Dear Dr. Hall, How does one find a good cosmetic dentist that can do good bonding work? Most cosmetic dentist outsource their veneers and crowns to labs, but bonding is in the hand of a dentist. How do we filter the good and the bad? Does your list of referred dentist look at bonding work, in addition to veneers and crowns?
James from San Francisco

James,
Yes, the excellent cosmetic dentists that I recommend, for the most part, will also do beautiful direct dental bonding work. I say “for the most part,” because even some excellent cosmetic dentists don’t like doing direct bonding, but I would say that 90% of them do.

But I’d also like to address this question about “outsourcing” of their porcelain veneers and porcelain crowns to labs, because some people have the mistaken notion that if it’s a great esthetically inclined dental lab, it doesn’t really matter who the dentist is because it’s the lab that creates the porcelain work. I guess they think of it like buying artwork from a gallery – it doesn’t matter which gallery you bought it from, it only matters who the artist is.

But there are a couple of reasons that this isn’t true.

First of all, a great dental ceramist cannot really work around a poor dentist to produce a beautiful final result. The dentist starts by preparing the teeth and planning out the case. How the tooth is prepared and the quality of the tooth preparation as well as the quality of the impression that is sent to the laboratory is critical to the success of the case. Then the dentist is the one who writes the prescription, giving detailed instructions about the shade map of the final result, the surface texture, the degree of translucency, a mock-up of the final result desired, and a lot of other details. And then when the work comes back from the lab, it’s the dentist who approves the work and decides whether the case is ready to be bonded onto the patient or needs to be sent back to the technician. No, while a great laboratory technician is required for a great final result, there is too much that the dentist does for the case for an artistic laboratory technician to be able to produce a beautiful result in spite of the dentist.

Second, a dentist without a great artistic eye will not use the services of a great ceramist. Those services cost more, and it just doesn’t happen that you would get a “great ceramist – poor dentist” matchup. Oh, there are some dentists who are not very good cosmetic dentists who will use a name brand laboratory like DaVinci or Microdental in California to impress their patients, but those are large dental laboratories with large numbers of ceramists of varying levels of ability, and they will not assign their best ceramists to work with dentists whose work they perceive to be of lower quality. I’m sure it’s not something they talk about, but it doesn’t happen that way.

So pick the artistic cosmetic dentist, and that dentist will assume responsibility for the quality of the final result. That is the way for a patient to get beautiful cosmetic dentistry.