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Can I get fangs bonded on my canines?

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Dr. Hall,
Can you bond permanent fangs on canines? I really want to get permanent fangs. If you can where are you located and if you can’t maybe you can help me find someone near me that can.
– Joylin from Nebraska

(See Dr. Hall’s answer below.)


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Joylin,
Doing fangs on teeth isn’t complicated, and I think that about any dentist could do them. You can click the link and read how I did them. But you need to find a dentist who will do them permanently for you.

When I was in practice, I did temporary fangs for patients before Halloween, to be a part of their costume, but they had to sign an agreement that they would have me remove them the day after. My office had a lot of fun doing that, and we got some TV publicity over it. During that time, I had a couple of requests to make permanent fangs, but I refused. That spooked me, and I didn’t want to be associated with that.

I just did a Google search and found several dentists who advertised a willingness to make permanent fangs. So if that’s what you’re looking for, do your own search and I imagine you’ll find someone.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Fixing a broken lower front tooth

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Dr. Hall,
I am 17 years old. 11 months ago my lower front tooth broke. It’s not a big chip, but it is very irritating to my lip, and I am hesitant to smile now. Is there any treatment to regrow it naturally?
I also went many times to a dentist. They bonded a filling on my broken tooth but it was not very effective as it fell off after every 3-4 days.
Can you suggest a solution to this problem?
– Raja from India

(See Dr. Hall’s answer below.)


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Raja,
The problem with restoring a chipped lower incisor is that the incisal edges hit the insides of the upper incisors every time you close your mouth. And often, the reason the tooth is chipped is because of that—there was an impact against the upper teeth. When composite is bonded to fix the chip, it can be subject to extreme stresses. The dentist fixing it has to know enough about occlusion to keep it away from any occlusal stresses.

Apparently the dentist fixing your tooth didn’t know that.

Here’s an example of a photo of lower anterior teeth with one of them chipped. I’m guessing that this patient had chipped both lower central incisors and they were both repaired with composite. (You can see the composite on the incisal edge of that tooth.) The bonding on the tooth on our right (#24) has stayed on, but on the tooth on our left (#25) it has come off. Look closely and you can see the composite on the incisal edge of #24.

photo of 4 lower incisors with one broken off

Lower incisors, before (photo courtesy of Dr. Ian Bell of Bellevue, WA)


Notice that tooth #25 is further forward than #24. If it were the same length as all the other incisors, it would hit first when the patient closes his mouth.

photo of lower incisors, with porcelain veneers on the front two

Lower incisors with two porcelain veneers (photo courtesy of Dr. Ian Bell of Bellevue, WA)

Dr. Bell treated this with two porcelain veneers on these incisors, and it is working just fine. Notice that tooth #25 has been shaved back to where it is now no further forward than #24. With all the lower incisors hitting the upper teeth at the same time, it reduces the stress on any one of the teeth and thus we have a successful repair. A similar result could be obtained with dental bonding in the hands of an expert cosmetic dentist.

But you’re in India where there are very few expert cosmetic dentists. The best that could be done where you are is probably to round off the jagged edges where the tooth is chipped, which should prevent it from irritating your lip.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

My new bonding is already getting stained

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Hi Dr. Hall.
I had my two front teeth bonded three weeks ago and they’re already stained. I think that’s because I drank coffee, tea and diet Coke. But the dentist never told me to stay away from these drinks! So I got Supersmile toothpaste.
I have two questions, if I may
1) Do I really have to stay away from coffee, tea and diet coke for the rest of my life ?? How depressing!!
2) Or will Supersmile allow me to continue these drinks and “stop” stains from attaching?

Thanks for your reply,
Selma from California

(See Dr. Hall’s answer below.)


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Selma,
While dental bonding is vulnerable to staining over time, it shouldn’t be getting stained within the first few weeks of getting done. I suspect that your dentist was a basic family dentist who doesn’t know much about cosmetic dentistry. Let me explain why I think you are having severe staining problems with your bonding.

