Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

December 29, 2017

Too much shine on my porcelain veneers


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Angela saw my post, “Do porcelain veneers lose their shine?” and wrote the following comment, which deserves its own post to answer:

I don’t know why he wants shine. I just had my porcelain veneers installed and I HATE the shine. That’s how you can tell that those teeth are fake, they have this crazy unnatural shine and spoil every picture. Is it possible to REDUCE shine? Is there anything I can do to make them shine less. Its a blinding shine that looks awful , real teeth don’t shine like that.
– Angela

Angela,
Thanks for a great comment. It opens up an opportunity to discuss an important aspect of a smile makeover that isn’t often discussed, and that is the shine and texture of the surface.

The glaze on the porcelain is very important. That’s what gives the porcelain it’s excellent stain resistance and gives the porcelain its natural sparkle that makes it look so real. But it needs to be applied correctly. In order for it to look lifelike, there has to be some texture. It sounds like what you have is a very flat surface on your porcelain veneers, and that will generally look fake.

Here is a photograph of someone’s smile. Three of these teeth are real and one, the lateral incisor on the right, is a crown.

photo of four front teeth showing the texture and sparkle of porcelain crowns

Notice that the surface of the teeth, while it is shiny, is irregular. This gives the teeth a sparkle, and is one of the characteristics of a beautiful, natural smile. And the amount of texture can be varied to create different impressions. Younger smiles tend to have more texture. As we get older, the teeth wear down and so have less texture on the surface.

But let’s go to your case, Angela. It’s interesting that you say that you just had these porcelain veneers bonded on and you hate them. That will never happen with an excellent cosmetic dentist. I talk with many expert cosmetic dentists and I ask them about the try-in procedure, and every one of them tells me how important it is to them that the patient love the new smile before they bond it on. Even if the patient says they like the veneers but they’re just lukewarm about it, an excellent cosmetic dentist will ask why and, if necessary, will send the case back to the laboratory to be re-done until the patient is enthusiastic about them. That clearly never happened in your case.

You say you want to reduce the shine. There are ways to do that. The quickest way is to have a dental hygienist use a Prophy Jet to polish them. This applies a powerful sodium bicarbonate spray to the teeth and will destroy the glaze from the porcelain. But then your veneers will readily attract stain, and, without the natural texture, they still won’t look natural.

My advice would be to go back to your dentist and see if you can talk him or her into re-doing them. You paid for a beautiful smile—that’s what you should get. And insist that you get to see them temporarily placed on your teeth and that you approve of them before letting the dentist bond them on.
– 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.

December 19, 2017

Staining around 1-year-old porcelain veneers


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I got veneers almost a year ago now & I am noticing staining between my teeth. I do smoke, but i thought veneers were pretty hard to stain? Should I make an appointment with the cosmetic dentist that did them? I’m still paying on these, almost finished paying them off. I don’t want to continue paying if this is going to get any worse. I can send a pic if you want. Thanks!!
– Kayla from South Carolina

Kayla,
I would like to have a picture of these, because it could be one of a couple of different things going on. Lacking a picture, I will take my best guess.

You’re right that the porcelain itself won’t stain unless the glazed surface is damaged somehow, like with a power polishing machine like Prophy Jet, or with a fluoride treatment with acidulated fluoride. If either of those had happened to you, however, there would be staining across the entire surface of the porcelain veneers.

Since your staining is between the teeth, it seems likely that it is at the margins where the porcelain meets the tooth. There are two or three reasons that this area could be attracting stain. If there is a gap between the porcelain and the tooth, that would be tricky to fix. But my guess is that there is just some area of bonding composite here, and that is pretty easy to polish. But I would go back to the dentist who did these veneers for you and not expect a general family dentist to know how to do this correctly. This area most likely was polished when you had your veneers bonded. It may just need to be re-polished.

