All posts by writeradmin

Porcelain Veneers

Three Different Color Teeth with Porcelain veneers

I had four porcelain veneers placed on my front teeth. Unfortunately, the two in the very front are turning gray. This has left me with three different colored teeth. First, there are my natural yellow teeth, which still show on either side of my porcelain veneers. Then, there are the white veneers next to them, and the two front teeth which have turned gray. I feel this whole endeavor has been a disaster. What can be going on and what can fix it?

Marla

Dear Marla,

A single porcelain veneer being placed on a tooth

The main problem you are facing with your smile makeover is the inexperience of your dentist. First, the porcelain veneers on your front teeth are defective. This can happen to a new cosmetic dentist. However, an even more basic error was made.

If you are only getting four porcelain veneers and your teeth are yellow, your teeth need to be whitened before your veneers are placed. Your dentist didn’t even know enough to do that.

As for the grey veneers, there are two possibilities I can think of immediately. I couldn’t tell you which without a photo, but I can describe it to give you an idea of what to look for.

If they are uniformly grey, then it’s likely the glaze has been removed somehow. This destroys your porcelain veneers because the glaze is what protects them from picking up stains.

If the gray is uneven, you may have what is known as microleakage. This means the bonding isn’t done correctly and you’ve got things getting between the porcelain veneers and your teeth. This will not only give them a splotchy look, but it will lead to decay.

Fixing a Porcelain Veneer Disaster

Because your family dentist is in over their head, I don’t think they’re going to be able to fix this. You need to ask for a refund and have this case redone by an expert cosmetic dentist. They’ll likely first suggest you whiten your teeth. Then they’ll do the case from scratch.

My suggestion is look to see if there is a dentist who is accredited by the American Academy of Cosmetic Dentistry in a reasonable distance from you. AACD accredited dentists are the top cosmetic dentists in the country. They will provide you with a stunning smile you will be proud of.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Cosmetic Dentist

gums inflamed after porcelain veneers

I had porcelain veneers placed on four teeth almost a month and a half ago. Since they’ve been on, my gums have been inflamed. I went in to see the hygienist and she said it is probably that I’m babying the teeth and not brushing well enough. I can assure you that is not the case. Then, at my one-month follow up the dentist removed some excess cement. That helped a little but it has been a week and a half since then and they are still inflamed. My dentist doesn’t seem concerned but I’m worried, not to mention in pain. What do you recommend?

Kay L.

Dear Kay,

Our experience has been patients love their new smiles so much, after getting porcelain veneers, they tend to take better care of them, not worse. Isn’t it a tad annoying when medical professionals blame the patient when they can’t figure out what is wrong?

Cosmetic dentistry is both an art and a science. The health of the gums is one of many things the American Academy of Cosmetic Dentistry looks at in evaluating cases when dentists are working toward accreditation.

The lateral incisors, in this case, received porcelain veneers. Because of the gum inflammation on these teeth, this case would be rejected as unacceptable by AACD accreditation examiners.

In the case above, the gum inflammation on the lateral incisors would be an indication this dentist did something wrong, causing the case to be rejected by accreditation examiners as a means of demonstrating competency.

While there are several reasons your gums could be inflamed, I’m leaning heavily toward your dentist not removing all the excess cement. You said he removed some at your one-month follow-up appointment. When done properly, all the excess cement would have been removed immediately after they were bonded. There shouldn’t have been any to remove at the follow-up appointment.

A couple of other possibilities would be uneven margins or the porcelain veneers going too far under the gumline. To truly know what is going on, though, you’re going to need to see an expert cosmetic dentist.

Getting a 2nd Opinion from an Expert Cosmetic Dentist

The first thing I want you to do is go to the website of the American Academy of Cosmetic Dentistry. (aacd.com). They have a link to find a cosmetic dentist. However, make sure you check the boxes for an accredited dentist. Membership is easy. AACD accreditation requires real skill.

Pick one which is reasonably close to you and schedule an appointment for a second opinion.

Finally, make sure when you go, you get a “blind” second opinion. This means you won’t tell them which dentist did the work or anything they said could be the problem. You want the accredited dentist to give his unbiased opinion without anything to sway him.

Best of luck.

This blog is brought to you by Lousiana Cosmetic Dentist Dr. Mike Malone.

CEREC

should I have gotten a cerec crown?

