Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

June 23, 2016

Follow-up on trouble speaking with new veneers


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This is a follow-up to the previous post, where Susan emailed Dr. Hall telling about problems she was having speaking with her new porcelain veneers.

Susan commented at the bottom of the post:

Thank you for the reply. I think I am going thru a bad nightmare. After complaining about my speech and bite, the dentist took off the front four permanent veneers, to replace them. As he was taking them off he broke #9 [the upper left central incisor] after which I had to have the tooth pulled and an implant put in. I am currently 2 months with the implant temporary. I have to wait three months for it to heal. I asked him to make a matrix of the temporary veneers and the final veneers to see what is wrong. He said all the molars are each side were made too short and the lab made the mistake by using my original bite. Right now I have 9 temporaries in my mouth with the implant. He didn’t replace the 1st molars because he claims they are fine. My temporary veneers were 12.4 length for #9 and #10. Now they 11.8 and hitting my lip. Could it be those back 1st molars being too short? Or should I just run and find a new dentist?

And here is my answer:

Susan,

Again, I do have to qualify what I answer here by saying that not being able to see exactly what is going on, I may be missing something, but I CAN tell that something isn’t right here.

The molars being made too short—that would definitely explain your speech problems. But passing the mistake off onto the lab saying they used the wrong bite? No, that doesn’t work for me. It’s not the lab’s fault. The dentist gives instructions to the lab and the issue isn’t your bite, it’s the vertical dimension. And that has the potential to cause long-term problems. It is called bite collapse. You absolutely need to have your bite opened to its original position. What is starting out as just speech problems can easily progress to TMJ disorder with possible chronic headaches and jaw pain.

Cases like yours where the vertical dimension is altered need to be approached with great care, and a dentist needs more training than what they receive in dental school to pull this off. The dentist will replicate your bite on a machine called an articulator where he or she can carefully study all your bite movements. He or she will establish a vertical dimension by testing it in your mouth with temporary restorations, and then will send your case to the laboratory on the articulator with careful instructions on how to reconstruct your mouth.

And then I’m aghast at what happened to your front tooth. When you take off veneers, the way to do that is to grind them off. You can’t “pop them off” or remove them in any way like that if they’re bonded on properly. They become like a second enamel and the only way is to grind them off, which is a gentle process that is similar to preparing the teeth in the first place. I am again suspecting that he didn’t actually do porcelain veneers but did porcelain crowns and called them veneers. But even then, with front teeth, crowns should also be ground off, and there is no excuse for breaking a tooth.

I would not let this dentist touch your teeth any more—this is getting worse every time he sees you.
Actually, I do know an excellent cosmetic dentist in northern New Jersey. I will send you the name. I know her personally and have absolute confidence in her. She is AACD-accredited, which is no mean achievement, and a Master of the Academy of General Dentistry, and I believe she is one of the best cosmetic dentists in the entire state.

A couple of additional points:
1. You need to get tough with this dentist. As I said, not seeing your case personally I’m at a little bit of a disadvantage, but based on what you are telling me he has violated the standard of care and is very vulnerable legally. He seems to have got in way over his head and has done multiple things wrong. If I were you I would call him and say that you’re going to be nice and not take him to court where you could sue him out the wazoo, but to avoid that he needs to pay for everything that this new dentist needs to do to fix you up. Go to the new dentist first, confirm the details of what has been done wrong, and then confront him.
2. I can’t imagine that your bite and vertical dimension are the only problems with your case. You haven’t said anything about how your teeth look, but it is rare for functional incompetence in dentistry to be blended with artistic excellence. In my mind’s eye right now I can’t imagine that you have a beautiful smile. But based on what you have told me, your case needs to be completely re-done. That is your silver lining. The new dentist, in re-doing this, can give you a beautiful 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.

March 26, 2011

Is this a case of gorilla bite?

Filed under: Dental crowns,Root canals,TMJ — Tags: , , , — mesasmiles @ 11:17 am

A little over three months ago I had a root canal and crown done. Tonight not only did the crown come out it broke off the post also. What do you reccomend doing to fix this? And since it didn’t even last four months should my dentist be responsible?
– Gerrard from California

Gerrard,
It sounds like a nasty situation, this tooth of yours. I suspect that the crown didn’t just come loose but broke off at the gumline. I’m guessing here somewhat, and answering based on what I’m visualizing of your situation, based on the few details you’ve given me. Not being able to see what has actually happened, I want to try to be helpful based on what is probably going on here. Anyway, if the post broke off, I’m guessing the tooth also broke off. It creates kind of a tough situation because there probably wasn’t a lot left of the tooth to start with. And if the post and crown have failed, it may be that the tooth really can’t be saved.

If not, then maybe the post was just weak and this can be re-done so that it works.

I want to be careful here, because I don’t want to make it sound like your dentist was anything other than well-intentioned and appears to have been trying to save a tooth that is proving pretty tough to save, which to me is admirable. And there could be extenuating circumstances. There are some patients that have what some dentists call a “gorilla bite” that generates a tremendous amount of force, and once they hit a certain age and their teeth start breaking down, they tend to break anything a dentist puts in their mouth. Having said that, if this post and crown only lasted three months, yes, if I were the dentist, I would eat some of the cost. What I would do when I tried what ended up being heroics to try to save a tooth, and I didn’t adequately warn the patient that this treatment might not work, I credited to the patient the cost of what I did do against the more aggressive treatment that I should have done in the first place. You are very likely going to need more aggressive treatment here – possibly a bridge or an implant to replace this tooth. So I think that credit would be fair. But whether the dentist is legally responsible to do that for you would depend on if he or she actually did something wrong, and it’s not clear that this is the case.

If you are one of these people with the “gorilla bite”, then your dentist may have to make you a night guard to help protect you against breaking off more teeth. You can tell the person with the “gorilla bite” by looking at the profile. If the bottom of the lower jaw is parallel to the upper jaw, that’s the “gorilla bite.” If that’s you, get a hard plastic night guard fitten to your upper teeth and wear it faithfully every night. I had three or four patients like that, and that was the only way to keep them from breaking off teeth. If you’re not, then count your blessings and just address this one tooth that may be unrestorable.

Dr. Hall

Links: Read about another patient who kept breaking teeth off, so had his whole mouth rebuilt with 28 crowns and has continued to break off teeth. This is likely a true case of gorilla bite.

 

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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.

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