Hi Dr. Hall,
Love your site. I am planning to have 6 front upper teeth redone by a dentist you recommend on your site. Four crowns and two veneers. The dentist and I discussed the shape of teeth I wanted, looked at photos. I mentioned several times that I wanted more prominent eye teeth. He said I would be able to see this if we made a model. I paid $365 to have a model done but the model looks kind of like what I have now. He said not to worry that he would make the adjustments when he does the teeth. Is that possible? Does this mean he is creating the shape when he makes the temporaries. He’s not been really clear about this. It is expensive so I’m concerned. Please advise as my appt. is in a few weeks.

Thank you
– Eileen from Michigan.

Eileen,
What your dentist is doing sounds reasonable. However, I’m worried that there may be a communication breakdown in the making here, so I will give you some advice on what to do.

The model you had made would be called a diagnostic model. When the porcelain veneers and crowns are made, the model will be used as a pattern only. The ceramist will have the model sitting on the bench in front of him or her and will visually use it as a guide. And the change you are asking for, having more prominent canine or eye teeth, is not too complicated. The dentist may make the change on the model before it is sent to the ceramist, or he will simply tell the ceramist the change.

But since there could be differences of opinion in what constitutes more prominent canine teeth or just how prominent you want them, it would be reasonable, in my opinion, for you to ask to see the model done the way you want it before your appointment, which I’m guessing is the tooth preparation appointment. Especially since you have paid for this diagnostic model. That will assure you that you are both on the same page. Be bold in your request. I’m confident the dentist will not be offended, and making sure you are happy with the design at this stage could save him time and money down the road.

Your basic guarantee that you will have the smile you want, that you will love, will come when the dentist does the try-in. Every excellent cosmetic dentist will want to be sure, before any new smile is permanently bonded, that the patient loves the smile and will be proud to show it off. The veneers and crowns will be tried in with some type of try-in paste, and you will be given a good look at the final result. If you are hesitant at all, make sure that the dentist understands your concerns and makes the requested changes before the case is bonded on.

This is a key difference between the 98% of dentists who may be good dentists but are not esthetically sensitive, and the remaining 2% who are excellent cosmetic dentists – they are passionate about making their work beautiful, and they understand that the beauty of the smile is in the eyes of the patient who owns it. I have talked with many of these excellent cosmetic dentists, and they all have that commitment to a successful try-in on a happy patient before a smile makeover would be bonded onto the teeth. If at the try-in, you are not happy with how it looks, every excellent cosmetic dentist I have asked has said that he or she would, without hesitation, send the case back to the ceramist to be fixed or remade. So speak up now, and it will save your dentist that risk.

If you have any difficult with this, please let me know. I would be more than happy to intervene on your behalf. It’s important to my reputation, also, that the dentists I recommend do beautiful cosmetic dentistry that pleases their patients.
– Dr. Hall

Eileen took my advice, had the teeth prepared, and then e-mailed me again two months later:

Dr. Hall,
You answered one of my concerns but now I have a much larger one. I went ahead and agreed to have my 6 teeth done with one of the people on your list. I think he is an excellent dentist but I am concerned about the place I find myself now. I did ask for a wider smile and it appeared that it was in looking at the model. What I didn’t realize is that in order to create that wider smile, the new teeth would overhang my bottom teeth creating a kind of overbite. It looks okay when I’m smiling and when my mouth is closed, but when I”m talking or my mouth is open, the bottom teeth look pushed back compared to the new teeth. I couldn’t tell this was happening in the model but mentioned it immediately after the temporaries went in. Everyone in the office said they really didn’t notice it.

I wrote the dentist a detailed email. He said I shouldn’t focus on the bottom teeth so much and that it looked fine and I should tell the lab about my concerns. Which I did when I went to see the teeth and the lab guy said he thought they looked fine too and wasn’t noticing the overbite. Then we got off on other subjects around the teeth. I called the next morning to say I felt we hadn’t really resolved the overbite issue and the lab guy said there wasn’t much he could do and had already finished the teeth for my approval.

The lab guy said he made the teeth less straight and a little more curved than the temporaries but that he really couldn’t do much about the overbite. I do feel that the “overbite” concern” really wasn’t ever addressed and I guess I’m wondering too if I’m just focusing on it too much. I’ve included some photos. Could you look at these and tell me whether you think this is within the acceptable range. I know the new teeth are slightly more curved at the bottom so that should help a little but I’m still concerned it looks a little weird. I’m attaching a couple of photos. These are the temporaries and my original smile.I’ve included two where you can see the overbite I’m concerned about. I do understand that compromise is always a part of something like this I just wonder if this was the right one…. Thanks so much for your help. Hope to hear your thoughts soon…..Eileen

Have liked you on Facebook. Great resource for all of this. The only one I trust online….

Here is my “before” smile:

And here are a couple of after photos, from the front and from the side:

Thank you,
– Eileen from Michigan

Eileen,
I looked at all the photographs, and your smile looks quite attractive. I don’t see any problem with the work.

I would see this with some of my patients – they would try to analyze their teeth with their “left brain,” and that doesn’t work too well and doesn’t produce a beautiful result. To really appreciate the attractiveness of a smile, you need to “disconnect” your left brain and look at it with your right brain – to perceive the feeling that the smile gives you. If you look at it for too long or try to get analytical about it, you reduce the smile to logic and formulas and miss the beauty. And the smile you are showing me is quite attractive – it has a lovely, warm feeling to it. I think your dentist was correct to focus on getting the upper teeth looking attractive and not letting that be compromised by the lower teeth.

This is also a problem that so many dentists have when they try to do cosmetic dentistry. They are drawn to dentistry because they like to fix things and they are left-brained, analytical people, so they can’t produce a beautiful smile. They simply have no artistic flair. And they get that way by focusing on technical details without ever stepping back and taking an assessment of the “feeling” a smile conveys.

My opinion.

Thanks for sharing this with me.

By the way, if you want to see what your smile makeover will look like before actually doing the work, computer imaging for your smile is an option offered by many cosmetic dentists.
– Dr. Hall