When I practiced, I encouraged my porcelain veneer patients to schedule regular re-polishing appointments where my hygienist would use ultra-fine polishing strips in this area and a special ultra-fine aluminum oxide polishing paste, to keep this area as smooth as possible and resistant to stain and plaque accumulation, to prolong the life of the veneers as much as possible. The point is that this is an ingredient of maintenance, and not anything that indicates that the veneers were poorly done. As such, I would expect to pay for this visit. For most patients, any accumulated stain would be minor. If you’re a smoker, though, it would be more obvious.

You can check out my page of tips for porcelain veneers post-operative care where I explain this polishing maintenance and address the possibility of staining.
– 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.

August 31, 2017

After my porcelain veneers, I need root canal treatments


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Dear Dr. Hall,
I had full mouth smile makeover done (veneer crowns) in January 2017, 12 upper teeth and 10 lower teeth. After they put permanent crowns on, I felt sharp pain on teeth #5 and #13 (upper second premolars). The dentist did crown height adjustment 3-5 times, finally the pain went away, but tooth abscesses formed on top of both #5 and #13 teeth within 4-6 weeks. The dentist x-rayed and said the teeth nerves had died, and I need root canals. I was upset and didn’t realize that nerve damage could be a risk involved in veneer crowns. I remembered I asked if there is any risk doing smile makeover during consultation, I was told there is no risk. The X-ray showed that my teeth nerve are fine before the procedure. I am confused and don’t understand what is going on.

The dentist said he didn’t know why, it rarely happened, I am the unlucky one. He referred me to an endodontist to perform the root canal procedure, and the endodontist found more teeth showing no response to cold test, also my gum flared up, swollen and very painful. So far I have had root canals done on 4 teeth (#4, #5, #13, #14), and #12 needs a root canal too, just matter of time. The tooth #3 starts feel strange too. Dr. did agree to pay half of the cost of the 4 root canals, but I am worried it will be an ongoing nightmare. What if the crowned teeth one by one goes bad over the time? I am very frustrated and feel misled. It not only financially cost me, but also add lots of stress on me. Please tell me what i should do and I need some advice. Thanks!
Sincerely,
Jenny from Texas

Jenny,
To answer your question, I first need to lay down some terminology so we’re clear in what we’re talking about. I’m a big fan of clarity in communication, which requires precisely defining what words mean.

two front teeth, prepared for porcelain veneers

Porcelain Veneer Preparation

You’re saying you had “veneer crowns.” But a porcelain veneer is one thing and a porcelain crown is something very different. A porcelain veneer requires very light shaving of the front surfaces of the teeth—sometimes no shaving at all is required. I found this photograph that illustrates a typical porcelain veneer preparation. Maybe half a millimeter of tooth structure has been shaved off, and the porcelain will be bonded over this.

two front teeth, prepared for porcelain crowns

Porcelain Crown Preparation

This second photograph shows a typical porcelain crown preparation for the same two front teeth. Much more tooth structure has been removed.

It appears from your description that what you had done were porcelain crowns, not porcelain veneers. It is very rare that a porcelain veneer preparation on a tooth will end up making it need a root canal treatment. But a crown preparation will go much deeper into the tooth, increasing the risk of a pulp exposure, resulting in an infection of the pulp and the need for a root canal treatment.

A smile makeover, by itself, does not require any aggressive grinding down of the teeth, which is what must have been done in your case. If your teeth had large fillings or decay before getting your makeover, then grinding them down was necessary. If that is the case, it wouldn’t be surprising if some of those teeth ended up needing root canal treatments. Anytime there is a lot of decay or large old fillings, there is a risk of teeth getting infected. But I would call that procedure a full-mouth reconstruction, not a smile makeover.

But if this that you’re calling a smile makeover was just for aesthetic reasons, then your dentist was much more aggressive than he needed to be, and I believe he should be responsible for the cost of the damages he caused. If you weren’t told of any of these risks up front, he is especially vulnerable.

