which I had no idea and the job looks terrible. Looks like whitish material lodged between my teeth and I am sad and regretting even doing it. Just thought if he said he would do it, it was an easy fix that would look nice. He said give it a couple weeks to get used to but he will refund me since I am not happy. I can’t even floss between the teeth except above the bonding.

He wants me to come back tomorrow to try and fix it. I am afraid to have him do anything else. And researched more and found that certain dentists are actually certified for this. Is this something I can get fixed and done correctly? I just wish he would have said this isn’t something he specializes in. I just want my teeth back to where they were before this now and want my gums to settle down. What do I do???

– Angie from St. Louis

Dear Angie,
Closing black triangles is really tricky. Fortunately, you a couple of excellent cosmetic dentists in the St. Louis area, and either of them could do a fine job on this for you.

Black triangles are usually caused by receding gums. Here is a photograph of a case where that occurred.

Black triangles from receding gums

Black triangles from receding gums.

In your case yours showed up after straightening your teeth with Clear Correct invisible braces. Now you said that they are tiny. Not seeing a photograph of your teeth, I can’t tell you my opinion about whether or not you need these areas bonded—you can figure that out, if you want to just have the bonding sanded off and go back to the way your teeth looked, or if you want the black triangles filled in somewhat.

If you have them filled in, I’ll let you know several issues that make fixing these black triangles tricky.

The first is that their shape can adversely affect the health of the gums. Simply adding bonding material to fill in the hole left by the gum–that will just create a food trap which will cause plaque and calculus to accumulate beneath it. This will cause gum disease. So the added composite has to be shaped skillfully so that there is no such trap created and then polished carefully to make it plaque-resistant. The best test of whether or not the shape is healthy is to floss between the teeth. If you can push the floss into the sulcus under the gum and then when you pull it up it pulls smoothly, that is a strong sign that the shape and the polish are excellent. In your case, you’re saying that you can’t even get the floss past the bonding material. This is a serious problem and needs to be resolved to avoid gum disease on these teeth.

The second issue is that this is a difficult area to bond anything. To get the final result shaped properly, the dentist should be working some slightly under the gumline. Gum tissue oozes fluids. And if the gum tissue isn’t healthy, this oozing is very difficult to control. Those fluids contaminate the bond between the composite and the tooth, making it so the composite doesn’t stick. There are techniques for retracting the gum and controlling this oozing during the procedure, and those techniques have to be meticulously applied.

The third issue is the esthetics of the case, and there are a couple of dimensions to esthetics at play here. You mentioned color. Teeth are quite a bit darker at the gumline than they are at the incisal edge, and many dentists won’t use a dark enough shade of composite here. Family dentists may not even stock appropriate shades, because they only stock general purpose composites that are used for fillings. Composites for esthetic work are different. And then the shape is another dimension. Just putting a blob of composite on the teeth to plug the hole isn’t good enough. The end result has to look natural, and it can’t be done in such a way as to compromise the health of the gums, as I mentioned above.

I respect your dentist for his honesty in acknowledging his inadequacy here. I would recommend that you have him remove all the bonding material, refund your money as he has offered, and then, if you want this fixed, go to someone who knows what they are doing. There are sandpaper strips that can be used to polish off all of the bonding. After it is removed, you should be able to floss easily, get the floss under the gum, and the surface will feel smooth as you rub the floss up and down on the tooth surface.

– Dr. Hall

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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.

June 15, 2016

My composite bonding is turning yellow


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Hello Dr. Hall, 9 months ago I had dental bonding done on my four front teeth. There is quite a bit of composite on each tooth because I have been re-doing it every 3 or 4 years for 20 years. My question to you is, I see a bit of yellowing, is it possible to just polish them to try and whiten them again since they were done just 9 months ago? Thank you for your time!
– Linda from New Jersey

Linda,
One of the big differences between composite bonding and porcelain veneers is that the porcelain is very hard and stain-resistant (it resists stains better than tooth enamel), and composite is much softer and much more susceptible to stains, so it has a much shorter lifespan.

The good news is that with the composite bonding, usually those stains can be polished out, depending on the type of stains.

Composite is susceptible to two types of staining. The first type, the type that can be polished away, is a surface discoloration. The surface of the composite will get tiny scratches in it and become roughened which causes it to attract stains of all kinds. A good polishing will get rid of the scratches and the accompanying stain and restore gloss to the surface. Below is an example of this type of staining. You can see that the surface of the two front teeth has a matte finish from all the tiny scratches, as contrasted with the gloss of the adjacent natural teeth:

dental bonding with yellow staining

Photo courtesy of Dr. Robert Soto, San Francisco, CA

But composite will also absorb stains into the actual substance of the material. Composite is composed of inorganic filler particles such as quartz or glass bound together in a plastic matrix. Certain colored liquids, such as coffee, tea, cola drinks, or highly pigmented fruit juices, will actually penetrate the plastic part of the material and become a part of it.

dental bonding stained yellow

Photo courtesy of Dr. Mark W. Langberg, Southfield, MI

This type of stain will not come out with polishing. But this staining also occurs more slowly and can take a couple of years to become noticeable. At the right is an example of this type of staining. You can see that the composite has retained its gloss. The discoloration is coming from deep within, as stains have been absorbed by the material.

