Tag Archives: finding an expert cosmetic dentist

CEREC

Something Is Off About My Dental Crowns

I have had same=day crowns before with no problems. They always matched fine. However I recently had one placed on a front tooth and something is off about it. The color is the same… sort of. It looks a bit flat and weird though. I don’t know how to quite describe it and my dentist thinks they look fine. What do I do?

Amelia

Dear Amelia,

Block of porcelain for a CEREC crown

 

My guess is that your dentist is a fine general dentist but does not do a lot of cosmetic dental work. Using same-day crowns are fine on teeth that aren’t front teeth. However, they don’t work as well on front teeth unless your dentist is an expert in color theory.

The reason for it is because CEREC crowns are milled from a single block of porcelain. Traditional crowns, on the other hand, are milled from several different blocks of porcelain so that they can mimic the natural changes in opacity that your teeth have.

When you are not talking about a front tooth, that is not as urgent. However, your front teeth are directly exposed to light when you smile, so then the differences become quite clear.

The only way you are going to get this particular crown to look right is to replace it. You will need an expert cosmetic dentist to do this. You’ll want someone who is AACD accredited. They can either provide you with a traditional crown or give you a new CEREC crown if that is what you want.

Don’t be surprised if even with an expert cosmetic dentist it takes a few tries to get it right. Because of that, they will need to try the crown in with a temporary try-in paste and allow you to examine the match in several different types of lighting in order to make certain that you have a perfect match. If it is not, they can redo them. This is a common procedure with a crown on a front tooth.

This blog is brought to you by Lafayette, LA Dentists Drs. Forman and Thimesch.

Emergency Dentist

Discolored Porcelain Veneer

My daughter is in college and still has several weeks before she gets out for the summer. A couple of years ago she had eight porcelain veneers placed on her upper teeth. Last summer she chipped one in a biking accident. Our dentist decided the solution was to shorten the tooth to even out the chip. That also meant shortening the tooth next to it so they’d match. This was not ideal and changed the character of her smile. A few months later, the tooth began to turn dark. We brought her in over the Christmas break but the dentist insists we’re being too picky and he doesn’t see anything wrong with it. When I pushed back against that a little, he told me that he is the cosmetic specialist and knows color better than I do. I mean, sure, he’s the dentist, but I did learn how to match colors in kindergarten and this tooth looks different. There is  now a weird blue/green tint to the tooth and we’re worried the veneer is going to fall off before she can get home. Of course, I think we’ll need a new dentist to do any thing about it, which is frustrating because I feel certain he’s the one who damaged it and should repair it. Do you have any recommendations for us? Should we get her to a dentist near her school or can it wait until she is home in a few weeks?

Sandy

Dear Sandy,

Leaky porcelain veneers
The bluish color on these temporary porcelain veneers are an example of leaky veneers in their early stages.

The blue/green color to me indicates that the veneer is leaking. Does it look a bit like the ones above? That happens when the bond between the tooth and the porcelain veneers is failing.  While it will fail at some point, it is better to let it fall off than to force it.

If the porcelain veneers falls out while she is at school, I would look for an AACD accredited dentist that can get her in for an emergency appointment and bond her veneer back on safely.  While there is no such thing as a specialty in cosmetic dentistry. AACD accredited dentists have proven expertise and artistry. With you away, this is one way for you to feel confident she is in qualified hands.

I also agree that another dentist is in order for your family. The way he rudely discounted your concerns is unprofessional.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

 

AACD Accredited Dentist in Lafayette

Dealing with Tetracycline Stains

I am almost 45 and have severe tetracycline stains. I’d really like to improve my smile so I won’t feel embarrassed to smile. However, I’ve been to three dentists and they all want to give me a mouth full of dental crowns. My teeth are very healthy so I hate the idea of grinding them down. Are there other options for my situation or should I resign myself to crowns?

Brenda

Dear Brenda,

porcelain veneer being placed

Tetracycline stains are some of the most difficult type of cosmetic cases there are. If a dentist is suggesting a dental crown for your smile makeover and you do not have a clinical need for them, that is a hint that they are not a skilled cosmetic dentist.

One of the trickiest parts of a tetracycline case is getting the dental work opaque enough to cover the stains themselves, but still translucent enough to look natural.

