Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

April 25, 2018

A situation where Invisalign didn’t work


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Hello Dr. Hall,

The reason I want to speak with you is because I started with Invisalign October 25th 2016 with a Dentist. We agreed upon me paying $4,675.00.

My goal we spoke about for my smile was to fix my midline and also make room to put veneers on my lateral teeth.

His expert recommendation was Invisalign over a period of 9 months. I finished my first set of trays during the 9-month period (August 2017). Since my midline was not straight after the 9 months, my dentist ordered a new set of trays.

I was supposed to be done in March 2018. I’ve sacrificed double the time to work with him to correct the midline as we had initially discussed in Oct 2016.

So at this point, I’m at my wits’ end. I’m frustrated from sacrificing so much time and money. I took it upon myself to speak with doctors about my current situation. These are doctors who work with both Invisalign and traditional metal braces. Their professional recommendation was Invisalign would not give me the results I need and traditional braces is the only option.

How do I go about getting a refund to be able to fund my new braces?

Thank you for your advice.
– Kristen

Kristen,
I’m going to give you a two-part answer, and in the first part I’m going to address whether or not Invisalign would work in your situation. I’m guessing that these other dentists, who sound like orthodontists since you said they work with both Invisalign and traditional braces, are probably right that this wasn’t a case for Invisalign. Having said that, in my experience, many orthodontists, educated in traditional methods, don’t give Invisalign the credit it deserves. I’ll tell a story as an illustration. When I was practicing, there was an orthodontist who was an excellent orthodontist, and he had a patient come to him who wanted Invisalign. He told the patient that traditional braces were the best way to correct his crooked teeth, and he wouldn’t do it any other way. With those options, the patient chose no treatment at all because he was dead set against wearing metal braces. Then he came to me, and I told him that yes, the orthodontist was right that traditional braces were the “best,” most predictable way to move his teeth, but that Invisalign would also work and if he was willing to accept the limitations I would take the case. I did, and the results turned out fine and he was very happy. The point is that some dentists have this strict mindset. This includes some orthodontists who stubbornly refuse to give Invisalign the credit it deserves. Part of what is going on in the backs of their minds, I am sure, is that you don’t need to be an orthodontist specialist to use Invisalign, and they feel protective of their status as specialists. Their identity and status is tied up in diminishing Invisalign as much as they can.

Anyway, moving a midline and keeping it straight is a little tricky to accomplish, and I think is best handled by a specialist—an orthodontist, so I think you’re now in good hands.

So that brings us to my second point—getting your refund. Different dentists are going to respond very differently to a situation like this. Some will be fine with giving a refund for a treatment that didn’t work, while others will be nasty about it. So you start with a simple request, and then you ratchet up the pressure until you hopefully get your way. Here are the steps for ratcheting up the pressure:

  1. Start with a straightforward, polite request to the dentist
  2. Ask another dentist to call with the request for a refund. If another dentists feels that a refund is warranted, this adds a lot to the strength of your request.
  3. Complain to a local peer review committee, if one exists. This step may not be too effective, and most people could easily skip this.
  4. Threaten, and then follow through, with a complaint to the state dental board. No dentist wants a black mark on their record with the dental board.
  5. Get a lawyer.

And through all of this, you don’t want to be emotional or nasty. Be polite, with a calm voice, but firm.

I wish you the best.
– Dr. Hall

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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 9, 2017

Tooth roots left behind

Filed under: Extractions — Tags: , , , , , — mesasmiles @ 4:40 pm

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This is a follow-up from Mozna from a post I answered yesterday: Will taking out this tooth root risk nerve damage? Mozna sent an x-ray with this comment:

Dr Hall

I have included a link to the x-ray. The surgery I need is for my bottom left tooth number 35. You will be able to see from the X-ray that I have roots left behind on both the left and right side of my mouth however the surgeon will only be extracting the root on the left side. Is it a good idea to do this extraction if it’s sitting on a root?

Many thanks,
Mozna

Mozna,
So this is a lower premolar, as I suspected, and we are talking about the risk of damage to the mental nerve, because of proximity to the mental foramen.

What I said yesterday stands, as far as the risk of damaging this nerve. This is a matter of good surgical technique. I do not believe that a skilled, careful surgeon would have any problem avoiding damage to this nerve.

Now about whether or not this root should be removed. Here is the x-ray you sent:
tooth roots left behind

Yes, I see that we are talking about a very sizeable part of the tooth. It looks like the entire root on the left side (which is our right) was left behind. On the right side, the tooth fragment is maybe 2/3 of the root.

In my opinion, you are getting good advice here. On the right side, the bone has healed around the remaining part of the root and there is no pathology. On the left side, however, the amount of root remaining is so large that the bone was not able to heal over the tooth, leaving a bony defect which could eventually threaten the teeth on either side.