Preventing This Staining

There are several preventive measures you can take to get the bonding to keep its nice appearance for longer.
1. First, choose an expert cosmetic dentist who stocks a full inventory of esthetic bonding materials. General dentists will typically stock general purpose composites that are actually impossible to polish to the high gloss needed to resist stain and look like enamel. The surface of the bonding should be a microfill composite that is polished to a high shine.
2. Second, don’t use an abrasive toothpaste. While Supersmile toothpaste is quite a bit more expensive than your typical Crest, Colgate, or other drugstore brand, those general brands have abrasives in them that will scratch the surface of your bonding. Some of the abrasives are worse than others. I always provided my bonding patients with a first free tube of Supersmile, because it has no abrasives but rather lifts stains off by chemically dissolving the protein pellicle on the teeth.
3. Third, make sure your dental hygienist is polishing your teeth with a very fine abrasive. Pumice tooth polish is a big no-no. She or he should be using a fine aluminum oxide polish. Ask for this. (See my web page giving tips for maintenance of dental bonding.)
3. Fourth, beware of staining beverages. If you need to drink them, swallow them quickly rather than letting them sit in your mouth. And remember that hot beverages have more staining power than cold ones because they cause a slight expansion of the plastic, opening up microscopic pores that can be penetrated with the stain.

Finally, I would seriously consider switching to porcelain veneers. I don’t know how much your dentist is charging for this bonding, but dentists who do it well will charge quite a bit. Which costs more–doing composite bonding six times over 20 years, or doing porcelain veneers once for those same 20 years? Porcelain veneers done by an expert cosmetic dentist can easily look beautiful for 20 years. Porcelain is harder than tooth enamel and more stain-resistant. But go to an expert cosmetic dentist for porcelain veneers–don’t ask your family dentist to do this.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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.

April 5, 2016

Fixing a single discolored front tooth

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Dear Dr. Hall,

I had a left central incisor that underwent root canal treatment in 2004. It subsequently turned grey and I underwent internal bleaching last year.

The tooth still looks grey under certain lighting conditions and does not match my right central incisor. I am hesitant to get a porcelain veneer or crown as I would like to be as conservative with tooth structure as possible.

Also, I am aware of people who have problems with their porcelain veneers/crowns – poor colour matching, cracks, dislodgement, that result in repeated adjustments and more damage to the enamel each time.

Hence, I am considering composite veneers on either one or both central incisors to match them – if I need to change the composite veneers due to staining 5-7 years later, will I end up grinding off more enamel each time the composite veneer is changed? Is it possible to only drill off part of the old composite and bond a new composite veneer on the old composite itself(i.e. composite-composite bond)? If a composite-composite bond is feasible, then I could replace the veneers as required without harming any more natural tooth structure each time.

As composite veneers only last 5-7 years, I am worried that repeated replacements will eventually damage all my remaining enamel if more enamel has to be drilled each time (I am in my late 20s).

Please kindly advise if composite veneers would be a feasible long-term solution. I do not mind repeated costs, or having to visit the dentist every few months for touch up. My main concern is being conservative to the enamel, and finding a sustainable solution in the long run.

Also, will well-maintained and well done composite veneers look natural and blend well with the rest of my teeth?

Thank you Dr. Hall
– James, from an undisclosed location

James,
You’re not going to have to worry about possible damage from having this work re-done repeatedly if you get it done right. But if you don’t have it done right, yes, I have seen a minor correction to make two front teeth match escalate into two full crowns for the front teeth, where each tooth gets whittled down to a stub.

The key is going to be getting the right dentist. It is a small minority of dentists who will be able to get your tooth matched. And it is a slightly smaller minority who will do that in an ultra-conservative way, which sounds like what you want. But even if the dentist isn’t ultra-conservative, as long as it is done right you shouldn’t have to worry about repeated assaults on your tooth.

So your situation is one slightly discolored front tooth, and you’re apparently happy with the rest of your smile. The way I liked to treat cases like this was with direct dental bonding. I would shave off some of the front surface of the tooth to make room for the bonding material and so that the result would be no thicker than the companion front tooth. And then, with a combination of opaquers, tints, and composites of varying shades and translucencies, I would build up the discolored tooth to match its companion. I preferred using composite to doing a porcelain veneer because I could monkey with the color right there and get a perfect match without trips back and forth to the lab and having to communicate what I was seeing to the lab technician.