Inexperienced cosmetic dentists try to get around this by using dental crowns. Unfortunately, that doesn’t really help. Given your unique situation, I would say you need an expert cosmetic dentist. They will be able to cover your tetracycline stains with porcelain veneers, which will give you the gorgeous smile you want without grinding healthy tooth structure down the way your current dentist wants to do.

While there is not a recognized specialty in cosmetic dentistry, the top 1-3% of cosmetic dentists are AACD accredited. The American Academy of Cosmetic Dentistry recognized the dilemma both patients and dentist’s faced. Patients needed a way to find good cosmetic dentists. Dentists needed a way to get the skills needed to do excellent cosmetic work that is not offered in dental school. As a result, they created their accreditation program.

It takes YEARS to get accredited. There are superb cosmetic dentists out there who have not yet received their accreditation, but your situation is quite challenging. I am going to recommend you look for a dentist who is accredited.

While not all dentists in our office are accredited, we do have one dentist in our office who comes in just for those challenging cases.  There is probably a dental practice in your area who has a credentialed  dentist. If there is not, it will be worth it for you to travel to a nearby state if you want to be assured of a gorgeous result.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Dental Implants

Trying to Get Answers About Beautiful Restorative Work

I am having a hard time finding the right information just by looking online on the internet so I am hoping you can help me sort through some things. I need a bunch of restorative work including ten dental implants on my upper arch and five on my lower. I’m not as worried about what my lower arch will look like, but I do want my upper arch to look natural. Here are some of my questions.

1. Which brand of implants is best?

2. Would I be better off with zirconium of porcelain crowns?

3. I had one dentist tell me that white colored metal fused to porcelain, or gold fused to porcelain, will not show a black line, Is this true?

4. Are zirconium abutments for my implants, more aesthetically pleasing than all white abutments?

Kevin

Dear Kevin,

Implant overdentures illustation

I can tell you are working hard to do your research and you have some great questions. I’d like to steer your questions in a slightly different direction. All of your questions are about the materials. What you should be asking, if you are looking for great aesthetic work, is whether the dentist has the post-doctoral training and accuracy to provide you with solid, yet beautiful work.

If you wanted to commission a beautiful portrait of your family, you probably would not be asking about which type of canvas or paint brushes should be used, but rather who would be the best artist to do the work. It is the same with cosmetic dentistry.

First, I would look for someone with post-doctoral training in dental implants. It won’t matter how beautiful they are if they don’t end up failing. After you have narrowed down some implant dentists, I would then look for their cosmetic qualifications. Have they done post-doctoral training in cosmetic work. Smile makeovers and other types of cosmetic work are not taught in dental school. Have you looked at their smile gallery to see if they produce beautiful work? Even better, do they have someone on staff that is AACD accredited?

These are the questions you need to look into. I will correct one piece of bad advice you were given. Any dental crown that is fused to metal will eventually show that black line. Additionally, it will end up looking more opaque because of the metal base that needs to be covered.

I hope this helps you.
This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Porcelain Veneers

Covering Tetracycline Stains

I am looking for a solution for my tetracycline stains. My sister and I both had them. She had hers fixed five years ago, but her dentist had to make them very opaque in order to cover the tetracycline stains. I was wondering if there have been some new developments that can make them more natural looking? Would I be better off with teeth whitening?

Laurie

Dear Laurie,

before and after tetracycline stains are treated.

Porcelain Veneers for Tetracycline Stains

I’m glad you wrote. You may or may not want to tell your sister this but it was possible to get translucent, natural looking porcelain veneers even back when she had them done. How that could have been accomplished would be by using an expert, artistic cosmetic dentist. Doing porcelain veneers is hard on its own. When you add tetracycline stains, it becomes even more complicated. In fact, it is one of the most advanced cases using veneers. In this case, I would only use one of the top of the line dentists. My suggestion would be an AACD accredited dentist.

Teeth Whitening for Tetracycline Stains

While teeth whitening is a possible treatment, you would have to be very persistent and patient. It would take a long time. If you pursue this avenue here are some tips:

  • Only use at-home professional teeth whitening trays. While Zoom Whitening is very effective, the number of sessions you would need to cover these stains would be cost-prohibitive. Using the trays allows you to do it long-term without breaking your budget.
  • Wear the trays for as long as you can each day. Ideally, you would wear them overnight.
  • The best time of at home whitening for this time of situation would be the KöR teeth whitening system.

Best of luck with whichever procedure you end up with!
This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Invisalign

Help! I Look Like a Chipmunk!