A smile makeover should be done with porcelain veneers whenever possible, to avoid problems like you are having. There is even a trend in recent years for excellent cosmetic dentists to place what are called ultra-thin porcelain veneers, which require even less preparation than is shown in the photograph above. Some even try to do the makeover without preparing the teeth at all. But many dentists who aren’t expert in cosmetic dentistry simply don’t know how to do porcelain veneers very well, and so they resort to full coverage crowns. Porcelain veneers aren’t taught in dental schools—they’re a cosmetic procedure for which a dentist should get post-graduate education.

As far as what you should do now, I don’t know what to tell you. You don’t really have any option, if you want to save these teeth, besides having the root canal treatments done. And it’s curious that your dentist is offering to pay half the cost of the root canal treatments. This seems to indicate that he is feeling some guilt over this. If that’s the case, I would press him to pay the whole thing.

About what to expect long term, it’s hard for me to tell for sure from here. My guess would be that any teeth that end up having problems, you will find out within the first few months and then things will stabilize.

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.

February 3, 2017

My dentist says I have too deep an overbite for porcelain veneers


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Dr. Hall,
My dentist told me that I am not a candidate for porcelain veneers because my top teeth almost completely cover my bottom teeth. Instead, he wants to put 6 porcelain crowns on my top front teeth. I want a beautiful set of teeth, and unfortunately mine are stained from tetracycline. I have 2 questions: 1) Have you heard of veneers being inappropriate for a particular bite such as mine? And 2) Since my bottom teeth will not be crowned, is it reasonable to expect that I can bleach them to match my new crowns on top?
– Susan from Louisiana

Susan,
Oh no, you don’t want to do crowns on all your front top teeth! To do that they’ll all have to be ground down to stubs. And you don’t need that. Having a deep overbite the way you do it actually makes more sense to do porcelain veneers, because nothing has to be done to the backs of the teeth—all the work is confined to the front.

This happens with cosmetic dentistry a lot. You want a cosmetic treatment. Your dentist doesn’t do a lot of cosmetic dentistry and doesn’t feel comfortable with the particular procedure you want, so he or she gives you some excuse why this isn’t appropriate for you. I’ll give your dentist credit for creativity at least—this is the first time I’ve heard of a particular bite being a reason for not doing porcelain veneers.

Furthermore, you have tetracycline stains. This is one of the most difficult smile makeover situations there is, and you don’t want to have your family dentist doing this. It requires a high level of expertise and a lot of experience with cosmetic dentistry.

And six teeth? People show eight to twelve upper teeth when they smile, depending on the width of your smile. Doing just six teeth when you have tetracycline stains would look really funny. This is another signal your dentist is giving that he is in over his head on this. Sorry to be so blunt about it, but I’m trying to look out for your best interests.

My recommendation: Go to one of our expert cosmetic dentists that we recommend. We have several in Louisiana who could do a great job for you and give you a beautiful smile. There is one close to you that I will email to you privately, so I don’t give any clues as to your exact location. If you otherwise like your dentist, explain what you are doing and that you’ll be back to him for your regular checkups, cleanings, and other work, but that you’ve been advised that this is a difficult cosmetic procedure for which you need a cosmetic specialist.

About bleaching your lower teeth—this is an option, depending on the type of bleaching and the severity of the tetracycline stains. This is another reason you want an expert who has experience with your type of case. The Kör deep bleaching system can give some pretty decent results with these stains.

– 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.

February 2, 2017

My veneers are too white AGAIN. What can I do?


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Dr.Hall,

I would appreciate your opinion. I had nine “ceramic” veneers done on my lower teeth, five weeks ago. When they first came back I told the dentist that the color was too white. My dentist sent them back and had the lab change the color. I asked that the new color should match my exiting teeth which are shade A-2.

When they came back, he glued them in without showing me or discussing the color.

