Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

February 27, 2018

Another porcelain veneer horror story


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Hello Dr. Hall,
I have had 6 veneers done on my top teeth. They are too bulky and not natural looking.

When I first started the process I was very clear with the lab and the dentist what I wanted. He sent back the first set because they were too bulky yet continued to use the same lab. At this point most of this was paid for so it wasn’t like I could have just gone somewhere else. It was all very rushed. There was no style guide whatsoever provided either. I really tried to be patient and put my trust in this dentist professionally. He was nice and everything but that is totally irrelevant.

The day of the cementing I was totally stressed with this whole process and when they held up the veneers for me to see they kept falling out making it impossible to make a proper judgment call. I was unsure about it but they kept telling me that they could make adjustments after. Which was untrue. They were not able to, hence me reaching out to you.

I have tried for the last month or so to get a hold of the dentist, asking for a refund and I’m being avoided it seems. Any advice would be so appreciated, how do I get my refund? I’ve cried so much over this, literally. It’s my teeth not a haircut—teeth don’t grow back after all.
– Leanne from Toronto, Ontario

Leanne,
Your basic problem is that the vast majority of dentists, while they may know in theory how to place porcelain veneers, don’t have the artistic inclinations to do a smile makeover. At the same time, most dental laboratories, while they know the mechanics of making the porcelain veneers, don’t know enough about the artistic aspects of the work to do a smile makeover.

So you go in to this dentist and you say you want porcelain veneers, and he thinks he can do this and thinks his regular dental lab that he uses for crowns can do this. When the first set came back completely inadequate, he’s not going to sour this long-standing relationship with the lab by demanding a refund and switching labs.

Every excellent cosmetic dentist has had a first smile makeover. I had mine, and I will tell you honestly that I wasn’t proud of how it turned out. But I have learned over the years in talking with hundreds of cosmetic dentists that the excellent cosmetic dentists have a fundamental difference in attitude in that they will not be satisfied unless the patient is excited with the result, and they will go through whatever expense or work they have to until the result is beautiful and makes the patient happy. You will never have what happened to you, where they pressure you to accept the result. In my case, my first smile makeover patient was borderline satisfied with the result and didn’t object to my bonding the veneers. But the teeth didn’t have any sparkle, and when she came back for a checkup I told her that her results weren’t good enough, that I didn’t want a mediocre smile out there attributed to me, and I re-did them with a different lab completely at my expense. I have learned since that this is what all of the really good cosmetic dentists will do.

So your dentist, because he lacked this commitment to your satisfaction, either didn’t bother to learn about try-in pastes or decided to skip that step so that you weren’t able to see for yourself how this would turn out before they were bonded. And now, rather than wanting to fix it, he doesn’t want to be bothered.

To get satisfaction and to hopefully get a refund, you’re going to need to get an excellent cosmetic dentist on your side. We’re a little thin on recommended cosmetic dentists in the Toronto area, but we do have Dr. Goodlin there. I would go to him for an opinion, and see if he will work with you to try to get a refund from your dentist. A call from one dentist to another can be very persuasive. Your legal leverage in this case, unfortunately, isn’t that great if the veneers have stayed on and are functionally okay. Your dentist has probably met those two standards, which is how the profession at large will judge your case. Your best point to make, legally, is that you were pressured to have the veneers bonded on against your will with false promises. If you have to go to a lawyer to get enough pressure on this dentist to refund your money, that is the point your would want to make.

I wish you well and hope you end up getting the beautiful smile you thought you paid for. And a tip for others in your situation—even though you have paid for the work, you can switch to another dentist at any point. A dentist is ethically obligated to help facilitate that change, for whatever reason you feel you need to switch.
– 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 10, 2016

Looking for a lab that makes gingival masks


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Dr. Hall,
Hi. We have a couple of patients who are in need of a gingival mask; but no labs in our area fabricate them. Can you please give me the name of a lab that we could work with that makes them?

Thanks!
– Diana from a dental office in Mt. Shasta, California

Diana,
For background for our visitors who may not know about the gingival mask, it’s a prosthesis for replacing gum tissue that is lost from severe gum disease, or after periodontal surgery. It is flexible and pink, and it snaps between the teeth to cover the black triangles left by severely receded gums. It’s usually made out of silicone, but I’ve heard some labs talk about making it out of soft denture liner material such as Molloplast.

A lot of dental labs make these, so I thought you’d have several choices, but then I looked up Mount Shasta and I see that you’re in a relatively remote area of northern California. So I can see where you would have problems maybe finding a lab that would make this.