Dental bonding is done with composite. Composite is a blend of a plastic resin with inorganic fillers. There are a wide variety of fillers used, including silica, quartz, and glass, and they are in particles of different sizes. The results are composites with a variety of properties. Some, such as hybrid composites, are stronger, but, because of the size of the particles, they cannot be polished to a high shine. Microfills, which have extremely small particles, aren’t as strong, but they can be polished to a very high luster, much like human enamel. They are sometimes called high-gloss composites. Newer nanofill composites claim to provide a combination of high strength and high polishability.

Most family dentists will tend to stock a composite that will be a general purpose material, which tends to be a high-strength material such as a hybrid composite. Expert cosmetic dentists will tend to stock a wide variety of composites. When they are doing esthetic bonding on front teeth, they will use a stronger composite, such as a hybrid, for the interior of the restoration. Then they will apply a microfill to the surface to get a high luster. Also, they will use various shades and translucencies of materials to mimic the appearance of natural teeth, which are composed of a more opaque dentin overlaid with a more translucent enamel, and a gradation of color.

My guess is that your dentist used a material that couldn’t be polished to a high shine. Or maybe he or she used a polishable material but didn’t take the time or didn’t have the polishing equipment to be able to give it a high shine.

My advice is to go back to your dentist, share what I have told you here, and see if he or she can repair your bonding and give it a high polish that will resist staining. If he or she can’t, you’ll need to find an expert cosmetic dentist who can do that for you. If the bonding covers the entire front surface of your teeth, you would be better off having two porcelain veneers. The porcelain will be extremely stain-resistant, more so than your own enamel. But again, you should have that done by an expert cosmetic dentist.

Oh, and about the Supersmile toothpaste. While Supersmile is very effective at preventing and removing stains on teeth, it isn’t as effective at removing stains in your situation, if the problem is a lack of polish. Once the composite is polished, Supersmile is also great at preserving the shine because of its low abrasivity.

Thanks,
Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Her dental bonding looks awful

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Dear Dr. Hall,

I chipped my two front teeth and had bonding done on them. Recently there was some discoloration of the bonding, so I asked my new dentist to fix the color. Things went downhill from there. There are multiple things wrong.

The color is wrong—the color is too white compared to the rest of my teeth. The bonding has a lot of texture, one tooth is longer than the other, and I now have a gap between the teeth. After she was done the dentist said that it’s not perfect but it’s better than before. But my only issue was a small discoloration. Now, when I looked in the mirror, I was like, “What the heck happened here?”

So I asked her to shave down the longer tooth to make it the same length as the other one. (I’m shocked that I even had to ask that!) The next thing was that the shorter tooth wasn’t straight across—it rose up in the middle, so I asked if she would just file it to make it straight. Then I asked her to fix the color a little bit a the top and she said that’s how normal teeth are with the different colors. Then I pointed out the large gap that wasn’t there before and she said yea with bonding it’s really hard to not have that. And then she said why don’t you see how you like it for a couple days then come back on Friday and I can go over whatever you don’t like. I have a good base to work with now. My question is should I let her try to fix it on Friday or just call her tomorrow and ask for refund. I feel bad because she is nice and all but this looks worse than it did when I went in. I’m very upset!

Michelle from Florida

I found your blog searching for bonding issues.

(See Dr. Hall’s answer below.)


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Michelle,
I wouldn’t hold out any hope that this dentist will get this right. The basic problem here is that dental schools don’t screen their applicants for artistic ability. They teach them the mechanics of how to fix teeth, but the schools aren’t designed to churn out dental artists. If this dentist can’t get this right, it’s time to make a separation and move on.

Dental bonding is the most artistic procedure that dentists do. They have a selection of materials of different colors, textures, and translucencies, and they have to put that all together to create a lifelike replica of tooth structure. A very small number of dentists are very good at this and can sculpt an entire tooth to look so real, no one can tell it’s dental bonding. A larger number of dentists can take on a small repair of a chipped front tooth and make it look pretty good. But it sounds like your dentist is on the far left of the bell curve and has trouble with very basic appearance-related dentistry.

