When people decide to pursue dentistry as a career, it is generally because they like to fix things. And when they go through dental school they are thoroughly trained in how to accomplish that. It is a completely different frame of mind from the cosmetic dentist, whose goal it is to create something beautiful. In the profession, there is tension between the vast majority of dentists whose sole focus is the engineering mentality and that minority who love to create beautiful smiles. Many general dentists view cosmetic dentists as taking advantage of the vanity of their patients. On the other hand, many cosmetic dentists view those dentists who have that attitude as lacking empathy and understanding of their patients.
When these general dentists try to do appearance-related dentistry, they may have the best of intentions, but they simply do not fully appreciate the demands of cosmetic dentistry, and so the treatment may be a clinical success but a cosmetic failure.
Here are some examples of work done by fine general dentists who simply didn’t understand enough about cosmetic dentistry, and the work had to be re-done by an expert cosmetic dentist. We asked one of our participating dentists to furnish us examples from his file. Many cosmetic dentists have numbers of photographs like these in their files, because much of what they do involves re-doing the work of general dentists.
This is Elenor. She had tetracycline stains, and two years ago she asked her family dentist to give her porcelain veneers to cover those stains. Here she is with the porcelain veneers. The problem is that the dark tetracycline color bleeds through the veneers, and she is not happy with the results. She had to pay several thousand dollars for this work.
Dr. Yaste re-did the eight porcelain veneers and was able to create a beautiful, lifelike look for Elenor.
Check the close-up photographs below that help show the difference in work by the two dentists.
Dr. Yaste also added that Elenor works for a local television station and has high visibility in the community.
You can see in this close-up that not only does the underlying dark brown tetracycline color bleed through the veneers, but it bleeds through unevenly. The front tooth is darker than the others. The veneer on the lateral incisor blocks out the color better, but the resulting color is still fake-looking. Dr. Yaste also mentioned that when he took off the old veneers, he found that they were leaking and decay was beginning underneath them. This is just a reflection of the lack of expertise the dentist had in bonding porcelain to teeth.
It takes a true passion for artistry and beauty to create work like this, to block out the dark brown color beneath and still have a vibrant, translucent look to the porcelain veneers.
Here is another case from Dr. Yaste:
Tonya’s general dentist had placed a crown on her right lateral incisor (the tooth next to the very front tooth) and had replaced the left lateral incisor with a Maryland bridge. The result looks fake, and she’s embarrassed to smile.
Here is the beautiful final result that Dr. Yaste was able to achieve.
Also, please check the close-up views just below.
As you can see, the general dentist had problems with matching the color and other aspects of the case. The left lateral incisor (the tooth next to the front tooth on the right side of the picture) is a false tooth. Notice how it is obvious that it is sitting on top of the gum.
Dr. Yaste was able to match the colors perfectly and also create the illusion that the false tooth is growing out of the gum.
Here is another case of a patient receiving poor porcelain veneers. On the right is a “before” photograph.There are multiple problems with this cosmetic dental work. The veneers are flat in color and poorly contoured. There is a gap between the front teeth. The gums are also inflamed, which is partly due to the contour of the veneers. On top of that, the veneers kept popping off and cracking.The re-do, pictured below on the right, not only looks better, but is healthier.
Below is the result that Dr. Yaste was able to produce for Ron.
The dentist who did the original work claimed to be a cosmetic dentist, even though his results show clearly that he lacked expertise and artistic talent. Patients need to realize that due to the indifference by the American Dental Association to the esthetic concerns of patients, any dentist can claim to be a cosmetic dentist without any additional training at all. Here is Ron’s story:
Ron came to Dr. Yaste complaining about his porcelain veneers that he had received from a dentist in Chicago. He thought this dentist was a cosmetic dentist, but the veneers kept cracking and popping off. And he wasn’t happy with how they looked. He asked Dr. Yaste what he could do.
Dr. Yaste’s first step was to get the periodontal disease under control, which improved the appearance of the gums and also gave a healthier result. Then the porcelain veneers were re-done. In re-doing them, Dr. Yaste gave them a natural contour. The original veneers were too bulky, creating food traps at the gumline, which helped create an unhealthy situation for the gums.
You can see the natural, vibrant appearance that was achieved. On the left is Ron after Dr. Yaste completed his smile makeover re-do.