All posts by iowasmiles

Dr. David Hall is a colleague of Dr. Malone's, an AACD accredited cosmetic dentist, the author of the consumer cosmetic dentistry information website mynewsmile.com, and the president of Infinity Dental Web in Mesa, Arizona.
Uncategorized

Should I get a Maryland Bridge or a conventional bridge?

I bit into a fork couple of months back. and hurt a lower tooth. I have just lost that one lower tooth(# 24). We are considering doing a bridge from canine to canine because the two on the two sides of the missing tooth are OK but kind of weak the dentist said. Options I have been given are 1) Maryland bridge or 2) fixed conventional bridge. I have tried to compare the two types from literature but I am not sure what would be my best option. I would really appreciate your opinion and advice.
– Avram from New York

Avram,
There may be more than those two options. I haven’t seen your case myself, so I can’t say for sure, but I’d maybe get a second opinion and see if there isn’t something else that can be done.

Neither of the two options sounds very attractive. A Maryland Bridge is conservative, but it is made out of metal, and it will darken the adjacent teeth. You may be interested to see a case of a Maryland Bridge that Dr. Malone removed to replace it with a more esthetic porcelain veneer bridge. The bridge from canine to canine sounds very aggressive for replacing just one missing tooth.

Was a dental implant considered as an option? I’d suggest finding a dentist who does a lot of dental implants and asking if this could be a case for an implant. There are also other conservative esthetic bridge options, such as a porcelain veneer bridge, an Encore bridge, or other choices that an expert cosmetic dentist could provide. You’re in New York. You can find an excellent cosmetic dentist by going to the mynewsmile.com cosmetic dentistry website.

Good luck.

Lafayette, Louisiana dentist

Porcelain Veneers

Bonding vs Porcelain Veneers

Hello, I had my 8 front upper teeth fully bonded about 14 years ago to close in gaps between them. I have taken extremely good care of them and they have held up well, although they have stained now from food and drink. I have been told my only option for white teeth is to remove the bonding altogether,then bleach and rebond or go the more expensive route, porcelain veneers. My question for you is this… if the tooth is actually what has become stained and it is showing through the bonding, why wouldn’t bleaching work? If the coffee, tea, etc. got through, wouldn’t they bleach also?? Thank you.
– Patti from Minnesota

Dear Patti,
I think you’re being given good information.

I’m not clear whether you want your teeth generally whiter or you want the stains removed. If you just want the stains removed, the bonding could maybe be re-surfaced. The cosmetic dentist would just remove enough of the surface of the bonding to get rid of the stain, and then bond new material over that. But if you want your teeth whiter than they are, too, then you need to remove the bonding, have the teeth bleached, wait a couple of weeks for the new color to stabilize, and then re-bond.

We do a lot of direct dental bonding, and the bonding material can produce beautiful results. But the bonding resin is a little bit porous, and over the years it will absorb stain. This stain doesn’t respond to any of today’s bleaching techniques, even the state-of-the-art Zoom whitening that we offer.

If you were my patient, I would encourage you to upgrade to the porcelain veneers. Porcelain has the added advantage of being extremely stain resistant year after year. You could have the whitest shade of teeth you want, and as long as you have to have the bonding removed anyway, why not go for the porcelain?

Other links:
Read more about dental bonding.

Invisalign

What is Invisalign reproximation?

I am just putting on my last Invisalign aligner. By the way, they sure do look good. However, on its package is written “Please check the invisalign website for information regarding reproximation.” This concerns me. I looked up reproximation online. I do not have crowding at all. Do you know if this is printed on everyone’s last aligner?
– Janice from New Jersey

Janice,
No, this isn’t printed on everyone’s last aligner package. Something seems not right about this message. I wonder if it was an error.

Reproximation is shaving of the sides of teeth. If you have a little crowding, but not enough to justify taking out one or two teeth, then we just shave a little off the sides of several teeth to get more space so that the teeth can be all lined up. But this is either done even before impressions are taken, in other words, the very first thing after the diagnostic work is done for the Invisalign. Or it is done very early in the treatment, during the wearing of the first few sets of aligners.