There is also a difference in their approach to the patient between excellent cosmetic dentists and repair-oriented general dentists, and that is in their listening to the patient. An excellent cosmetic dentist will keep on a case until you, the patient, are happy with how it looks. Your dentist, however, is showing a tendency to be objecting to how you think this should look. When patients aren’t happy with the appearance, many of them will try to tell you that you just need some time to get used to it, rather than addressing your concerns. Listening to the patient is what drives the excellent cosmetic dentist to create beautiful work.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

His bonding is the wrong color and is falling off

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Dr. Hall

I recently had bonding done due to fluorosis staining. The doctor originally placed my bondings but they were uneven colored and we can still see the stains through them. A few hours after 3 of them fell off. I returned 2 days later he replaced them and I let him know I was unhappy with the color so he added a thicker layer however 3 days later they are falling off again. He said I have a bad bite and need a mouth guard which I got and wear but it didn’t help. I’m not eating anything hard to make them fall off. He says it’s not a permanent thing and they sometimes fall off. However he said it’ll be in like 5 years it’s only been a few days. At this point I’m frustrated and want my money back so I can go somewhere else.

– Chance from Maryland

(See Dr. Hall’s answer below.)


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Chance,
For certain, you’re not in good hands and you need to go somewhere else. This is approaching a cosmetic dentistry horror story.

It can sometimes be a little tricky demanding a refund for cosmetic dentistry if the complaint is simply that you don’t like how it looks. But a basic standard for dentistry is that it needs to stay on, and the fact that your bonding fell off gives you great leverage. If your dentist resists refunding your money, you can always take your complaint to a peer review committee, to the dental board, or the insurance company (if there’s insurance involved), and they will likely stand behind you.

Let me say a couple of additional things about your case.

First of all, for the benefit of our readers, fluorosis is a condition where you consumed too much fluoride while your teeth were developing. Mild fluorosis results in white spots on the teeth that may be very slight spots, as pictured here.

two front teeth showing mild fluorosis staining with slight white spots and a little brown

Mild Fluorosis

Many patients suffering from very mild fluorosis may feel that no treatment is necessary. However, if the white spots become more extensive, they can cover the entire front surface of the teeth giving a mottled appearance to the teeth.

In severe fluorosis we see brown spots appearing. It can be quite ugly, as pictured below.

photo of front teeth with severe fluorosis showing ugly brown spots and white spots

Severe Fluorosis

As far as your bonding, your dentist appears to be in over his head. You need an expert cosmetic dentist. One thing about placing dental bonding is that the dentist sees the results as he or she works. So the fact that after the first appointment you had to be the one to tell him that the bonding was the wrong color and you could see through it shows a gross insensitivity to aesthetic issues. And the answer to your problem is certainly not to plaster on a thicker layer but to start over with the correct materials and correct technique. If your dentist is an ordinary family dentist, he probably doesn’t even have the proper bonding materials to do your case correctly.

Fluorosis stains are generally pretty superficial and confined totally to the enamel. When they are treated with cosmetic dental bonding, the first step would be to grind out the discoloration and then to bond a composite that is designed to replicate the appearance of enamel. Depending on the case, it may be best to lay down a base layer of a composite that has some opacity to it, and then overlay it with a more translucent layer. If the fluorosis is mild, the bonding may be quite shallow and only a translucent composite will be needed. The surface composite should be of a type that will accept a high level of polish. Many family dentists stock only all-purpose composites which cannot be polished to a high sheen, so for the best result I would recommend an expert cosmetic dentist. The end result should be a tooth that looks so natural, no one can tell that any work has been done.

As far as the bonding staying on, this is pretty basic. Bonding to enamel requires a couple of steps. The first step is to etch the enamel, rinse, and dry it. It should show a frosty appearance if it has been etched properly. If there is severe fluorosis present, the etching time will need to be doubled. But it should be easy to tell if the etching is adequate because it will show that frosty appearance. After that a liquid bonding agent is applied and cured with a curing light. Then the composite is placed over the cured bonding agent. It should stay so firmly that it has to be ground off. You shouldn’t have to be careful about what you eat. Your dentist is doing something very wrong here, unfortunately.