I had a crown placed which led to pretty severe gum inflammation. My dentist couldn’t figure out why so he sent me to a periodontist. She couldn’t figure out what the cause was either. Off I go to a prosthodontist. This doctor thinks it is because the dentist placed the crown too deep. He also said if I don’t have it treated I will develop gum disease. But, he said the surgery will likely lead to cosmetic damage to the gum area. I feel stuck. I don’t want gum disease, but I don’t want a cosmetic issue either. What do I do? Would this have happened if I’d gotten a CEREC crown instead?

Mary

Dear Mary,

CEREC Crown being placed on a tooth
Sometimes a dentist gets in over their head

It’s a shame this happened to you. I think your dentist should help cover this as his actions led to the problem. One thing that worries me is the prosthodontist acting like if you treat your gum disease, you’ll end up a cosmetic freak.

The truth is, whatever damage was done to your gums cosmetically speaking, is already done. Now your choices are repair this to help you prevent gum disease or leave it and end up with gum disease. It’s pretty much a no-brainer, but they didn’t put it to you that way..

Maybe they said it that way so you wouldn’t think they botched something after the procedure.

In the meantime, I’m going to suggest you rinse with an antibacterial rinse, like Peridex. This will help you with the gum inflammation.

CEREC Crowns Versus Traditional

You asked if this would have happened if you’d had a CEREC crown instead of a traditional crown. In reality, while CEREC crowns are milled by computer, which does make the fit as accurate as possible, the placement of the crown is still done by the dentist. If he placed a traditional crown improperly, he’d likely do the same with a CEREC.

The only other advantage to getting a CEREC crown would be having it done in one appointment instead of needing a temporary crown and two appointments. The dentist really matters more than the type of crown.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Invisalign

Fixing a single front tooth

The tooth just to the right of my front tooth is crooked. It goes a little behind the other teeth. I’ve had one dentist say braces were my only option. Another suggested I just pull that tooth. I don’t like either suggestion, but given the choice between the two, I’d pick pulling the tooth. I have a last ditch effort to keep my tooth. Is there any chance Invisalign would work in my case?

Penny

Dear Penny,

Whatever you do, don’t let anyone pull the tooth. Your smile would never look right. Even if people didn’t know exactly why, an uneven number of front teeth will always look off.

You have two great options for straightening your tooth.

Option One: Invisalign

Invisalign aligner
Invisalign: The adult solutions to braces

Yes, Invisalign is an option for you. It used to be that it could only handle the ideal cases, but that is no longer true. Advancements in Invisalign have enabled it to take on more challenging cases these days.

It has an additional benefit as well. The aligners can double as teeth whitening trays. This will enable you to straighten and whiten your teeth at the same time. It’s like getting a mini smile makeover.

Option Two: Porcelain Veneers

A single porcelain veneer being placed on a tooth

These are more useful if you want to change more about your smile. Porcelain veneers are the go-to procedure for total smile makeovers. It can simultaneously, change the shape, size, and color of your teeth.

While it won’t straight the crooked tooth the way Invisalign will, it will make your smile look completely straight.

One thing to be aware of is while any dentist who offers Invisalign can use it with equal skill, it takes an expert cosmetic dentist to do a beautiful smile makeover. The best cosmetic dentists are AACD accredited. They can create a stunning smile for you.

This blog is brought to you by Louisiana Cosmetid Dentist Dr. Mike Malone.

Dental Bridge

a Maryland bridge is not a temporary tooth replacement

My daughter had a gymnastics accident which damaged a tooth. Three failed root canal treatments later and we need to extract the tooth. My plan is to eventually replace the tooth with a dental implant when she is old enough. In the meantime, we need a temporary replacement. My dentist suggested a Maryland Bridge. I just wondered what you’d think about that. I asked about a partial flipper, but he said she’d lose them because they’re removable and this will bond to her teeth in the back.

Patricia

Dear Patricia,

First, I want to say your choice of doing a dental implant for her permanent replacement is a fantastic idea. It will serve her very well. I’m glad you realize she will have to wait until her jaw is fully developed. Some parents mistakenly think they can get a dental implant right away, while their child is still a teenager.

dental flipper
Dental Flipper

As for a temporary replacement, your idea is better than your dentist’s suggestion. While a dental flipper is removable and, yes, there is always a chance that your daughter will lose her flipper. In all honesty, though, you could replace several of them for the price of one Maryland Bridge.

With a traditional dental bridge, a false tooth is suspended between two crowns. That requires grinding down the two adjacent teeth, which is definitely not something you’d want to do to healthy tooth structure.