I think they are still too white. My son was getting married five days after the permanent placement, so it seem futile to discuss at the time, especially since they were already placed.

Then three weeks after placement, one of the veneers broke in half (from the bottom). The dentist said my teeth will be replaced for two years w/o charge. Is the amount of time reasonable? Do I have reason to be concerned about the long term sustainability of this investment? Can an objective person look at my teeth and not notice the difference in color? If so, what is my possible recourse? Is ceramic more durable/stronger then porcelain? I had some gum coming through my teeth. Would veneers be made to “cover” them? This was not done.

Can one determine if the material that was used is defective? I have the broken half.

Thank you for your time and consideration,

Benjamin from New York

Benjamin,
I’m not sure I’m understanding correctly what happened here. Are you saying that your dentist bonded on these veneers and you weren’t aware that he was doing that? You say that he put them on the second time without showing you. Did you agree to that, that he didn’t show you? Or did he do that without asking you?

If you didn’t give your consent to having them put on, the dentist could be in real trouble over this. Consent is key to any dental or medical treatment—you have to consent to any treatment done to you or it is malpractice. And even if you did give a passive nod to your dentist to go ahead and bond them, a good cosmetic dentist will never bond on a set of veneers without being absolutely sure that you love how they look. Further, missing the color twice? I would never put up with that in a situation like this. This is not a challenging color situation, what you have described to me.

And the veneer breaking after placement, this complicates your dentist’s situation. The veneer breaking isn’t because the veneer itself wasn’t strong enough—it’s because it wasn’t bonded properly. Porcelain veneers by themselves are very thin and fragile. They get their strength by being bonded to the underlying tooth. You can often break them in your fingers before they are bonded to the tooth, but once they are bonded they are very hard and strong enough to withstand normal biting forces and other functional stresses. Porcelain is one of several ceramics that are used for veneers, so I’m not sure what you’re meaning by ceramic veneers. Most other ceramics are stronger than porcelain, but, as I explained, that isn’t the problem. It’s the bonding strength.

About the color being noticeable—lower veneers that are whiter than uppers look particularly funny. You can usually get away with the lowers being a little darker than the uppers because they tend to be further back in the mouth and thus we expect them to look a little darker. If they’re whiter than your upper teeth, I wouldn’t put up with that.

I think you should go to an expert cosmetic dentist for a second opinion and then pursue getting a refund from your dentist and using the money to have this done right. I believe you have a fair amount of leverage with this dentist. You could report him to the dental board or even get a lawyer involved, and I think it would be in his best interest to do whatever he can to satisfy you. You also may want to read my post, “How to ask for a refund from your dentist.”

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.

November 12, 2016

My porcelain veneers are turning gray


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Dr. Hall,
I had 4 upper front teeth veneered and two of these front teeth have turned a light gray! They don’t look like they looked when the dentist first placed them on in August. One is more dark than the other, this particular tooth was already darker and when it was filed down seemed to be even darker underneath. The dentist told me that we would just need to make the veneers thicker so it doesn’t bleed through. I don’t know if this is the case or if something else is wrong but I’m very upset as I have three different colors; my real yellowish white teeth, my gray veneers and my white veneers! This was the whole reason that I wanted to get veneers in the first place to correct old looking teeth. She has already replaced one veneer because when it was put in it was put in slightly crooked, so I just got that fixed. I almost don’t want this dentist to touch any more of my teeth but I don’t want to walk around looking ridiculous I don’t know what to do.
Sincerely
– Michele from Massachusetts

Michelle,
There are two parts to your question: 1) What went wrong; and 2) What do you do now.
Actually the second part is easier, so I’ll start with that. Your dentist clearly is in over her head. There’s the issue of the four veneers not matching. Her suggested solution is the wrong solution—don’t let her make the veneers more thick. One veneer got on crooked. And you only hinted at one fundamental mistake she made when you said that your real teeth are yellowish white and then you have two white veneers and two grayish veneers. Having four front teeth that are noticeably whiter than the rest of your teeth isn’t attractive and any true cosmetic dentist would not have done that to you.