The same result could be accomplished with a single porcelain veneer. Some dentists will be very aggressive in their tooth preparation for a porcelain veneer and will grind away a lot of the tooth. But most expert cosmetic dentists will be pretty conservative, removing only a fraction of a millimeter of tooth structure. I would think that would meet your requirements of conservatism. And with a porcelain veneer, if the cosmetic dentist has done a lot of these, he or she will want to charge a premium fee, as I did, because there are going to be many trips this veneer will make back and forth to the lab with multiple try-ins to get the color perfect.

Lifespan of dental bonding

As far as the lifespan of the work, I will explain why I don’t think that should be a problem. With the bonding, it is the surface that deteriorates after maybe 3-5 years (longer if you use a gentle toothpaste like Supersmile), and the maintenance would simply be re-surfacing the composite. It wouldn’t have to be totally ground off and start over. With the porcelain veneer, if it is done right it could last many years. There isn’t a fixed lifespan there. If you take good care of it so that you don’t get decay on the edges or fracture it, it could possibly last twenty years. It’s not like a tire that wears out, but more like a piece of fine furniture that could fall prey to abuse, but if it is well cared-for could last indefinitely. And then a good cosmetic dentist would have tools to be able to remove the porcelain and bonding composite without significantly affecting the tooth.

If you get a dentist who wants to treat both your front teeth so as to guarantee a perfect match, take that as a red flag. The dentist doesn’t have confidence in his or her color skills to be able to match the adjacent tooth.

If you do want to share your location, I could help you further by possibly steering you to a cosmetic dentist who would be up to this task.
– Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

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 31, 2015

Dentist got the tooth bonding color wrong, doesn’t want to fix it

Dr. Hall,

I would like to send photos of what we consider is a bonding error. My granddaughter (25 years old) had a gap fixed between her two front teeth, and then had her lateral incisors bonded to make them a little larger. She immediately remarked on the color difference between her front teeth and her lateral incisors. But the dentist then told her, “The color difference was to match your eye teeth.” But then later he told me on the phone that he used the same material on all her teeth. So these are two different stories. The central incisors look fine and the color looks fine, but he told my granddaughter that he used a darker color on her lateral incisors to match the eye teeth, but he told me he used the same color.
He now wants further payment for a correction. He says to try whitening toothpaste too. I already paid $350 for whitening by tray and gel, and $900 for the bonding work. Her lateral incisors are a definitive blue/grey.
Where can I send pictures?
Thanks
John from Ontario

(Note – John then sent these photos of his granddaughter’s teeth after I told him how to send them)

before dental bonding errorBefore dental bonding[/caption]

dental bonding error - color mismatchAfter dental bonding error showing color mismarch.[/caption]

You can see in the after photo that the lateral incisors look substantially darker than the centrals.

Dear John,

Actually, truth be told, the lateral incisors should be slightly LIGHTER than the central incisors—just slightly, and then the canine teeth are darker, in a natural smile. I think this dentist knows that, which makes it seem like he is trying to make excuses. So my answer is, yes, this is a dental bonding error, a cosmetic dentistry mistake. The teeth look fake and her smile doesn’t look natural. And you didn’t ask about the shaping of these two lateral incisors, but that looks off, too. The tooth color error is particularly noticeable and makes the case unacceptable, in my opinion. Like you said, they’re kind of a gray putty color and are actually darker than even the canine teeth.
But then the next question is what do you do about this. You say that you’re okay with the work that was done on the central incisors. It looks like there was a chip in one of the centrals that he must have fixed and a gap between the two central incisors that he also closed. That much looks okay to me, thought the photo is a little fuzzy.
There are two directions to take in trying to get some satisfaction from this dentist. You can ask that he fix it himself, or you can ask that he pay to have someone else do it right. Generally it is better, when you’re talking about cosmetic dentistry, to forget about trying to turn the first dentist into an artist. That just doesn’t happen. So I usually recommend getting someone else who can do it right and getting some compensation from the first dentist to cover those costs. But in this case it looks like he maybe did okay on fixing the central incisors (though the photo isn’t as sharp as I would like). And while the shaping of the laterals isn’t great, you seem satisfied with that and are only concerned about the color.
You’re welcome to take this dentist my email here. I would recommend not being confrontational. Like I said, it appears that he did a nice job on the central incisors. See if you can get him to agree to re-do the bonding on the laterals. Bleaching isn’t going to work. Toothpaste isn’t going to work. I kind of think he knows that, too. The color is embedded in the bonding, and it needs to be removed and replaced with a lighter color. It needs to closely match the central incisors, maybe just a teeny tad lighter.
And then, of course, this needs to be at his expense. You paid to have a nice smile, and you haven’t gotten it yet. He should make good on the work.

Dr. Hall

Read more about fixing a discolored tooth from a root canal treatment.

Click here to ask Dr. Hall a question of your own.

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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.

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 — mesasmiles @ 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

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 3, 2010

I have one tooth turning dark

Filed under: Porcelain veneers,Tooth bonding — mesasmiles @ 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 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

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.

May 22, 2010

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

Filed under: Tooth bonding — mesasmiles @ 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

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.

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