While a Maryland Bridge does not require damaging the adjacent teeth, it is not the temporary tooth replacement your dentist is saying it is.

tooth preparation for a Maryland Brdige
Tooth preparation for a Maryland Bridge

While the Maryland Bridge has two metal “wings” which will bond to the back of the adjacent tooth, without cutting a little groove in the tooth for it to hook into, the bonding is not going to stay. Whenever you are doing any removal of tooth structure, that is not a temporary replacement.

Go with your original idea and get a dental flipper for your daughter.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

CEREC

can I fix the color of my cerec crowns?

I had a CEREC crown done on one of my canine teeth about three weeks ago. We never really discussed the shade while I was in the office, but as soon as I got home, I realized that it was a bit lighter than the rest of my teeth. Well, once I saw it, I couldn’t un-see it, and now every time I look at myself, all I see is that darn tooth. It looks fake.

I didn’t want to bother my dentist with this at first, so I started playing around with at-home whitening products to try to get the rest of my teeth to match, but I’m just not getting them as bright as that CEREC crown. This probably sounds crazy, but I’m starting to wonder if he can darken it just a bit, so it’s a better match. Is that even possible?

Thanks,

Stan

Dear Stan,

CEREC crown restorations and materials

There are a couple of things about your case that give away that your dentist isn’t really what I would call a cosmetic dentist. Every dentist who is serious about cosmetic dentistry, when they place a crown on a front tooth, will make sure you get a good look at it before it is permanently bonded on. He didn’t do that.

The other problem is that it is a CEREC crown. The CEREC material is a block of material that is a set shade. Unless the dentist is an advanced cosmetic dentist, he won’t know how to use color theory and stains to match a front tooth.

To match a front tooth, a true cosmetic dentist has the ability to customize the shade. Each tooth in your mouth has differences in color from the neck of the tooth to the tip, and it is quite a process to mix different materials to get a crown to match the surrounding teeth.

Tints and Stains Exist

There are tints and stains that can be applied to the CEREC to customize the shade. But on a ceramic, that has to be baked into the crown, so that has to be done before the crown is put in your mouth, obviously.

Sounds Like You Will Have to Have Your CEREC Crown Replaced

You deserve to be happy with your smile and he biffed the color. Hopefully, your dentist will agree to re-doing the crown. However, this time, make sure you get to look at it BEFORE they cement it. Check it out under various lighting conditions—seriously. Look at it in the chair. Get up and go into the bathroom and check it there. Venture to an outside window and view it in natural sunlight. If it isn’t right, don’t let them cement it.

Request a Lab-Made Restoration if All Else Fails

There are crowns that have a core that is made like a CEREC crown and then have porcelain baked over the top. If you want a natural-looking crown on a front tooth, this is the way to go. Although you’ll have to wait two weeks for the lab to make it, the lab technician will be able to tint the crown to match your existing teeth. But the dentist also needs to have a good eye for color and the ability to describe the color variations in your tooth, and your dentist doesn’t sound like he is that much into that. For the best results, you’d really want to switch to someone who specializes in cosmetic dentistry for these sorts of things, but you’ve already started with him, so as long as you’re keen to continue, give him the chance to fix his work too.

If he can’t, look for a dentist who has been accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country.

This blog is sponsored by Lafayette, LA Dentist Dr. Mike Malone.

Porcelain Veneers

does smoking stain porcelain veneers?

I am almost done paying for my porcelain veneers. I’m a little worried because they have started picking up stains around the edges. I do smoke. I’m wondering if my smoking is the problem. If so, shouldn’t my dentist have warned me about this? I was told they were very stain resistant. What should I do?

Ben

Dear Ben,

A single porcelain veneer being placed on a tooth

As long as your porcelain veneers still have their glaze, they are very stain resistant. In fact, they are more stain-resistant than your natural teeth. However, there are things that can damage the glaze. If your hygienist used something like a power prophy jet during your cleaning, or even acidulated fluoride, the glazing would be damaged enough.

Once that happens, they quickly begin to pick up stains. I don’t think this is your problem, though. If that were to happen, the staining would be over the whole tooth and you’re saying it’s just on the edges.

To me, this is saying the major problem you’re facing is with the resin which is used to bond your porcelain veneers to your teeth. Your dentist likely polished these when you first had the veneers placed. However, these can stain. They’ll stain faster if you smoke.

Your cosmetic dentist who did the work should have told you what needs to be done to care for them. Here is a great link about regular maintenance for your porcelain veneers.

In the meantime, you still need to have these stains dealt with. I want you to go back to your cosmetic dentist and have him polish the sides. They should use an ultra-fine polishing strip in this area and a special ultra-fine aluminum oxide polishing paste. This will help with the staining and increase the longevity of your smile investment.