Can you advise me? I’m looking for a second opinion. My two front teeth are long and stick out a bit from the rest of my teeth. I always feel like my teeth make me look like a chipmunk. My dentist is suggesting I extract them and get dental implants, but I want to make sure there is not another option before I go that route.

Avery

Dear Avery,

Invisalign aligners
Invisalign Aligner

Whatever you do, please do not have your teeth extracted. That is way too drastic a solution. I suspect your dentist said that because he doesn’t have any training or familiarity with cosmetic dentistry options for people in your place.

Bear in mind that I have not examined you. However, I do have some general advice. Though, I’d like you to see an expert cosmetic dentist and get his or her opinion. Look for someone who is AACD accredited.

One thing you can do is trim down the protruding teeth. This can be done with diamond burrs and diamond strips. A dentist skilled in this procedure can file them on the sides and bottom to make them match the remainder of your smile more appropriately.

The next step would be to move the front teeth back into place. You have a couple of options for this. The first is to get a retainer to move them back. The second would be to use Invisalign. That would be my suggestion.

If a lot of the tooth structure has to be removed in the trimming process, you may need porcelain veneers to cover the exposed dentin. The key to all this will be a great cosmetic dentist who looks at your specific case and makes recommendations. However, at least now you know you have good options and don’t have to remove your teeth and replace them with dental implants.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

CEREC

Are CEREC Veneers Risky?

I plan on getting CEREC veneers, but I have not exactly used this dentist before. He told me that he generally makes porcelain veneers 1.55 mm. I have done some research and that seems a little thick to me. Should I reconsider? I understand that the dentist who does the veneers could affect the outcome so I’ll tell you ahead of time, his name is [ name withheld ].

Patricia,

Dear Patricia,

porcelain veneer being placed on a tooth

I am very glad you wrote. Instead of saying “the dentist could affect the outcome”, I would say the dentist determines the outcome. He or she would be the key to the outcome of your smile makeover.

Doing CEREC veneers is much harder than doing traditional porcelain veneers using a master ceramist. In that case, the skill and training of the dentist becomes even more important. I looked up the dentist you mentioned to me. I started by looking at his website and I saw nothing that indicated any cosmetic training. That was a red flag. But, I went ahead and did some extra work and looked up the institutions that do the type of training he would need. He is listed on none of their alumni lists. Because of that, I am going to recommend you go a different direction.

If you are set on CEREC veneers then I suggest you go to a practice that has an AACD accredited dentist on their staff. Nothing less than that would give you the outcome that I believe you want.

Let’s say you go to a dentist to get a smile makeover and he or she does a terrible job. You will have no recourse. The standard of care is that it the results of the procedure are functional, not attractive. This is not what you are going for when you want a smile makeover. Therefore, you as a patient, as to be proactive and find the dentist who will not only care that you have a beautiful smile, but has the training and skills to provide them for you.

This blog is brought to you by Lafayette, LA Dentists Drs. Forman and Thimmesch.

Porcelain Veneers

Cavity On A Porcelain Veneer Tooth

I have porcelain veneers on four teeth. One of them now has a cavity and my dentist wants to remove the porcelain veneer and replace it with a dental crown. Is that absolutely necessary?

Dana

Dear Dana,

Porcelain veneer being placed on a tooth

I am going to recommend you get a second opinion on this for a few reasons. First, in order for a tooth to need a dental crown for decay, the amount of decay would have to be pretty substantial. I would say over 20% of the tooth would have to be decayed to justify needing a dental crown. If that is not the case, then why would he recommend one?

The most likely reason is that he is not comfortable treating a cavity with porcelain veneers. The margin is where a tooth with porcelain veneers is most susceptible to decay. If that is where your cavity is he may not have the tools or skills to bond the composite to a porcelain veneer.

That leads me to the second reason you need another opinion. If he’s recommending a crown unnecessarily, then his cosmetic skills are limited. This does not bode well for the crown either.

I would say only about 2% of dentists can match a dental crown on a front tooth to a porcelain veneer. In fact, You would need one of the best cosmetic dentists around, like an AACD accredited dentist. If he is pushing you toward a crown, he is not the dentist to do the work.

Getting a Second Opinion

I’d like you to see an expert cosmetic dentist and have them look at the tooth with the cavity. It is important you make this a blind second opinion. By that, I mean do not tell him who your dentist is or what the diagnosis and recommendation were. If he or she asks, tell them you are keeping that to yourself in order to get an unbiased opinion.