I’d ask your dentist if he or she knows anything about this comment. But I suspect that it is just an error by the Invisalign people – that they used this package for your aligners and didn’t realize it had that comment on it.

And we’re glad to hear that Invisalign has worked so well for you. There is an extremely high rate of patient satisfaction with Invisalign. And we just love doing this treatment for people.

Dr. Mike Malone is a Lafayette Louisiana cosmetic dentist. Click the link to learn more about our office.

Click here to learn more about our Invisalign services, to know if this would work for you. You may also want to read about fixing crooked teeth without braces.

Invisalign

Stains on my teeth after braces

I have had braces in the past and now have stains on my teeth. Can they be whitened either professionally or by in-store products, or will this harm my teeth? Some people have said that the teeth are now softer because of the braces. I realize that I probably caused this by not following through with a better cleaning process while I had the braces, but, now would like to correct the problem. Do the whitening products on the market cause problems with people who have had braces?
– Kathy from Oregon

Kathy,
I am guessing that your stains are uneven. Usually the stains that your teeth get after braces are spots where decay started around the brackets. They start out turning white and then become brown. And they’re in spots.

Bleaching is not the correct treatment for spots. It will make them look worse. Because, while it will whiten the spots a little, it whitens the unspotted parts of the teeth more. So the spots become more prominent. Bleaching is for dark teeth that are evenly dark.

What you need for your spots is tooth bonding. You need a cosmetic dentist who will remove the dark spots and then cover them over with composite bonding material. That will “erase” them and bring back your beautiful smile.

If you want to bleach, a Zoom whitening treatment before doing the bonding will make the white parts of your teeth whiter, and then the bonding material can be a lighter color. But you will need to do the tooth bonding – you can’t get around that.

One of the advantages of Invisalign invisible braces is that you don’t ever get this spotting of the teeth. The spotting comes when you don’t get your teeth clean after eating, and food debris collects around the brackets, and then the enamel starts to break down because the decay process starts around the brackets. With Invisalign, you can remove the aligners to eat and to clean your teeth. There are no brackets to collect food.

Uncategorized

Zoom whitening turned out funny

I had the rare opportunity to have a professional Zoom tooth whitening done at cost at a cosmetic dentist. Unfortunately, we didn’t realize until after the first go-around that the color of my teeth seems to be due to natural variation and not stains. That said, the color differences are rather stark after the treatment and I’m unhappy with how noticeably uneven the color of my teeth are. Is there any way to reverse or fix this without having to get expensive bonding or veneers?
– Marcy from DC

Marcy,
I’m hoping your dentist knows more than you seem to be indicating, because from what you’re telling me, there’s a lack of expertise in cosmetic dentistry in your case. One problem with dentistry in the United States is that cosmetic dentistry isn’t a separate specialty recognized by the American Dental Association, and because of this any dentist, with no extra training at all, can call himself or herself a cosmetic dentist.

Zoom whitening will whiten teeth that are naturally dark. It isn’t just for accumulated stains. Most Zoom whitening patients, when they are done, will have teeth that are whiter than any natural color. It removes stains, but it also bleaches out the natural darker colors that are in everyone’s teeth.

However, Zoom whitening and other professional whitening techniques are not appropriate for teeth with uneven coloring. Many general dentists who attempt cosmetic dentistry make this mistake – they try to whiten teeth with spots or stripes, and this only exaggerates the problem. Spots, stripes, and other uneven colorations need to be treated with tooth bonding or porcelain veneers.

Unfortunately, there isn’t a simpler solution for your problem

Related links:
Lafayette dentist
Lumineers – a specific brand of porcelain veneers

Uncategorized

Why do I need a 4+ surface porcelain onlay?

My dentist stated I need to have a tooth onlay.