I’m sorry that you were so poorly served by your original dentist. It seems like you are in good hands now, though.

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.

September 25, 2012

This new tooth gap is really serious – her teeth may fall out

Filed under: Gum disease — Tags: , , , — mesasmiles @ 6:09 pm

What would you recommend for my smile? I had a huge overbite as a child from sucking my thumb, had braces and was very happy with the results. My problem is that I’ve been told I have periodontal disease and now have a HUGE gap between my lateral incisor and canine tooth and makes my smile look crooked.
– Karen from Washington

Karen,
Your periodontal disease sounds serious. Once your teeth start moving, they are already getting loose and may have lost half or more of their bone support. So your treatment plan is going to have to focus on that first. Exactly what options are available to you, that is going to depend on the severity of your periodontal disease. And your first step is going to be getting your periodontal disease under control, if that is even possible. Your dentist has hopefully made that clear to you.

And from there, you need to proceed cautiously. If saving your front teeth is a hopeless proposition, for example, you probably won’t want to invest thousands of dollars in porcelain veneers. Instead, you may want to be looking at getting dental implants, or a removable appliance to replace the hopeless teeth. On the other hand, if the periodontal disease can be brought under control and the destructive processes stabilized, the teeth may be able to be moved back into an esthetic position with braces and stabilized there with some type of splint that will prevent them from moving again.

You do want to be sure that your dentist is one of the small minority of dentists who is truly sensitive to appearance-related issues. 98% of dentists have a strong engineering mentality, focused on fixing things. While they are generally honest and skilled practitioners, they are not artistic and would not fully appreciate your concerns about your appearance or be able to give you back your beautiful smile. I would urge you to check our list of screened cosmetic dentists and choose one of those. That is why I operate this website.

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.

April 30, 2012

Is it possible to save a few dollars on a beautiful smile makeover?

Filed under: Cosmetic dentistry costs — Tags: , , , , — mesasmiles @ 5:30 pm

Dear Dr. Hall,
I had braces as a child however I never wore my retainer after they were removed due to the lisp they caused when I talked. As an adult, I’m now paying the price as my upper teeth are slightly crooked and my lower teeth have lots of crowding. My general dentist has also said I’ve worn the enamel off most of my teeth due to grinding/clenching. And to make everything worse, I have some yellow discoloration that my dentist has blamed on the large doses of antibiotics I was on as a child (was treated with IV antibiotics for several years on and off).

I also have a mild phobia of dentists and don’t go as often as I should.

The older I get, the more I realize that my smile is affecting my self-confidence and I really want to do something about it. I wouldn’t trust the guy I’m going to now for any cosmetic work, since reading your blog and looking at dozens of before and after shots from other dentist, I’m beginning to understand that you really need a professional who has a passion to get good quality work. A family member of mine has recommended me to his dentist, who did a lot of cosmetic work and gave him a beautiful smile makeover, but cost him upwards of $30,000+. I don’t have this kind of money to spend, and I personally think my family member was overcharged.

My question to you is can you recommend someone in my area that I can trust? I see a lot of advertisements in my area (I live close to NYC) for these “top rated” cosmetic dentists, but it seems like they all overcharge you so they can put another fountain in their office. I appreciate any feedback you can provide and I found your blog very knowledgeable!

Thanks,
Randy from New Jersey

Randy,
We have a variety of dentists that I recommend on mynewsmile.com as far as the fees that they charge. I don’t know the relative fees of most of the dentists we list – I do know some.

The ones we recommend in Manhattan are all expensive. And any dentist who markets heavily is likely to be expensive.

To get a handsome smile, it sounds like you will need a smile makeover with either porcelain veneers or porcelain crowns. Probably porcelain crowns – since you say you have worn your teeth down from grinding your teeth.

Here’s what I would do. You’re in New Jersey. Call the dentists on our New Jersey page and ask what their fee is for a porcelain crown. Some won’t give you a fee over the phone, but some will. And use that to find a dentist who fits your budget.

All the dentists I recommend have passed my careful screening, so I have confidence in all of their work. But not all of them are expensive. So give that technique a try.

If a dentist is really expensive, it’s not an indication that they do great work. Some mediocre dentists charge high fees. However, if a dentist is really cheap, it is generally a good indication that the work is poor. Some excellent dentists have moderate fees, and some have high fees. But that is the extent that the old maxim “you get what you pay for” works. What you want to find is that excellent dentist in your area whose fees are moderate.

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.

March 16, 2012

I’m 16 and still have my baby canine teeth. Can I get dental implants?