You really only have one choice of what to do from here—you need to find an excellent cosmetic dentist and get this fixed in their office. Doing beautiful smile makeovers requires a passion for appearance-related dentistry, which your dentist doesn’t appear to have. It also requires several years dedicated to post-graduate training, which your dentist also doesn’t appear to have. There is too much wrong here to have hope that your dentist is going to be able to get it right.

I’m going to assume that your dentist is an ethical person but just in over her head on this one. It shouldn’t be difficult to get some kind of refund for the work that has been done. You paid for a beautiful smile. You didn’t get it, so you should get a refund.

And then your new expert cosmetic dentist may want to start over from scratch. The first step would be to bleach your natural teeth to an acceptable color, to get rid of the yellow you mention. Then, after a delay of a couple of weeks for the new bleached color to stabilize, do the four veneers. They don’t have to be thick to block out any underlying color. If the one tooth is particularly dark, an easy way to manage that is to prepare it just a little deeper than the others and then apply a layer of opaquer over the prepared tooth, before taking the impression, so that all the prepared teeth now look the same color. Or, working with an excellent esthetic dental laboratory, they can make the one veneer with an opaque liner—but that is a little trickier to do because it requires great color communication between the lab and the dentist.

As far as what went wrong with your first set of veneers, it would be easier to tell if I had a photograph. If they are an uneven gray, it could be micro-leakage getting under the veneers because of their not having been bonded properly. If the gray color is even, then something has happened to the glazed surface of the veneers. Maybe they weren’t properly glazed in the first place, maybe they aren’t really porcelain, or maybe that glaze has been damaged somehow since they were put in. Glazed porcelain is very color stable, much more so than natural tooth enamel, so something had to have gone wrong for them to undergo any color change at all.

It couldn’t be the underlying color bleeding through because if that were the case, they would have been gray from the start. But you said they have turned gray.

My best wishes. I hope you get the beautiful smile you paid for.

And how to find an expert cosmetic dentist? That’s the purpose of this website. If you go to our list and don’t find someone near enough to you, get back to me.

– 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.

August 19, 2016

Can no-preparation porcelain veneers work for any patient?

Filed under: Ultra-thin Veneers — Tags: , — mesasmiles @ 8:19 am

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Dr. Hall,
At the bottom of your Lumineers section on your website, you have a photograph of Dr. Arnold’s patient who just had her braces taken off and wanted her teeth to look bigger.

Do you think this beautiful result was achieved because she had tiny teeth to begin with? Was that what enabled her to get away with a no prep and a non bulky result? Thereby making this less achievable to a patient with average-sized teeth. Realizing that he used his own ceramist to better control the result as well.

Thank you for your reply.
Wendy from California
.

Wendy,
You are referring to a case done with another brand of ultra-thin veneers, not with Lumineers, that is posted at the bottom of our Lumineers page. I have posted the full-smile photographs below.

no-preparation porcelain veneers, before

Alexandra’s smile, before

no-preparation veneers, after

Alexandra, after no-preparation porcelain veneers

Yes, you are correct that a factor in the success of this case was that the teeth were a little on the small side to begin with. There has to be some care in case selection if the dentist is going to use a no-preparation technique. Not every porcelain veneer case is going to be a candidate for no-preparation veneers. Even with the veneers as thin as 0.3 mm, that is adding to the thickness of the teeth, and a little bit will be added to their length. If you look at the “after” photograph of Dr. Arnold’s case, you will see that the incisal edges of the upper front teeth are maybe a millimeter closer to her lower lip, so he lengthened those teeth about a millimeter.
Also, the teeth were straight. If a tooth is crooked, there will be a portion that will be sticking out, and that will have to be trimmed back in order to get a beautiful result.