And finally, unless I am missing something about your case, this bonding should only be on the front surface of your teeth and there should be no need of any diet restrictions or night guard.

We have several excellent dentists we recommend in Maryland. I would go to one of them. I would think it would be worth it to travel a little to get this done right.

Oh, and one more thing. If you were my patient, I would suggest bleaching your teeth before we started this bonding. The reason is that if you ever later wanted to whiten your teeth, you would have to re-do the bonding because it wouldn’t whiten any.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Can a dentist remove composite without damaging the tooth?

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Dr. Hall,
I was wondering if there are any methods to remove all the composite bonding on a front tooth without damaging the existing enamel, eg laser or air abrasion and whether these methods might cause any damage?
Catherine from London, UK
 


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Catherine,
Yes, it is fairly easy to remove composite from a tooth without damaging the tooth, so long is that bonding material is placed on enamel, not the softer dentin of a tooth. I’ll give you three methods that could be used.

  1. Sandpaper disks that a dentist uses for polishing composite are probably the easiest. They have the advantage of leaving a smooth, highly polished surface. Since they are flexible, they bend to accommodate the shape of the tooth.
  2. There are also high-speed carbide drills that are made for polishing. When they are used with light pressure, they are faster than sandpaper disks and still very good at removing composite and not damaging the enamel. However, because of their shape, they tend to leave streaks of material on the tooth. So when I would use these burs, I would finish up with a sandpaper disk to be sure I had it all removed.
  3. And then yes, air abrasion works well here also. However, most dentists don’t have air abrasion equipment in their offices. Little sand-blasting nozzles will also work here. Many cosmetic dentists will have one of these units, which is called a micro-etcher. Again, though, this is a slow method and would be best used as a finishing step, and not for removing the bulk of the material.


When I was in practice, often just before Halloween we would offer to do decorative bonding for patients, creating vampire fangs for patients that would be removed right after Halloween. So we had a lot of experience with this task of removing composite from the surface of enamel. You can read the page I’ve linked here to see a little trick we used to make this removal go quickly.

I will also add that often Lumineers are promoted as being reversible. Since no tooth structure needs to be removed before they are placed, it is argued that they can be removed if you change your mind. This, however, is theory and, for all practical purposes, is a fantasy in my opinion. Lumineers and other brands of porcelain veneers are made out of porcelain, which is very hard. Removing them without damaging the tooth is extremely tricky. My advice to a patient if any dentist tries this pitch on them is to ask them to show you photographs of a case where they removed the Lumineers. I will bet that they won’t be able to. But if you ask an expert cosmetic dentist who is truly good at what they do, my guess is that their experience would be very similar to mine—they have never had an instance where a patient ever wanted a new smile removed—they are so thrilled with their new smile.
 

– Dr. Hall

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

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.

My teeth look splotchy after my bonding was removed

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Dr. Hall
I had extensive bonding on teeth to improve some wear and chips. I hated it as it felt bulky and I couldn’t speak properly. I had it removed but my teeth have been left patchy and discoloured. My dentist and the one she referred me to for another opinion both tell me it’s my natural teeth and I just hadn’t seen it before. I’m devastated as feel my teeth have been damaged.
– Marie from the UK

Marie,
I can’t fully tell what has happened to you without seeing your case personally, but I can make a good guess based on what you are telling me.

It sounds like you are in the hands of a basic general dentist who doesn’t know enough about cosmetic dentistry to give you a beautiful smile, and there are two things that were done wrong.

The first is that your bonding made your teeth bulky, so much so that it interfered with your speech. Dental bonding should never add significantly to the bulk of the teeth. That doesn’t produce an attractive appearance, plus it can interfere with speech, and it could create food traps that can lead to either tooth decay or gum disease. I don’t understand, if you’re just dealing with wear and chips, why you would need any bulk at all added to your teeth—the dentist should be able to just fill in the chips and replace tooth structure that has worn away. Look at the photographs of dental bonding work on this website. None of them look bulky at all.