This blog is brought to you by Lafayette, LA Dentists Drs. Thimmesch and Foreman.

Invisalign

Advice on Fixing One Crooked Tooth

I have one crooked tooth in the front that is well behind the other front tooth. So far behind you can barely see it. Dentists keep suggesting different things and I don’t know who to trust. One dentist said to get braces. Another suggested I just pull that tooth. Then there are all the pieces of advice in between. Would Invisalign even be a possibility for me?

Marie

Dear Marie,

Invisalign aligners
Invisalign Aligner

It used to be that Invisalign would only work on the more ideal cases. These days are different. Invisalign can work on all but the most complicated cases. Because of that, there is a great possibility that Invisalign will be a good solution for you.

They also have the added benefit of the aligners being able to double as teeth whitening trays, which means you can straighten and whiten your teeth at the same time, if that is something you are interested in.

Don’t let the dentist pull your tooth. First, if you left it as is, you would never look normal with a smile that is asymmetrical. If you wanted to replace the tooth with something like a dental implant, you would still need to open up the space with some type of orthodontics. In that case, why not keep your natural tooth structure?

If you decide not to go with Invisalign, another possibility is to use porcelain veneers. These will not actually straighten your teeth, but it will make them look straight,

Veneers are typically used by someone who wants a full smile makeover. That is because they can change the shape, size, and color of your teeth. If you decide to go that way, you will need an expert cosmetic dentist, like an AACD accredited dentist because your case is more complicated.

My suggestion, if the only thing that bothers you about your smile is that one crooked tooth, is to see a dentist who offers Invisalign. Let them examine you and they’ll be honest about whether or not you are a good candidate.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Porcelain Veneers

My New Teeth Keep Popping Off

For our anniversary, my husband told me I could get a smile makeover. I’ve dreamt of one for several years. My teeth are chipped here and there, stained, and I have a few that are shorter than the others because of teeth grinding.

My dentist ground my natural teeth down to tiny yellow nubs and gave me temporary veneers. Then, my permanent ones came in. All totaled I have eight veneers. They look okay. Certainly at least whiter than my old teeth. The big problem I am facing is they keep popping off.

While she always puts them back on for me, I am living in constant fear of being humiliated in public. This week, two fell off while I was eating bread at a restaurant with a friend. I spent the entire rest of the day crying from the shame. It is always the veneers that have a slant on the back that seem to come off.

My dentist is blaming it on my teeth grinding, but I wear a nightguard for that, which I was told would protect both my natural teeth and my veneers. What do I do now? We’re a military family and about to get transferred to another base in the states. I’m afraid no dentist will want to deal with my freakish nub mouth. What do I do? I thought this would be a wonderful experience and it has turned out to be a nightmare.

Angie

Dear Angie,

This is a cosmetic denistry horror story for the books. I am so sorry that this was your experience. I believe this dentist has committed malpractice. First, I’ll tell you why and then we’ll go over what you can do about it.

The first thing you should know is that she did not give you porcelain veneers. What she provided was dental crowns and called them porcelain veneers. This is unethical. Here is how I know this.

Image of teeth prepared for porcelain veneers
Tooth preparation for porcelain veneers

When your teeth are prepared for porcelain veneers only a small layer on the front of the teeth is removed. Directly above I posted an image showing what this type of tooth preparation looks like. This is not what you described.

Image of tooth preparation for dental crowns
Tooth preparation for dental crowns.

Instead, I think your teeth look more like what you see in this picture– little nubs. This means she gave you porcelain crowns. Unfortunately, once that tooth structure is gone, there is no way to get it back. This weakens your teeth and makes them more susceptible to breaking later down the road.

Second, she hasn’t been able to bond your dental crowns on properly. While there are a number of dentists who would not know how to properly bond porcelain veneers, every dentist has been taught how to place and bond a dental crown. The fact that she can’t keep yours in shows a serious lack of basic skills. It also violates the basic standard of care.

Your dentist is legally liable for the damage done to your teeth. I don’t want you to just ask for a refund. Instead, I believe she needs to pay to have this repaired properly. I want you to find an expert cosmetic dentist in your new area and have them repair your smile makeover. When y ou get to your new base. Look up on mynewsmile.com to see which cosmetic dentists they recommend in your area.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.