And then Dr. Arnold, since he wasn’t using the Lumineers brand, was free to use his own master ceramist, Michael Morris, who is also very talented. I will repeat here what I have often said about the Lumineers brand. The company that makes Lumineers restricts their use to their own dental laboratory, which is why I don’t recommend Lumineers. I have yet to see a Lumineers case that has resulted in what I would call a beautiful smile. But this result by Dr. Arnold, as well as other cases I have seen, are truly beautiful. I have met Alexandra (this patient) in person, and even as a trained, accredited cosmetic dentist, I could not tell that she had anything but her own natural teeth showing in her smile.

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.

August 17, 2016

Why you shouldn’t ask your family dentist to do porcelain veneers


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Dr. Hall,
2 days ago, I had a porcelain veneer placed on one of my upper 2 front teeth because it was chipped. I had bonding on this tooth before, but that fell off. This new dentist said bonding was out of the question because 1/5 of the tooth was chipped, and she recommended a crown. But I told her that I would like to do a veneer as it is less invasive than a crown.

Just before the veneer was placed, I had a chance to look at it on my tooth. It looked nice. It was lighter than my other tooth–I picked a few shades whiter anticipating bleaching my teeth afterwards. The shape looked perfect, so I signed the consent.

Once it was glued on, I had no chance to view it. The dentist and the assistant told me it looked great.

Once in the car, I looked in the mirror, and was in shock. The length of the tooth is a millimeter over to the next tooth and it looks like it is now placed a little forward. It looks like she put too much glue and that overall, the tooth looks protruded. On the back side of the tooth (closer to the tip of the tooth), I can feel a gap between the placed veneer and the back of my original tooth. When I bit in my sandwich I can feel the length difference of my teeth.

I called the dentist today and explained the issues. The assistant said the gap in the back of the tooth may be fixed but nothing could be done regarding the length. She even said it’s probably because the tooth moved. I told her I noticed right after the procedure when I got back to my car.

I have the feeling that I may need a second opinion. I made an appointment with the dentist, but I’m afraid to go.
I don’t know what to do, where to start. Any advice would be much appreciated.
Thank you so much in advance.
– Jennifer from Virginia

.

Jennifer,
Unfortunately, I hear about this type of situation a lot.

Most dentists have an engineering mindset, and their appreciation of esthetics in a smile is very rudimentary. This is why they don’t take the time and trouble to learn proper techniques for doing esthetic procedures.

Let me tell you how I’m reading this situation. Admittedly, I’m making some assumptions, and I could be way off base as far as this individual dentist is concerned. But this will help you understand how many dentists think and also understand better how to get this done right.

First, the dentist says that bonding is out of the question. Why? And why so dogmatic about it? There’s no discussion of the pros and cons, just “out of the question.” It worked before, so it’s clearly not “out of the question.” With 1/5 of the tooth chipped, bonding would have been my first choice for repairing the tooth, and it would be the first choice of many cosmetic dentists. My guess is that she’s not that good at bonding. This is what dentists will do to deflect requests for procedures they don’t feel comfortable with.

So she recommends a crown. You perceived this as overkill (I would agree with you), so you asked her to do a porcelain veneer. Based on what happened to you as this procedure was completed, it seems to me that this dentist has limited or no experience with porcelain veneers. But your dentist, thinking that the artistic part is going to be done by the dental lab and not wanting to push you too hard, agrees to do the porcelain veneer, even though she doesn’t feel completely comfortable with that procedure either.

So the veneer is done and tried on. You said the shape, length, and thickness were fine when the veneer was tried on. You got a good look at it, which is appropriate. So far, so good. But then when the veneer was bonded on, this is where it gets odd. The instinct of the dentist would be to show you the final product. They had a mirror that they used before, why none now? That was always the last thing we did in my office whenever we did work on the front teeth–hand them a mirror so they can see the final product. Goodness, even my barber does that. But why didn’t your dentist? Because she’s embarrassed at how it turned out. They just told you it looked great. Ooooh, that part really annoys me, that they would try to tell you that.

