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Another full mouth reconstruction gone bad. This case could be a mess.

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Dr. Hall,
I have recently gotten ALL of my teeth crowned. My old teeth were ground down to almost nothing, the front ones were paper thin and chipping daily and on the bottom left I was missing #21 and top right missing #3 and #4. I have also in the past had many unfortunate traumas to my jaw so it clicked loudly all the time when opening.

The dentist said I needed to have my bite opened in order to get my front teeth restored (all I actually wanted in the beginning was just top/bottom front teeth done) He said it would not be possible to do without doing my whole mouth. Fast forward to now, got bottom done all at once and was told that would be the hardest part for me to endure, it wasn’t it was a piece of cake compared to the pain I had for 3 weeks with the top ones. So anyway now i have had the new top ones in for 2 days and I will say they LOOK beautiful no complaints on the smile but the left side teeth touch whilst the right side has a space and my teeth do not touch at all 19-21 bridge not touching but bridge 2-5 hits fast and hard and my jaw is killing me.

He did cement them in with permanent cement and now my question to you is can he file this bridge down enough so my other side will hit and then can he polish it so my ground down rough teeth will not ruin my new crowns on bottom, or does the fixed bridge need to come out and be re-done. We have spent so much money on this and while we do have insurance it covered next to nothing and my husband is in the military and we cannot afford to have all this redone. I am really stressed out and any help you can give would be appreciated.
Thank you 🙂
– Erin from Alabama


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Erin,
You have had what is called a full mouth reconstruction. This is a highly complex procedure because it re-does your entire mouth and your bite. Dental school alone doesn’t train a dentist enough to be able to perform this kind of a procedure – it requires advanced training and/or considerable experience. And there are several well-known institutes that provide this advanced training. There is the Pankey Institute in Florida, and the Dawson Center for Advanced Dental Study, also in Florida. Another is the Las Vegas Institute for Advanced Dental Studies.

But even with that advanced training, these complex procedures should proceed cautiously, especially in situations like yours where the bite is being opened. It should first be opened with temporary crowns and then the bite adjusted with the temporary crowns until you are comfortable with the new vertical dimension. When that is settled, then the permanent crowns are made to replicate the new opening.

But that isn’t all. The crowns and bridgework should be seated temporarily and adjusted to a comfortable bite BEFORE being cemented permanently. And you are a perfect illustration of why this should be done. Here you are, already with TMJ problems (you mentioned loud clicking in your jaw) and apparently over-closed. And now crowns are cemented and your bite is off. Yes, the case needs to be re-done, and the dentist who did this is responsible for that. And if you have lost trust in him, then you need to have this done somewhere else and have this dentist pay for it.

Here’s the problem. Yes, the bridge that is throwing your bite off could theoretically be ground down in your mouth to where your bite is even. But from the sounds of your description (the other side isn’t meeting at all), it would take a tremendous amount of bite adjustment, and he would likely be grinding all the way through the porcelain in some places. Plus, the whole object of the treatment was to open your bite, and now he is going in and grinding it down, so your vertical dimension is going to be off. And this amount of change in the bite is much more difficult to do correctly in the mouth than in the laboratory. The crowns should have been carefully crafted in the laboratory to provide the proper bite relationship with all the cusps, grooves, and other anatomical features precisely mapped out so that your jaw functions correctly.

Having said this, it doesn’t take much for the bridge to throw your bite off enough to be painful. Maybe the discrepancy is only a fraction of a millimeter and it just feels to you like it is a lot. In that case maybe it could be adjusted to fit. And maybe he did try it in temporarily and it fit fine, but in the final cementation something went wrong and it didn’t fully seat. But if that did happen, at least the bridge should be re-done.

I would suggest a second opinion. You want a dentist who has been trained at one of the three institutes I mentioned to help give you assurance that they know what they are talking about, and I would suggest going out of town for the second opinion, to avoid any conflicts with dentists who may be buddies or competitors, which would interfere with getting an honest second opinion.

– Dr. Hall

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.

Did you really need that full mouth reconstruction? I’m suspicious.

