Hi Dr. Hall,
I thought I was getting either e.max or zirconia veneers. My dentist said I was a better candidate for 360 wrap veneers. I asked her assistant how much tooth would be taken off, and he replied, a very small amount. So I went ahead and did them.
While I was in temporaries, the left temporary canine fell off 3 times. Now that I have the permanents, last night, while only brushing, the permanent fell off for the 3rd time. It popped out into the sink. My tooth remaining is one little nub. I am flossing the way the assistant told me. I am not eating anything hard, and I cut everything up small and put further back to chew.
I am so stressed out with this experience. Except for this last time where tooth fell into the sink both the temps and permanent fall outs occurred during the night. I religiously wear my night guard. Thank goodness I woke each time and haven’t swallowed the tooth. This is giving me so much stress. Today they said they are ordering special cement. But they had used a stronger cement already and obviously, it is not working.
Back in May, they did a CBCT scan for which I paid $300 out of pocket back. I also had three bridges replace with them prior to having any cosmetic surgery started. I have repeatedly asked to see the results of the CT scan, but they always come up with excuses. In addition, I have been waiting for almost two months for my day time guard. They took the impression when the permanent 360 veneers were put on. The holidays are upon us, and am so worried will be with friends or family and I’ll lose the tooth. My incisors do not feel that sturdy either. I wake during the night, running my tongue over my teeth. My quality of life is being affected. Please, any advice is welcomed.
– Mary Thompson
(See Dr. Hall’s answer below.)
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Mary,
Oh, I’m so sorry for what has happened to you. I’ll be blunt with my advice—you need to get another dentist to fix this.
Let me start by pointing out something that should be a huge red flag to you and that is that your dentist’s office tricked you. You asked the assistant how much tooth was going to be taken off, and he said, “a small amount.” But you are telling me that when the canine “veneer” came off, the tooth was just a nub. In other words, there was a lot of tooth reduction. That was your big clue that you’re dealing with an ethically challenged dental practice. The assistant had to have known the teeth would be ground down to nubs, and had to sense that this was important to you. But he didn’t want you to know that lest you would not agree to having the work done.
Porcelain veneer preparations
A porcelain veneer is a thin shell that is bonded to the front of a tooth to change the appearance of the tooth. A crown is a restoration that covers the entire crown of the tooth, the part that is above the gum. For the crown to fit on the tooth, the tooth has to be ground down so that it is tapered so the crown can slip on it. The picture above on the right shows relatively aggressive porcelain veneer preparations. It shows maybe half a millimeter of tooth reduction. Many porcelain veneers are done with less than that, and some can be done with no preparation at all.
Porcelain crown preparations
When you had this work proposed, you asked a question that is on the minds of many patients, “How much tooth will be taken off?” People know that for crowns, a lot of tooth structure has to be removed, and that is especially the case for front teeth. They tend to not like that and that can be a make-or-break issue for them in deciding whether or not they want a smile makeover. But for patients who have done some research, they know that veneers are much more conservative. The term “360-degree veneer” is then a way to make a crown seem like something it isn’t.
That leads to the question, why doesn’t the dentist just do the more conservative veneer when that will accomplish the objective? The reason is that a veneer is a more technically demanding procedure that isn’t taught as part of the regular dental school curriculum. A dentist needs some post-graduate training, extra attention to detail, and possibly some extra tools to do veneers. Realizing that your dentist didn’t want to be bothered with the extra training gives you a clue as to why she may be having problems getting your crowns to stay on. Since she didn’t want to do conventional porcelain veneers, I’m guessing that she doesn’t have a full understanding of adhesive technology. And from your description of the tooth it sounds like she has also done a quickie overly tapered tooth preparation. (For more information about why crowns don’t stay on, see my blog post about why crowns fall off.)
It is possible for a dentist to do crowns that don’t fall off. You shouldn’t even need a nightguard to keep crowns from falling off, much less a day guard. In my over 20 years of practice, I never had a crown that I did fall off. The problem in your case is that it could be tricky for another dentist to recover from the mistakes your current dentist has made, but that’s the direction I would go. You will need a dentist of considerable expertise. If you want, I may be able to help you find a dentist who knows what he or she is doing for a case like this. You just need to let me know where you are. And then you should be wanting some kind of refund from this dentist.
– Dr. Hall
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About David A. Hall
Dr. David A. 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 advanced internet marketing for dentists.
Dear Dr. Hall,
First let me apologize for not thanking you, as I just discovered that you had replied to my questions. Today is April 19, 2022. Thank you very much for your response. Have an appointment with my dentist tomorrow, 4-20-22, to discuss a few things: why they have not given the results of the $300 CBCT scan, why the surface of the ‘360 veneers’ are darkening, why the ‘veneers’ on the right have no luster compared to ones on the left, etc. I asked to see another dentist in their practice, but they are not allowing me to do so. So again thank you so much. I cannot even begin to tell you how you have given me hope. It gives comfort that you understand all the concerns.
Just as an aside: While searching for reviews of this particular practice, found that most are glowing reports. However, I saw that the practice was listed with the BBB. A patient complained on the Better Business Bureau site, whereby the dentist threatened the patient with slander. The patient backed down; as it was obvious she had been intimidated and did not want to be taken to court by the dental practice. Thought that very odd, as between RealSelf, Yelp, BBB and other social media websites, reading and giving reviews is what helps the community to make decisions regarding how and where we spend our money. Apparently this practice does not feel comfortable with transparency.
As to the ‘crown’ falling out five times in total: The assistant made another canine (did I mention they make the veneers themselves in office?) I asked a question on RealSelf regarding the permanent veneers falling off, even during the night. One dentist responded and advised me to ask the office to check for ‘bite interference’. I had never heard that term. So I did when I went in for it to be re-cemented. Only then was my bite corrected. The canine has since remained in place. However, during all the fallouts, the assistant made a new tooth as if original mold was faulty. Therefore I have in my possession the first permanent canine. The assistant did not ask for it back and just placed the new one and finally fixed my bite.
Do you know of where I could send the canine to be tested as to the material used? My treatment plan indicated porcelain, but as all seven ‘360 veneers’ have darkened considerably over the last 6-7 months (don’t drink coffee, red wine or tomato sauce) Everything I have researched indicates that porcelain would not, should not darken. They are not crowns made over metal and were pretty and bright in color at first. Now they are almost the same color as my unbleached lower teeth. So stressful and disappointing. The new bridges they made prior to the veneer work are made of either Emax or Zirconia and are still bright and translucent. Not sure if they were made in-house or out-sourced to a ceramist.
Again, my appointment is tomorrow and not sure you will see this email. Whenever you can respond, I will again appreciate your dental wisdom. You are doing such a great service to dental patients everywhere! I am very grateful to you Dr. Hall.
– Mary
Response by Dr. Hall:
Mary,
Yes, a bite interference can dislodge a weakly cemented crown. But even with eliminating the bite interference, that crown is at risk of coming loose.
As far as the material in the crown, you are right that glazed porcelain will not stain. It should be fairly easy for a new dentist to tell you whether or not the crown is porcelain. Once the glaze is broken on porcelain, drawing a dental explorer across the surface will leave a dark line. That part is easy. Determining exactly what the non-porcelain material is could be more challenging, but shouldn’t be necessary.