This sounds like a case of getting the veneer positioned wrong when the bonding material was applied, and then when they got done curing it they saw that. This positioning of the restoration is something that is very different between veneers and crowns. It is very easy to seat a crown on a tooth–you just slip it on and it’s very easy to tell when it is fully seated and on correctly. With a veneer, the dentist doesn’t get that same feel for it being seated correctly and it is very easy to get the veneer seated in the wrong position.

It also bothers me that when you called with this rather serious issue (your smile has to look at least a little funny with one front tooth longer than the other) that they had the dental assistant answer your questions. And the dental assistant is not right. Of course something can be done if the veneer is too long. If it were otherwise okay, it could be trimmed. In your situation that wouldn’t be good enough–the veneer needs to be re-done. But trimming it would certainly help. And it’s ridiculous to attribute the problem to your tooth moving. Your tooth isn’t going to move like that regardless of how much time had elapsed since the veneer was bonded.

As I said, they probably just got the veneer seated wrong. That’s not a fatal mistake. That actually happened a once to me. The bigger problem to me is their reaction to it. They should have said something to you immediately. The correction, after the veneer is bonded, has to be to completely re-do the veneer. So if this had happened in my office, I would have trimmed and polished the veneer so it looked like the adjacent tooth, I would have told you what happened after showing you the result, and then made an appointment to re-do it.

Oh, and another point. If you’re going to bleach, the dentist should have bleached your teeth FIRST, then waited a couple of weeks for the bleached color to stabilize, then done the veneer. Your front teeth need to match exactly, and you can’t bleach teeth to match a certain color. The only way to get the teeth to match is to do the bleaching first. An expert cosmetic dentist would have told you that.

So, what to do from here?

First you need to get with a genuine cosmetic dentist. Go to our website, put in your city, and see what your options are. We have several near you in northern Virginia.

And of course your dentist should refund your money. It seems to me that she is embarrassed about this, and I believe she won’t put up much resistance to your request for a refund. If she does give you any trouble over that, you could file an ethical complaint with the dental society or the dental board. But my guess is that she will want to make this right for you. Be sure you get good documentation about how this looks–have the expert cosmetic dentist take photographs of the front and back of the tooth, because it should be fairly easy to show that the veneer isn’t seated fully. This is a clear error that any dentist should recognize.

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 20, 2016

I’m having trouble speaking after getting my porcelain veneers


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Dr. Hall,
I had 10 porcelain veneers placed and two crowns on each side 2nd to last tooth. The final temps looked and felt great. When the permanent teeth were put on I was having trouble speaking. Biggest problem is my tongue is very uncomfortable. It feels like it is too big for my arch and resting on the back of my bottom front teeth.
What is making my tongue sit low in my mouth. My dentist can’t figure it out. Could it be the back of front teeth are too thin? or maybe the two crowns that were put on premolars?

Thank you,
Susan from New Jersey

Susan,
It’s going to be hard for me, not seeing your case, to really tell what is wrong. But your question gives me a helpful starting point for saying something about smile makeovers and speech.

As far as your case, porcelain veneers, if that’s what they are, in most situations shouldn’t be affecting your tongue or your speech. They sit on the fronts of your teeth, so your tongue shouldn’t feel any difference. But some dentists actually do porcelain crowns for smile makeovers and call them porcelain veneers, so that’s a possibility for you. Crowns cover the entire tooth.

If you do get a smile makeover of porcelain crowns, that will have the potential to affect your speech. Expert cosmetic dentists are trained in the effect of the teeth on speech and will be careful about the contours of the crowns and how they affect your tongue. The thickness of the crowns on the lingual surfaces (the insides of the crowns) will affect the pronunciation of certain letters. The length of the front teeth and the positions of the incisal edges of those teeth will affect other letters. The height of back teeth will affect others. To assess all these effects, any new smile that changes any of these critical measurements in your mouth should be tested in provisional restorations first, and the provisionals should be adjusted to accommodate your speech to where they feel comfortable to you before the design is finalized in porcelain.