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Dr Hall,
I have been going to a local female dentist here for the last 10 years and over the last few years she has put new crowns in the top front (6 or 8) teeth with the metal backed crowns and they leave a black stain across my gums (and chipping, breaking) all the time and she charges to repair these…. so she doesn’t back up her work.

I found a cosmetic dentist in nearby (town’s name withheld), Dr. (doctor’s name withheld) and he inspected my mouth and told me that not only did those horrible teeth need to come out but that my bite wasn’t right and the top teeth were wearing down the bottom to the point of my bite collapsing. Well yesterday Dr. (name withheld) gave me 28 new temporary crowns – will get my permanent ones next week. They will be porcelain and the temps look great it’s just that I find it difficult to eat and maybe it will take some time. I guess I need to get used to it and learn to deal with it.

One more thing is when I order my new permanent crowns I want to make a couple of changes, such as slightly lengthening my eye teeth or maybe offset them slightly to give me a less perfect smile or should I say maybe they won’t look like false teeth. Do you have any input on this situation? It will be about a week or more before I have this done but I want to come out with the best “natural” looking and less fake smile. Is there any other tips! or tricks that I could do as well?

Thanks,
– David from Mississippi

 

David,
I’m glad you e-mailed me. You could be in for a lot of trouble, and you should take your next steps very carefully. I would not let this dentist put your permanent crowns on until you get two big issues solved. I am highly suspicious of this whole situation. I’m going to give you my phone number, and I want you to call me about this. But let me explain your situation first.

1. The number one issue is that you need to be sure that your bite is comfortable with the temporary crowns before proceeding with the permanent crowns. If I were you, I would call the dental office and ask that the laboratory order be put on hold until you have temporary crowns that are comfortable to your bite. Your dentist is opening your bite with a full mouth reconstruction. This is a risky procedure, and could leave you with serious TMJ disorder if it’s not done right. Clue number one for your impending trouble is that you find it difficult to eat. Clue number two is Dr. (name withheld)’s website, where, when I read his bio, I don’t see any clue that he has the advanced training that would be necessary to do work of this complexity. Ordinary dental school education isn’t enough – there are institutes such as the Pankey Institute in Florida or the Las Vegas Institute for Advanced Dental Education that train dentists to do this. And when dentists go through the trouble to obtain this advanced education, it is highly unusual that they would have a website that wouldn’t mention it.

2. You have some matters you want addressed in the appearance of the teeth. Those need to be settled BEFORE the dental laboratory starts making them.

Here is what you need to do, and I am emphatic about this. DO NOT let Dr. (name withheld) or anyone on his staff talk you out of this.
1. Get the laboratory work put on hold until you get the two issues above solved, and until you can get a second opinion about this work.
2. Go get a second opinion. You are spending well up into five figures on this, plus you are putting the rest of your life on the line. If this work isn’t done right and you end up with TMJ disorder, that can make you miserable for the rest of your life until you would get the work re-done. Don’t take this lightly.

I’m going to recommend you go see an excellent dentist in Lafayette, Louisiana, for an opinion on this. I have looked for excellent cosmetic dentists in your part of Mississippi, and haven’t been able to find any, so I think it would be worth it to you to make the trip to Lafayette. I looked up directions on Google Maps, and I see this is a drive of several hours for you. But that’s a small thing when you’re talking about something so major. It is Dr. Mike Malone. He is highly expert in both cosmetic dentistry and reconstructive dentistry. He’s a past president of the American Academy of Cosmetic Dentistry and has been trained in advanced reconstructive dentistry at the Pankey Institute. But more than that, I have known him personally for many years, and he is a decent, honest dentist who will tell you what you need to do. Additionally, if you get out of the Jackson area, you avoid complications that can occur when the dentist giving the second opinion knows the first dentist. They might be buddies, which isn’t good, or they might be fierce competitors, which could be worse. And be sure you see Dr. Malone personally. He has two associates who do the general dentistry, and he does the advanced restorative. When you call, tell him that I referred you. His website is www.mikemalonedds.com, and the contact information can be found there.