In other parts of the country, you may want to consider Glidewell Dental Lab in Newport Beach, California, where they are used to shipping cases all over the country. They are fairly familiar with gingival masks. While just about any dental lab that makes dentures would be able to make one of these, if you have to explain to the technician what a gingival mask is, that wouldn’t inspire you with confidence. That won’t happen with Glidewell.

Thanks,
– Dr. Hall

Question and answer go here.

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 19, 2015

I have a bad feeling about how these Lumineers are going to turn out

 

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Dr. Hall,
My husband and I went to a local dentist who advertised cosmetic dentistry. We wanted Lumineers. Our teeth were prepped and impressions were taken. She told us the veneers would arrive in 2 weeks. Exactly 2 weeks later the dentist called and told us that the lab had called, there was a problem with the impressions, and that we needed to return to have the impressions redone. My question: is this common? We paid upfront so they have our money. Your thoughts will be so helpful as we are a bit anxious. Thank you so much.
—Didi from California

Didi,
I’m a little concerned over your situation.

That is not a big deal, to have the first impression not work out and to have to take another impression when you’re having laboratory work done. That happens in the best dental offices from time to time. And I’m confident you’ll get your Lumineers.

What concerns me about your case is what I’m reading between the lines. Admittedly, I’m doing a little guesswork, but this is informed guesswork. And I have some advice for you on how to handle this. It appears that you are dealing with a dentist who may not know what she is doing. I’m drawing this conclusion from the time delay in discovering that the first impressions were inadequate and that this information had to come from the lab.

Knowing what goes on behind the scenes with these things, here’s what appears to have happened. The dentist sent the case to the dental laboratory. The laboratory began working with them and realized that there was a fatal flaw in both impressions. They then called your dentist and told him that. Your dentist would likely resist, because this is embarrassing to have to tell a patient that they need to come back for new impressions, so the flaw must be serious enough to make the case unworkable. The problem is that the dentist didn’t recognize the problem herself, but had to be told. And it wasn’t just one of the cases, but both of them. Added to that is the fact that these are Lumineers, not another brand of porcelain veneers, and Lumineers tend to attract novice cosmetic dentists.

Here’s what I recommend that you do to protect yourselves. Insist that before the Lumineers are bonded to your teeth that they be placed with try-in paste. Insist on this. If your dentist doesn’t have any try-in paste, tell her to get some, because you need to have a good look at these on your teeth and be sure that you are happy with them. If you have any hesitation at all, backing out before they are bonded onto your teeth is comparatively simple. They can always be sent back to the lab to be re-worked or even re-made. And if your dentist can’t put them in with try-in paste, or if she can and you’re not happy with how they look, you can easily switch dentists if it’s before they’re bonded. By the dental code of ethics, enforced by the dental board, your dentist has to cooperate fully if you want to switch dentists, even if it is in the middle of a procedure like this. She would have to forward the models and Lumineers to another dentist. And if it comes to that, let me help you find an expert cosmetic dentist who will be sure that your case turns out looking good.

And don’t accept any excuses here. I have all kinds of stories in my files of patients who had try-ins like this and they didn’t like how they looked, and the dentist pressured them to having them bonded saying that once they got bonded permanently they would look better. Or they would look better in a couple of weeks. Or the patient would get used to them and learn to love them. Don’t buy any of these lines.

Try-in pastes for Lumineers or other brands of porcelain veneers are water-soluble gels that will hold the Lumineers on the teeth very loosely–not firmly enough so that you could wear them out of the office, but enough so that you could stand upright and look at yourself in a mirror. As I said, you and your husband need a good look at these before they’re bonded on, and if your dentist can’t do this for you, then you can find a dentist who can.

Now there are other possibilities for what has happened here. It’s possible that the impressions were damaged or lost after being sent to the lab. Or it could be something else. But I would still insist on the try-in based on this suspicion that we’re dealing with a novice. Excellent cosmetic dentists will all do this and if you have any hesitation about how the smile makeover looks, they will insist on fixing it before they are bonded on. Do a search on “beautiful smile guarantee,” and you’ll find the websites of a number of dentists we have advised about this and will learn how each of them has a variation of this same practice. They will try on the veneers before they’re bonded, and if you don’t love them, they will adjust them or even re-make them until you do and then bond them on. And maybe this is what your dentist was planning on doing all along. But if not, you still have a right to insist on this.

I hope this is helpful.
Dr. Hall

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.

October 4, 2011

My dentist thinks these implant teeth look great, I hate them!

