Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

June 11, 2018

Another family dentist trying to do cosmetic dentistry


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Dr. Hall,
Last year, I had a tooth with composite bonding chip. My dentist retired and the new dentist suggested veneers. After realizing my teeth had fillings, he said he could only do crowns. Unfortunately, I didn’t question him because I knew nothing about this procedure at all. Now, I have six porcelain crowns on my front teeth that I hate. My front two teeth look gray in pictures and do not blend with the other four crowns. What can I do?
– Anna from a small town in central Georgia

Anna,
So you have another cosmetic dentistry horror story. You have spent a lot of money and probably look worse than before you started.

There isn’t a whole lot you can do except have at least these front two crowns re-done. Hopefully your dentist cares enough about his work that he will take care of this for you without charging you.

In re-doing them, you should insist on a try-in before they are bonded, and you should make sure to get a good look at the crowns before they are bonded or cemented into place. And when they are tried in, that should be done with a clear try-in paste that will help transmit the color of the underlying teeth through the porcelain of the crowns. Since your dentist clearly doesn’t have much expertise in cosmetic dentistry and so is unlikely to have try-in pastes, he can just use clear glycerin or any other clear water-soluble gel which should work just as well. Otherwise, you can get a false reading of what the actual final color will be.

If your dentist won’t do that for you or balks at any part of these instructions, you will have to go somewhere else. If that is the case, I would strongly recommend taking the two-hour drive to Atlanta where you can go to a real cosmetic dentist who knows what he or she is doing. Check our list of recommended cosmetic dentists—any one of them could do a beautiful job of this for you.
– 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.

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

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.

October 7, 2015

These crowns are not the color they appeared to be when they were tried in

 

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Dr. Hall,

I have just had two all porcelain crowns made for my two front teeth, #s 8 & 9. The crowns were a wonderful color match to adjacent teeth and I unreservedly authorized them to be cemented in. After the cementing procedure, I looked in the mirror and IMMEDIATELY noticed a slight grayish hue to the teeth. I inquired about this, and the dentist stated that the cementing product he used was transparent in color. I have looked at the teeth in different light conditions over the past several days and STILL see this. Is there something in the cement or its curing that could have caused this?
– Sara from Florida

Sara,
Did the dentist try in the crowns dry? Or was there some type of try-in paste used between the crown and the tooth under it?

That is one possibility that could account for a difference in perceived color between the crowns when they were tried in and when they were cemented. If the crowns are dry, they don’t transmit the underlying color of the tooth as well as they would with a bonding medium between the tooth and the crown. Darkness, stain, or metal posts in the teeth underneath could cause a gray tinge to the crowns. What I did in my practice when my bonding cement was going to be transparent was use a clear glycerin to accurately mimic what the resulting color would look like when it was bonded.

If that’s not the case, then the only other explanation I can think of for a discrepancy in the color like this would be color metamerism, which is the property certain materials have to appear one color under one light and another color under another. Some porcelains may match the teeth under a cool fluorescent light but then won’t match in, say, daylight or under incandescent light. But a clear bonding cement made by a reputable manufacturer will not change colors upon curing and won’t impact the color of the final result beyond helping transmit the underlying color.

If the grayness is only very slight, maybe it isn’t really noticeable, and since both very front teeth are the same, it shouldn’t be distracting. However, if the grayness is significant and noticeable to others, I think your dentist should fix this. At his expense. It could be a great learning experience for him.

Dr. Hall

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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.

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