Don’t have your family dentist try to do this. Most of the time, knowledge like this is limited to those who’ve studied cosmetic dentistry.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Invisalign

will a dental flipper make my teeth look straight?

I’m too old for braces, but the way my teeth stick out is really holding me back professionally. Is there a way if I put a dental flipper over my teeth it could make my teeth look straight?

Kimberly

Dear Kimberly,

Invisalign aligner
Invisalign: The adult solutions to braces

I think you are confusing a dental flipper with Snap-on Smile. A dental flipper is a temporary tooth replacement that clasps onto the adjacent teeth. It’s designed to be used while you are waiting on the completion of your permanent tooth replacement.

Snap-on Smile is a false tooth arch made of crystallized acetyl resin. It can snap over your teeth. Because this will add bulk to your teeth and you mentioned your teeth are already sticking out, I don’t think this would be a good solution for you. Your teeth would stick out even farther.

Invisalign: The Adult Orthodontic Solution

I know you said you’re too old for braces. As an adult, I wouldn’t want metal wires and brackets on my teeth either. Fortunately, you don’t have to.

Now we have what is the equivalent of invisible braces, called Invisalign. These use clear aligners instead of wires and brackets. These will straighten your teeth without anyone even knowing. They are invisible, even at a conversational distance.

Invisalign has an added benefit. The aligners can double as teeth whitening trays. Now, not only can you have straight teeth, but you can whiten them simultaneously. This is a two for one mini smile makeover. You’ll have a brand new smile you’ll be proud to share.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

Lafayette LA Dentist

dental bridge or implant

I have to replace two teeth and get a dental crown on another one. I’m trying to decide between dental implants and a dental bridge. What do you think would best work?

Kevin

Dear Kevin,

Both a dental implant and a dental bridge are good tooth replacement options. Which one you get will depend on a couple of things. First, I’ll go over how both of them work. Then, we’ll discuss which to choose.

An illustration of a dental implant among natural teeth
A Dental Implant

With dental implants, a prosthetic tooth root is surgically placed into your jaw. There is a time of healing after the surgery and to allow the bone to integrate around the implant. After that time period, a dental crown will be placed on it

There are benefits to dental implants. They’re completely secure and the closest thing to having a healthy, natural tooth in your mouth again. Additionally, the root form signals to your brain the jawbone in that area is still necessary, thereby preserving it.

Illustration of a dental bridge
Dental Bridge

With a dental bridge, a false tooth is suspended between two crowns. This is secured by being bonded onto the adjacent teeth. It makes more sense when one of the adjacent teeth already needs a crown. Without that, you’re just grinding down healthy tooth structure.

Implant or Bridge?

If you need a false tooth next to the tooth which needs to be crowned, then it would be a good idea to get the bridge. If the tooth which needs a crown is elsewhere, I’d get the dental implants to replace the tooth and then get the single tooth crowned.

I hope this helps. This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

CEREC

Cerec crown is too big

I had a dental crown that was about five years old. It broke and I needed to replace it. I decided to get a CEREC crown to speed up the procedure and get a crown as quickly as possible. I’ve had crowns before. But, this one has been a problem. It feels huge in my mouth. So big that it was hurting and causing problems with my speech and gums. It’s also causing me to bite my tongue at night in my sleep. I went back to my dentist and she tried filing it down but I’m still having problems. I though the CEREC crown would fit better.

Kathy

Dear Kathy,

Block of porcelain for CEREC crowns

It seems to me as if you’ve had two dud dentists recently. Dental crowns shouldn’t break. Normally, with a CEREC crown, a tooth is scanned before it is prepared for the crown. Then they use the shape of the tooth in the software to design the crown.

Without that, the dentist can use the software to form the crown, but it sounds like your dentist doesn’t know how to do that yet. I wouldn’t ask her to fix it with her CEREC machine.

Instead, I would ask her to give you a traditional crown which is done at a lab. It will take a little longer, but you need a well-fitted crown. CEREC is capable of doing that. In fact, the software can design a precise crown. Your problem is the dentist.

Do not settle for a crown where you are biting any part of your mouth. This can lead to tumors. A crown should not be noticeable at all.

Turning this Into a Benefit

If you’re going to have to have the crown re-done, I would look at it as an opportunity to improve your smile. This isn’t at all necessary but could be something beneficial.

One of the first things people notice about us is our smile. A great and inexpensive way to make your smile look years younger is with teeth whitening.

Now I don’t know where this crown is, but if it is at all in a visible part of your smile you should consider whitening your teeth before having the permanent crown made so it can be made to match.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.