Dear Dr. Hall,
In 2010 I had dental implants placed, it is now a year later and because the dentist had lab troubles I got my front and bottom bridge just this week – but they look so phony and out of proportion. She keeps telling me they look great I just need to get used to them but I know they are wrong. I am going to one of the cosmetic dentists you listed here Friday for a consult and hopefully a more successful outcome. I wanted to send you a pic to see your opinion but there is no place to attach. If that is possible I would really like your opinion. Thank you so much for your time.
– B.C.

Dear B.C.
Go ahead and send me the photos. I’ll take a look and say what I think. I see this response from dentists all the time when the patient isn’t happy with how the dental work looks – “You’ll get used to them.” But a good cosmetic dentist will never say that, and won’t contradict a patient by trying to tell them something looks great when the patient doesn’t think so.

From what you’re telling me, it sounds like this dentist has very little appreciation for esthetics and a low level of concern about whether or not her patients like the appearance of her work. A good cosmetic dentist will try in the work and if you have any misgivings about the appearance of it, will fully address those, even sending the work back to the lab if necessary, until you’re happy with how it looks.

Read B.C.’s follow-up e-mail and see a photo of her smile, of what she calls the phony-looking cosmetic dentistry.

 

 

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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 7, 2011

Which looks better and is more durable, e-Max or Lava crowns?

Hi Dr. Hall,
I am about to go through a procedure that will hopefully change my smile. I currently have a metal crown in the front right tooth and it looks TERRIBLE. In addition to that the left front tooth has a very bad discoloring but also has deep fillings, and next to it, the tooth also has major fillings. My dentist initially recommended that I restore my smile with Lava Crowns, and then decided that he would use e-max crowns.

Is there a difference between these two products? I keep on searching the web to see which is better but I usually find sources that support both products. In addition to this I want the product to look as natural as possible. Is one better than the other? My dentist told me that the e-max crowns usually cost more, but that he would leave it as the same price as the Lava Crowns (which – according to him – cost less). Is this also true? And my last questions would be, what is the durability of each of these? Please help.
– Angie from California

Angie,
The key questions in how these crowns are going to make your front teeth look are not going to be anything about which brand of ceramic crown your dentist uses. The key questions are going to be, “How artistic is your dentist?” And, “How artistic is the dental lab that your dentist has chosen?” Both questions center around your dentist, because an artistic dentist will make sure that the dental lab he or she uses produces highly esthetic work.

The Lava Crown and the e.max Crown are both fairly similar. Both have a high-strength core that is milled rather than cast. Lava crowns have a zirconia core and then have a layer of feldspathic porcelain baked over them. The e.max crowns come in two types. One has a lithium disilicate core and the other has a zirconia core. The e.max crown comes from Ivoclar, and it can be covered with either a baked feldspathic porcelain or a pressed ceramic. The consensus is that both of these are highly esthetic, but I don’t think either of them is the very most esthetic crown. On pure esthetics, I would lean toward a pure feldspathic porcelain that is bonded directly to the tooth without an inner milled core. Both e.max and Lava are high strength, and I couldn’t tell you which is stronger. Pure feldspathic porcelain isn’t as strong, but it will last as long in the mouths of most people as long as you don’t have an abusive bite. Some esthetic dentists think the pressed ceramic is the most beautiful, but more lean toward the feldspathic porcelains. Some esthetic dentists will choose one or the other depending on the demands of a particular case.

But again, the key ingredient is the dentist. Let me ask you this. If you were asked by your community to commission an oil painting for the foyer of a local concert hall, would you research the brand of paint, or would you focus on the selection of the artist and let the artist pick the paint he or she felt most comfortable using? I think you would pick the artist. But you’re approaching the creation of a life-like reproduction of your two front teeth as if it is some commodity to be purchased at a discount store, and all you have to worry about is the brand. Dentists vary greatly in their artistic abilities. 98% of dentists have very little artistic inclination – they chose a career in dentistry because they like to fix things. Some dentists rise to the top in artistic abilities, and they become renowned among celebrities who will fly across the country to see a particularly artistic dentist. On the mynewsmile website, I cater more to the general public and I search out from among the top 1% of artistic dentists and list them here for the benefit of my visitors. I have a lot of e-mails from disappointed patients who make the same mistake of thinking that the dentist on the corner, by virtue of having a dental license, is an artist. It doesn’t work that way.