Filed under: Dental implants — Tags: , , , — mesasmiles @ 11:03 pm

Dr. Hall,
I’m 16 and I currently still have two baby teeth – my two top canines. Last year I found out that my two bottom canine were baby teeth as well, and had them removed. It was very embarrassing but luckily my right permanent canine was behind my baby tooth and over a year is somewhat in the regular spot but, my other canine tooth on the bottom(left) was removed and my permanent tooth is growing far behind and close to my lateral incisor.

I don’t know what to do, it is very embarrassing to have an empty spot in my teeth. My top baby canine teeth are still here though, I had to go to the dentist to remove them but I don’t want to have gaps in my smile, especially since I will be taking my senior pictures soon. I also don’t want to remove them because I’m scared that like my bottom canine they will grow far behind. What should I do? Are dental implants a possible solution to this?
– Cathryn from California

Cathryn,
Are you having regular dental checkups? And if you are, why hasn’t your regular dentist addressed this? This is not an uncommon problem, and dentists are taught in dental school about how to address it. Knowing what to do requires good x-rays of your entire jaw.

If you still have your baby canine teeth at age 16, the most likely reason is that your permanent canine teeth are impacted. In order to do the right thing with your baby canine teeth, you need to know about the permanent teeth. Where are they? Are they impacted? Are they in fact behind your other permanent teeth? Or are they in front of them? And if they are impacted, then an orthodontist should be able to help get them erupted into the correct positions.

There can be permanent teeth that never form, but it is very rare for those to be the canine teeth. Lateral incisors are one of the most common teeth to not form, as well as lower premolars and sometimes wisdom teeth. When you still don’t see the permanent canine teeth at age 16, it’s usually because their eruption is blocked. The treatment for that is to help them erupt, usually by making a surgical opening in the tissue to expose the tooth and then possibly to attach a bracket to the tooth and help it erupt using braces. Though sometimes surgically exposing the canine is all that is needed to help it erupt.

If there isn’t room enough for the canine tooth to erupt into its normal position, then that is a question for the orthodontist to address. Since the canine tooth is an anchor tooth and an important part of your smile, it is usually best to remove the first premolar to make space for the canine and then straighten the remaining teeth.

Replacing the canines with dental implants won’t work if your permanent canine teeth are impacted, because the implants will run into those teeth. You can only place dental implants if there are no teeth under the surface where you’re putting them.

I hope this is helpful.

Dr. Hall

We thank our advertisers who help fund this site.

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 19, 2011

My dentist won’t do the crowns unless I do the braces

Hi, I went to dentist today to inquire about replacing the crown on my two front teeth. They were put on about fifteen years ago and are discolored and embarrassing. I was told I need full ortho braces before I can get the crowns replaced. I do not have the money for that and I don’t see why I can’t just get new crowns and do the other stuff later. My front teeth in question are a little crooked and bucked out but not that terrible. What should I do?
– PJ from Wisconsin

Dear PJ,
I don’t like it when dentists put these restrictions on their treatment – they will only do the perfect treatment or nothing. People have budgets and sometimes less than ideal is the only thing within their budget.

You certainly should be able to get these crowns replaced without doing the orthodontic treatment. You could forgo the braces entirely, or you could do it later. The dentist should still be able to do great crowns and get them looking great.

I would find another dentist who is a more sympathetic and understanding type who will work with you and your budget.

And I would be sure to do all-porcelain crowns on your front teeth. Otherwise they will tend to look fake and will end up showing a dark line at the gumline. Make sure your dentist feels comfortable with this type of crown. Don’t press your dentist to do a certain type of crown – but ask what type the dentist recommends, all-porcelain or porcelain fused to metal. And if he recommends porcelain fused to metal, you’re in the wrong office. Just quietly exit and find a dentist who loves doing the all-porcelain.
– Dr. Hall

We thank our advertisers who help fund this site.

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 28, 2011

Can I use a flipper to make my teeth look straight?

Filed under: Invisalign — Tags: , , — mesasmiles @ 5:56 pm

I have teeth that are not straight. I was wondering if I could get a flipper that could go over all my teeth and make my smile look straight. I don’t want to go and pay a lot to go and get braces when it takes a long time … and is more painful. thanks
– Taylor from New York

Taylor,
A dental flipper is used to replace one or more missing teeth, and it snaps onto your existing teeth with a small wire clasp.

What could work for you is a Snap-On Smile. This snaps over your teeth, and could work if you have crooked teeth – it will make them look straight.

But especially if you have teeth that stick out a little, the Snap-On Smile would have to be made even a little extra bulky. It might not look great for you. I’d recommend going to an excellent cosmetic dentist so you get an honest opinion about how this would look.

If it’s the pain of braces and the long time it would take, the best thing may be Invisalign invisible braces. It takes about half the time of conventional braces – most cases can be done within 9 months to a year. And there are no painful brackets or wires. I’d check that out.
– Dr. Hall

We thank our advertisers who help fund this site.

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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