Now I got the estimate and Description say Onlay Porc/Ceram-4+Surface. What does that mean 4+ surface? I thought I was getting one tooth onlay.

My plan covers a Max of $1000 and they are billing me 1300. Plan will only pay 923.50. Why do I need 4 +surface on the onlay?

Any insight would be greatly appreciated.
– Hector in New York

Dear Hector,
You’re running into some very technical jargon here, and I can see where it may be hard to understand.

The 4+Surface refers to the number of surfaces of the tooth that are covered. Insurance plans reimburse more for restorations that cover more surfaces of the tooth. There are five surfaces on any back teeth – the chewing surface and the four sides. So you’re just reading the documentation of the dentist that this onlay covers four or more surfaces and thus entitles you to their maximum benefit for this tooth. Onlays usually cover four or five surfaces.

And $1300 sounds like a very reasonable fee for a porcelain onlay in New York. You are experiencing first-hand how dental insurance has not kept up with the times. Back in the 60s, their common $1000 maximum benefit for a year would cover a reasonable amount of dental work.  Today they have the same yearly limit and it covers very little.

And for those who don’t know what a porcelain onlay is, it is a very nice restoration. It usually covers the entire chewing surface of the tooth, so it reinforces a weakened tooth. But it only goes partway down any of the sides of the teeth. Since it usually doesn’t touch the gum tissue, it is very comfortable, and requires less grinding away of the tooth. If you are interested in having a porcelain onlay, ask Dr. Malone.

Related links:
A related restoration is a porcelain crown
Read about how to fix crooked teeth
Lafayette cosmetic dentist

Uncategorized

My lip is catching on my Lumineers

I recently got Lumineers and, while I like how they look, I am having problems speaking. My lip keeps getting caught on the Lumineers. What can be done to fix this?
– Joy

Joy,
This is one of the problems with the technique that is promoted for doing Lumineers. It sounds wonderful to be able to bond on a new smile with no anesthetic and no shaving of the teeth before the porcelain veneers are put on. But then people get these problems.

When Lumineers are placed on the teeth without first shaving the teeth back about half a millimeter, they will end up thickening the teeth. And even a slight thickening can make them look a little bulky and can cause problems like this with your lip. I think it would be embarrassing to have your lip keep sticking on your teeth when you talk.

You just have to decide if this is bothering you enough to want to have these re-done.

Other links:
Read another blog post about problems with Lumineers
See the home page of Lafayette dentist Dr. Mike Malone

Porcelain Veneers

Can I get my porcelain veneers replaced for $2400?

I’ve had three veneers on my front teeth for about 8 years and then they suddenly fell off one by one very fast. I even saved two of them, but, as I can guess, new ones will be needed. I do not think any artistry is required for this, just to restore what was there before. Besides,i’m in retirement at this point and have very limited resources.

So, my question: If a good professional can be found who can do this job within $2400 that i have at my disposal at this time. It actually took 4 years for me to save this amount, $50 each month. I’ll very appreciate your response,whatever it is. Thanks so much.

– Joe from New York

Dear Joe,
It looks like you’re a man who is very careful with his budget. I admire that.

A couple of points that will help you. First, I wouldn’t say, “there is no artistry required – just to restore what was there before.” Porcelain veneers are used to improve the appearance of the teeth. And getting front teeth to look good, even if it’s only a matter of replicating what was there, it’s art. A painter who paints landscapes is only reproducing what is in front of her eyes, and that’s still art. Bargains can be very expensive here. “No art” would be to leave your front teeth the way they are now.

So here’s what I’d do. Find an excellent cosmetic dentist. And discuss your situation over the phone to find out if they’ll work with you on this. You actually CAN have the old porcelain veneers re-bonded, IF you go to an expert cosmetic dentist who truly understands the procedures here. That would be the best way to save money – not to go to a bargain-basement dentist. While you can get bargains with basic drill-and-fill dentistry, you will get really stung if you try to get that with cosmetic dentistry – it’s a different marketplace for that. I think you could get done what you need to for the amount of money you’ve saved.