As far as a choice between e.max and Lava, I think probably more cosmetic dentists use e.max. I have an e.max crown on one of my premolars. Done well, in the right hands, it can produce a nice result for front teeth. Depending on the amount of discoloration in your one front tooth, Lava or e.max can help block out some of the unwanted color. But I would still prefer straight feldspathic porcelain in that situation with a great lab technician who knows how to use opaquing porcelains. I think e.max may tend to cost a little more, but that’s going to depend mostly on the laboratory that’s doing it. Costs for both will vary greatly depending on the laboratory technician that is using it.

It does bother me some that your dentist switched recommendations. My guess is that he spoke with his laboratory technician about your case, and the technician recommended e.max, so the dentist is going along. An excellent cosmetic dentist would have a firm idea from the very beginning of how to best treat your case and wouldn’t be wavering about this.

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 23, 2009

My cosmetic dentist wants to use Zirconia crowns

Dear Dr. Hall
To find an accredited cosmetic dentist I used your website. The dentist was not aware of using bonded all porcelain crowns for front teeth, the accredited cosmetic dentist relied on the advice of the lab tech. The lab tech refused to use bonded all porcelain on front crowns (upper)and insisted the dentist use Zirconia. Who is more knowledgeable or experienced in accredited cosmetic dentistry, the lab tech or the dentist? Thanking you in advance for your prompt reply.
Gina from Connecticut

Gina,
I’m not sure I understand what you’re saying.

Are you saying that you went to a dentist that we recommended on mynewsmile.com, and that this dentist had not heard of bonded, all–porcelain crowns for front teeth?

If so, I’d like to know, and I’d like to know which dentist that was.
And how was it that the lab tech was asked?

l want to try to figure out what happened with your case and then see if I can help you.

Thanks,
Dr. Hall

Dr. Hall
When I mentioned to Dr. N. Summer Lerch of New Haven,CT that I was looking for an accredited cosmetic dentist that would be skilled in bonded all– porcelain crowns for front teeth. Dr. Lerch did not confirm or acknowledge your findings that bonded all-porcelain crowns for front teeth would have the strength that Zirconia would have. Dr. Lerch relied on the lab tech’s recommendations for the crowns. Actually the lab tech refused to make the crowns in stackable porcelain. Unable to find another dentist at that time because I was charged in full for payment of my crowns on the day the lab tech refused to use stackable porcelain on front crowns.
If all this is confusing I will include my home phone if you have questions.
Thanks
Gina

Gina,
Zirconia crowns ARE stronger than bonded all porcelain. They have no metal, and while they are not all-porcelain, I would call them all-ceramic, and their appearance is excellent. They can be made beautifully translucent. A conventional porcelain is usually baked over the zirconia framework, and the end result can be made to look so natural that you could not tell them from natural teeth.

I don’t believe that your dentist was unaware of bonded all-porcelain, but rather than for your situation she felt that zirconia would work better. I’m not in a position to second guess that recommendation, not being able to examine you.

Which particular crowns should be used in a given situation is a matter that depends on a number of factors. I don’t recommend that patients try to push their dentist into using a particular type of crown, because often part of the decision is based on what works well in the hands of a particular dentist, and this will vary from dentist to dentist. Rather, I recommend that each patient find a dentist whom they trust and has the skills necessary to produce a beautiful result, and then give that dentist free rein to choose the material that works best for them in each particular situation.

Dr. Lerch was carefully considered before I recommended her on this website, and I am absolutely confident that she could produce a beautiful result for you. She has been on the accreditation examining board, which means that her esthetic talent and technical ability are highly regarded among her peers.

As far as relying on information from the lab tech, when a dentist has a trusting relationship with a skilled laboratory technician, yes, we often use them as a source of information on new materials. Zirconia is an up-and-coming material that many top cosmetic dentists are turning to, because it is so strong and can be made highly esthetic. And when it comes to the technical information about the strength of the material and its suitability for various situations, then yes, we will turn to the technician. I have criticized on this blog dentists who use the laboratory technician for a shade-matching appointment, because an excellent cosmetic dentist needs to have a great eye for color and an ability to communicate color. But the dentist and the technician are a team and each brings expertise and talent to every project.

I’m skeptical that the laboratory technician made the final decision in your case. If you were giving me trouble over my choice of material, I might use the lab tech’s opinion to help avoid arguing with you. When we as dentists are faced with a difficult patient who wants to push us into a treatment we know will be sub-standard, it’s easy for us to say things that may seem to that patient to be unreasonable. I’m inclined to believe that Dr. Lerch was showing integrity in your case, but I can see how it wouldn’t appear that way to you.
Dr. Hall

Related information:
Read more about porcelain crowns.
Click here to find an expert cosmetic dentist.

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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