I can’t make any declarations for sure without seeing you myself, but as I said in the beginning, I am highly suspicious. There are dentists who recommend full-mouth reconstructions purely for the profit involved. I certainly hope this isn’t the case with you, but you need to find out before this work proceeds any further. If the dental laboratory doesn’t make the crowns, that makes this whole thing a lot easier financially. You could transfer to another dentist, for example, for no additional expense. On the other hand, if the crowns are installed, then fixing you would involve starting all over from the beginning, preparing the teeth, and making new crowns from scratch.

Please call me on my cell phone, and you can talk to me about this.
– Dr. Hall

Link: Click here for information on getting a referral to an excellent cosmetic dentist.

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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.

A $30,000 cosmetic dentistry blunder

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I had an interesting exchange with a visitor named Robin, and in this case, I am not even going to identify what part of the country she is from. But here is what she asked me:

Dr. Hall,
I recently endured an all-porcelain full mouth restoration with crowns and veneers due to bruxism and tetracycline stains. The dark margins of the tetracycline-stained teeth are becoming visible. Also, I am unhappy with the bulky, opaque appearance. Do you know of an artistic dentist in [name of state] who is very experienced with the complexities of masking these stains while retaining the translucency of the natural tooth?
– Robin

Robin,
That full mouth reconstruction with porcelain crowns and porcelain veneers
cost you well into five figures. What a shame that it was done by a poor cosmetic dentist. But that’s the state of the profession. Any dentist can claim to be a cosmetic dentist, because the profession doesn’t require any special training or certification, but 98% of dentists could not do a decent smile makeover.

Robin, one of the standards I have before I list any dentist on our website is that they would be able to do the type of work you want done and have it turn out beautiful. One of the basic differences between a dentist who takes appearance-related dentistry seriously and one who doesn’t, is what happens when the work is tried in and you finally get to see how this will look in real life. The vast majority of dentists will give you a quick look and say something like, “How’s it look? Good. Let’s hurry and put them in.” The excellent cosmetic dentist will actually want to know what you think of it, and if there is even a hesitation in your voice as you maybe say, “I guess it looks okay,” they will ask you what is wrong. “Why don’t you just love how it looks?” Every excellent cosmetic dentist will have that approach to their work. So you would be safe going to any dentist on our list.

[I then gave her the names of what I feel are the top cosmetic dentists in her state. But what surprised me was her answer and what I had learned about the dentist she visited. See the following post for that exchange.]

We thank our advertisers who help fund this site.

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 bite is off, so my dentist wants to crown every tooth

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Dr. Hall,
I have had braces, and I thought my teeth were aligned. However, my dentist stated that my bite was “off”. He offered to correct my bite with full restoration. I do not want to cap every tooth in my mouth. Granted I do have fillings in many of the teeth the bands for braces were placed on. I’m a 40-year-old professional and want the best option for my appearance within financial reason. I’ve been researching my options.
– A veterinarian in New York

Dr. Hall’s answer:
I am very suspicious of your treatment plan. A full mouth restoration based on a statement by the dentist that your bite is “off”? Such a radical treatment would be called for if there were major functional problems, but the complaint would originate from the patient, not by a simple statement of the bite being “off.” Almost everyone’s bite is “off” to one degree or another. It’s not clear what problem this dentist is proposing to solve. My own bite is “off,” and I don’t need any treatment for it.

TMJ disorder is a serious disorder. It can cause debilitating headaches, and premature wearing down of all your teeth. In some cases, the best treatment for that disorder is a full mouth reconstruction, which means putting crowns on all your teeth. But that is a very complex treatment, and a dentist needs considerable post-graduate education in TMJ treatment to do that successfully. And even for those elite dentists who have been trained for that treatment at a prestigious institute such as the Pankey Institute, or the newer Las Vegas Institute, they would first try removable splint therapy and test a new bite alignment to see if it solved the problem before committing the patient to a permanent bite re-alignment.

I’d recommend a second opinion. I’d recommend Dr. ( — ). He’s not a super artistic dentist like some of those in Manhattan, but he’s an excellent restorative dentist who is tuned into esthetics, and I believe he is a solid and ethical practitioner. I’d see what he says about your options.
– Dr. Hall

We thank our advertisers who help fund this site.

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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