You can also save some money if you are willing to travel outside the New York City area, say, to the lower Hudson Valley or New Jersey. Fees vary quite a bit geographically, and New York City is one of the highest fee areas in the country.

Related links:
Lafayette cosmetic dentist
How to fix crooked teeth
Louisiana Lumineers

Uncategorized

How to fix a gap between my teeth

Dr. Malone,
I have a gap in my two front teeth in the top of my mouth. I want to close it but I don’t want braces. Are there any other methods I can use?
– Ashley from Alabama

Ashley,
There are several ways to close a gap between your two upper front teeth, and which way is best may depend on other conditions in your mouth.

If that is the only thing wrong, the easiest and nicest way to close it would be with tooth bonding. With tooth bonding, we add dental composite to the two front teeth and make them each a little wider, so that there is no more gap. I match the color and translucency of your teeth exactly, and shape and polish the composite so that you can’t tell anything was done to the teeth. You should be able to find an excellent cosmetic dentist in Alabama to do this for you. Don’t go to your family dentist for this – doing this right requires considerable artistic ability and special bonding materials and tints that many general dentists don’t stock. Look for a dentist who is accredited by the American Academy of Cosmetic Dentistry.

Another option is to do porcelain veneers. This is more aggressive, because the veneer will cover the entire fronts of the two front teeth, and may even involve other front teeth. But if there are other defects in the teeth, this may be the best.

Another option is to use Invisalign invisible braces. You said you didn’t want braces, but these aren’t conventional braces. There are no metal brackets, and the teeth are moved about twice as fast as they are with conventional braces.

The tooth bonding is by far the least expensive way to go, and the nicest way, too, if the gap is your only problem.

Other links:
Lafayette Louisiana cosmetic dentist

Uncategorized

What’s the best temporary replacement tooth?

My 15-year-old daughter is missing her upper eyetooth. She had braces and after the braces came off, she had a retainer to wear during the day that had a fake tooth on it, along with a retainer to wear at night that did not have a fake tooth. She developed a reaction to the retainer, and when she would take the retainer out you could see the impression on the roof of her mouth and the roof was very red and inflamed.

We have three doctors trying to determine the best thing to do and I would like your opinion if you have time:
1. The periodontist wants to put in a temporary implant, (he will not put in a permanent implant because she is not 18) but the orthodontist says he has seen the patients that have had this done and it does not look good at all.
2. The orthodontist wants her to have a Maryland bridge done but her dentist has said the teeth will look grayish.
3. The dentist wants the orthodontist to make a different retainer that she will not have a reaction to.
– Stephanie from Georgia

Stephanie,
When I read comments like yours where you have opinions from different dentists and you’re concerned about the appearance, I look for how sensitive the different dentists are to appearance issues. In my opinion, that’s the key point you can take away from this. The vast majority of dentists are technician-minded and not that appearance conscious. Surprisingly, this is true of most orthodontists, too. People think of orthodontists as specializing in appearance-related issues, but most of them are dedicated to “straight teeth”, not to “beautiful smiles.” There’s a difference.

And with these comments, please realize that without seeing the case, this advice is partially guesswork.

Yes, a Maryland Bridge makes the teeth on either side a little grayish. Many dentists think that amount of gray isn’t significant, but to patients it is. The fact that your general dentist is sensitive to this issue is noteworthy.

A dental implant is the best permanent solution. So I’d plan on that in a few years.

For now, a removable retainer with the tooth on it, made out of a material that she isn’t sensitive to. There are a variety of materials to make these out of.

Bottom line – it appears to me that you should trust the general dentist here.

Related links:
Read more about your options if you have missing teeth.
One option is a dental bridge.
Click here to read more about fixing crooked teeth.
mynewsmile.com, the most popular cosmetic dentistry web site on the Internet, has a case of Dr. Malone’s posted with photos of a Maryland Bridge replacement. Dr. Malone did a porcelain veneer bridge.