Hi Dr. Hall,
I thought I was getting either e.max or zirconia veneers. My dentist said I was a better candidate for 360 wrap veneers. I asked her assistant how much tooth would be taken off, and he replied, a very small amount. So I went ahead and did them.
While I was in temporaries, the left temporary canine fell off 3 times. Now that I have the permanents, last night, while only brushing, the permanent fell off for the 3rd time. It popped out into the sink. My tooth remaining is one little nub. I am flossing the way the assistant told me. I am not eating anything hard, and I cut everything up small and put further back to chew.
I am so stressed out with this experience. Except for this last time where tooth fell into the sink both the temps and permanent fall outs occurred during the night. I religiously wear my night guard. Thank goodness I woke each time and haven’t swallowed the tooth. This is giving me so much stress. Today they said they are ordering special cement. But they had used a stronger cement already and obviously, it is not working.
Back in May, they did a CBCT scan for which I paid $300 out of pocket back. I also had three bridges replace with them prior to having any cosmetic surgery started. I have repeatedly asked to see the results of the CT scan, but they always come up with excuses. In addition, I have been waiting for almost two months for my day time guard. They took the impression when the permanent 360 veneers were put on. The holidays are upon us, and am so worried will be with friends or family and I’ll lose the tooth. My incisors do not feel that sturdy either. I wake during the night, running my tongue over my teeth. My quality of life is being affected. Please, any advice is welcomed.
– Mary Thompson
(See Dr. Hall’s answer below.)
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Oh, I’m so sorry for what has happened to you. I’ll be blunt with my advice—you need to get another dentist to fix this.
Let me start by pointing out something that should be a huge red flag to you and that is that your dentist’s office tricked you. You asked the assistant how much tooth was going to be taken off, and he said, “a small amount.” But you are telling me that when the canine “veneer” came off, the tooth was just a nub. In other words, there was a lot of tooth reduction. That was your big clue that you’re dealing with an ethically challenged dental practice. The assistant had to have known the teeth would be ground down to nubs, and had to sense that this was important to you. But he didn’t want you to know that lest you would not agree to having the work done.For me, my first clue that we have an ethically challenged dentist is in her use of this term “360 wrap veneers,” or “360 degree veneers,” as others put it. This term is an oxymoron that is deceptive, and I’ll explain why.
A porcelain veneer is a thin shell that is bonded to the front of a tooth to change the appearance of the tooth. A crown is a restoration that covers the entire crown of the tooth, the part that is above the gum. For the crown to fit on the tooth, the tooth has to be ground down so that it is tapered so the crown can slip on it. The picture above on the right shows relatively aggressive porcelain veneer preparations. It shows maybe half a millimeter of tooth reduction. Many porcelain veneers are done with less than that, and some can be done with no preparation at all.Below that is a photo of a couple of porcelain crown preparations that are on the conservative side. You’ll notice that they have to be tapered, and in order to create that taper, the sides of the teeth have to be shaved down considerably.
When you had this work proposed, you asked a question that is on the minds of many patients, “How much tooth will be taken off?” People know that for crowns, a lot of tooth structure has to be removed, and that is especially the case for front teeth. They tend to not like that and that can be a make-or-break issue for them in deciding whether or not they want a smile makeover. But for patients who have done some research, they know that veneers are much more conservative. The term “360-degree veneer” is then a way to make a crown seem like something it isn’t.
That leads to the question, why doesn’t the dentist just do the more conservative veneer when that will accomplish the objective? The reason is that a veneer is a more technically demanding procedure that isn’t taught as part of the regular dental school curriculum. A dentist needs some post-graduate training, extra attention to detail, and possibly some extra tools to do veneers. Realizing that your dentist didn’t want to be bothered with the extra training gives you a clue as to why she may be having problems getting your crowns to stay on. Since she didn’t want to do conventional porcelain veneers, I’m guessing that she doesn’t have a full understanding of adhesive technology. And from your description of the tooth it sounds like she has also done a quickie overly tapered tooth preparation. (For more information about why crowns don’t stay on, see my blog post about why crowns fall off.)
It is possible for a dentist to do crowns that don’t fall off. You shouldn’t even need a nightguard to keep crowns from falling off, much less a day guard. In my over 20 years of practice, I never had a crown that I did fall off. The problem in your case is that it could be tricky for another dentist to recover from the mistakes your current dentist has made, but that’s the direction I would go. You will need a dentist of considerable expertise. If you want, I may be able to help you find a dentist who knows what he or she is doing for a case like this. You just need to let me know where you are. And then you should be wanting some kind of refund from this dentist.
– Dr. Hall
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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.