The second mistake was in removing the bonding. While some dentists who lack confidence in their cosmetic dentistry skills will tell patients that dental bonding is a reversible procedure because it can simply be ground off if you decide you don’t like it, that may not be as easy as it sounds, especially in the hands of a basic general dentist. So the dentist starts grinding off the composite bonding and stops when he or she hits the enamel. But the composite looks just like the enamel, so how do they know when it stops? In this process, it is very easy to believe that your dentist may have removed a small amount of the enamel of your teeth. I don’t know—I’m just guessing. But you clearly know that they don’t look the same as they did. Of course she’s going to want to tell you that this is how your teeth were. And as far as the dentist she referred you to, there is no way for that dentist to tell you how your teeth used to look or whether any enamel was removed. Your complaint is very credible to me. If your teeth were always splotchy, that would have been your chief complaint and the reason you got the bonding, and you would certainly know it.

A good cosmetic dentist would have taken “before” photographs, and there would be no argument then about how your teeth looked before the work was started.

So what do you do now? I would go to an expert cosmetic dentist and either have this bonding done correctly or go with porcelain veneers, which will be the much more durable and cost-effective alternative. You should be able to get a beautiful smile out of this. We have an excellent cosmetic dentist listed in London, and I see by the city you mentioned that you are just outside of London. He should be able to take care of this for you.

I think your leverage for a claim against your current dentist is rather weak, because of the lack of documentation of what you are saying. Maybe you can get some kind of refund from her, but it seems to me that this would be entirely voluntary on her part.

– Dr. Hall

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

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.

Dental bonding turning yellow after 5 days

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Dr. Hall,
I had bonding done on 3 front teeth 5 days ago. I used baking soda and wondered if I should’t have because now they look yellow. I was soooo happy to have fairly straight teeth, but now they look yellow. Is there a product available to whiten bonded teeth?

Thank you.
Brianna from Connecticut

Brianna,
Baking soda, unfortunately, used as a toothpaste, is very abrasive, and can damage the polish on the bonding. And no, there isn’t a product available to whiten bonded teeth.

Since this is so recent, I would return to the dentist that did the bonding and ask him or her if they would mind just freshening the polish for you. And then I would switch to Supersmile toothpaste. Supersmile was designed for the maintenance of dental bonding work.

There is a possibility that I should mention and that is that the dentist could have used inferior materials for the bonding. I hope that isn’t the case, but knowing that the vast majority of general dentists have a low level of expertise in cosmetic dentistry, I worry about that. It bothers me a little that it doesn’t seem that they gave you thorough post-operative care instructions for bonding. If you go through this process, use the Supersmile toothpaste, and the yellow comes back (or never goes away), then you may need to check out one of our recommended cosmetic dentists to fix this. The entire bonding probably wouldn’t need to be re-done, but it may need to be re-surfaced in a better material with a better polish.

– 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 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.

Bonding to teeth with fluorosis stains

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Dr. Hall,
I am an orthodontist and recently had a 24-year-old Hispanic man come for treatment with severe fluoride staining. In your experience, would you expect braces to have acceptable bond strengths to be useful for two years of treatment? Is there a special protocol to help?
Thank you,
Dr. David Lehman

Dr. Lehman,
I’m going to generalize my answer so it is useful to as many people as possible.

My experience, of course, was with doing dental bonding procedures on patients with fluorosis. For the lay person reading this post, that is the clinical name of fluoride staining, and it comes from consuming excessive amounts of fluoride during childhood. We don’t see it too much in the United States, because the vast majority of our water supply is adjusted for optimal fluoride content. I’m guessing that this Hispanic man grew up in another country, which may explain the fluorosis.

I did not see extreme fluorosis in my practice, but did see mild to moderate fluorosis, and never had any problem bonding to those affected teeth with normal etching. If the staining is severe, my understanding is that the recommendation is to double the etch time. There was a study done on this some years ago, and I believe that was the conclusion, and I concluded from the data that doubling the etch time, when fluorosis is severe, should produce a bond that would be equal to that of normal enamel.

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.

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

(See Dr. Hall’s answer below.)


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Dear Angie,
Closing black triangles is really tricky. Fortunately, you have 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 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.

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