But you said that the temporary teeth looked and felt great and you only had trouble when the permanent teeth were put on. Something isn’t right there. What is usually done is that an impression is taken of the temporary smile makeover and that is sent to the dental laboratory so that the ceramist can duplicate that result in porcelain. That must not have happened exactly that way in your case. Either the dentist didn’t send those models to the ceramist (maybe only a photograph) or the ceramist didn’t follow the instructions.

Having said all that, ordinarily patients will adjust to new positions of the teeth and speaking will feel normal to you again after a while. If a couple of months go by and you still have problems, I would insist that it be fixed, even if it involves re-doing the case and/or referring to a different dentist.

Dr. Hall

Follow-up – Turns out, this was just the beginning of Susan’s problems. Read what happened to her when the dentist tried to fix the problems and what Dr. Hall said in response. See the follow-up to problems speaking with new porcelain veneers.

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.

June 13, 2016

Placing new Lumineers over old Lumineers


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Dear Dr Hall~
I have been reading all your expert information and advice about cosmetic dentistry and I am quite impressed. However, I noticed that you have not mentioned if it is possible to reapply new lumineers over existing lumineers. I have lumineers that just are not white at all and can never be whitened with any kind of bleaching due to the nature of the porcelain material. Would you recommend this “new over old” lumineer procedure and is it possible? My dentist is aware that I originally desired whiter lumineers but his tech said that was not available at that time. I do not want to insult him now because he is super nice but I feel there is no reason for “dingy” teeth in this day and age. Can you please respond with your thoughts? Thank you kindly.
– Gilda from Pennsylvania

Gilda,
Yes, you can do new Lumineers over old ones. But you wouldn’t want to, and I’ll explain why.

First, I noticed that you’re saying Lumineers without capitalizing it. Some people don’t realize that Lumineers is just one of many brands of porcelain veneers, so I wonder if you meant to refer to only the Lumineers brand. It’s the same answer whether you’re talking about Lumineers or another brand of porcelain veneers.

Lumineers are distinguished by the heavy marketing that has been done by the manufacturer. Back a few years ago, they were promoting among dentists this idea of putting Lumineers over old crowns, which is close to the same thing you’re suggesting. I think what happened is they ended up with a lot of patient complaints over how this turned out, and so I haven’t seen any of these ads for maybe five years now. Here is a photo of one of the ads in a print dental journal:

new Lumineers over old

Two main reasons you don’t want to do this.
First, it’s just as much work to put new porcelain veneers over old ones as it is to re-do the old ones. The dentist would have to prepare the old veneers some, at least, to have the final result be not too thick. So you’re going to pay the same as if the dentist just started over.

Second, the “new over old” technique wouldn’t last as long as brand new veneers and has a risk of looking funny. Bonding porcelain on top of porcelain doesn’t give as reliable a bond as bonding porcelain to a natural tooth. Even if the dentist did get a good bond, what happens if the underlying, original porcelain veneer fails? By adding another veneer on top, you’re doubling the chance of failure. It would be much better to have a brand new one.

And then the margin where the new porcelain meets the old tends to be more susceptible to staining than margin at the porcelain-to-enamel bond.

Another point about your question. Whiter Lumineers or porcelain veneers have been available since the time Lumineers were invented. Telling you that the whiter color wasn’t available at the time—that’s simply not true. I question whether or not this dentist or this tech is up to speed on cosmetic dentistry. Only about 1-2% of dentists are capable of doing a beautiful smile makeover. This team you have sound like they’re in that bottom 98%. I’d seriously consider looking for an expert cosmetic dentist if you want a better smile.

– 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.

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