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Archives for October 2019

Dental Bonding Disaster- Help!

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I had my four front teeth bonded. One of my front teeth sticks out too far over the second one. One of the lateral teeth is too far back and the other one has a big chip. He said he could fix this, but it’s ended up a disaster. First, he ground down the front overlapping tooth, then he added bonding material to the lateral teeth to fill in the missing depth and fix the chip. However, he insisted on doing them yellowish, even though I wanted them white. Now I feel they look ugly, plus the one he ground down is sharp and painful. I know there is no going back, but can this be fixed? My dentist seems to think he did a great job.

Adabelle

Dear Adabelle,

woman giving a thumbs up from the dental chair

Getting a beautiful smile requires a skilled cosmetic dentist

Even though I don’t have a picture of your smile and can’t give you specifics of what was done incorrectly, I do know what the major problem is. Your dentist is likely a very good family dentist who did his absolute best for you, but he was in over his head. Maybe he could have pulled off a basic dental bonding case. Maybe. Those are difficult to begin with because they need to be done free-hand. Your case requires an even more advanced dentist because of the structural issues that need to be dealt with.

This would need a dentist in the top 1-2% of cosmetic dentists, which requires significant training outside of general dental school. They’d need training in color theory, polishing the bonding material, and shaping the teeth. Your dentist obviously didn’t have this. Plus, a true cosmetic dentist would never be satisfied if his patient wasn’t thrilled with the results.

What you need is an AACD accredited dentist. These are the top cosmetic dentists in the country. In order to become accredited, they have to pass stringent exams, as well as have a large number of specific cases they’ve personally done evaluated for technical proficiency, beauty, and artistry. You can locate them by going to the website of the American Academy of Cosmetic Dentistry. Make sure you check you want an accredited or accredited fellow. Being a member isn’t enough.

Once You Have an Accredited Dentist

Once you’ve located an excellent cosmetic dentist in your area, you have two choices to get the smile you want.

Option 1: Re-do the Dental Bonding

Dental bonding is less expensive than the next option I’m going to make you aware of. When done by an expert cosmetic dentist it can blend in perfectly with your teeth, comfortably, with a natural translucency. If you want your bonding whiter than your adjacent teeth currently are, it will be in your best interest to whiten all of your teeth first. This will enable the dentist to blend the bonding material to your beautiful new white color.

Option 2: Get Porcelain Veneers

While these are more expensive than bonding, porcelain veneers can change anything about your smile— the shape, the size, the color, even the character. The other big benefit is they last much longer. Well taken care of porcelain veneers can last a lifetime. The dental bonding will have to be re-done every five years or so. Either one can be made beautifully.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Her Gums Inflammed After Getting Porcelain Veneers

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I’m a little worried about my gums. I had porcelain veneers placed a couple of months ago. Since it happened. my gums have been inflamed and painful. I went back in and the hygienist said she’s never seen it happen before. The dentist came to look and both of them accused me of not brushing enough. I was quite annoyed. I’m a grown adult and know how to brush my teeth. Why in the world would I not brush after spending a fortune on these porcelain veneers? When I went back in for a routine one-month follow up he removed some excess cement. That has helped some but I’m still in pain. What do you recommend I do?

Avery

Dear Avery,

illustraing on lateral incisors inflammed by poorly done porcelain veneers

These lateral incisors are inflamed from poorly done porcelain veneers

When patients have a smile makeover they’re proud of, they tend to take better care of their teeth, not worse. I don’t like it when medical practitioners blame patients for things they don’t quite understand. Please bear in mind that I haven’t examined you so I can only give possibilities.

There are a few possibilities going on here. It can be one or a combination of them. With the first possibility, he could have left some cement in that is irritating the gums. This seems a very real possibility, especially because you said he removed some excess cement a month out from placement. The cement should have been removed right away, while it was still soft. The fact that your gums felt a little better after he finally did remove it. Now it is getting a chance to heal.

That doesn’t mean that is the only thing irritating your gums, though. I say that because It doesn’t sound like your dentist has invested a lot of time in understanding cosmetic dental work. Another option is there is some unevenness or temporary shelving in the margins between the porcelain veneers and the gumline. This is sometimes called bulky margins.

This will cause things to get trapped in between the gums and the porcelain veneers, leading to inflammation and, eventually, gum disease and tooth decay.

There are other possibilities too such as the extended wearing of temporaries, the veneers encroach on the gingival attachment, and, allergies to the materials used in bonding.

Dealing with a Disastrous Smile Makeover

The first thing I suggest you do is get a second opinion. When you do, make sure it is a blind second opinion. Don’t ask your dentist for a recommendation and don’t tell whomever you do see who your dentist was. Most of the time, they know one another. You want an unbiased opinion. What you don’t want is him feeling torn between an honest evaluation and betraying his friend. That’s why a blind second opinion is best.

If it is just a matter of the cement being trapped there, then when your dentist removed it at the last follow-up, that should help as it heals. The second opinion dentist can make sure there isn’t any more there. If, however, the problem is with the margins, the porcelain veneers will have to be completely re-done. Because it puts your oral health at risk, you are entitled to have them re-done free of charge. Though, my recommendation would be to get a refund and have a more experienced cosmetic dentist do this.

Look for someone who is recommended on the mynewsmile.com website. They are highly skilled and they will sort them by area of the country for you.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Dental Bonding Staining

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I have dental composite bonding on all my front teeth. I have them re-done every three or four years. This latest set is only six months old and is starting to look yellow. Can this be polished to look right again or do I have to re-do them early? What would cause this to happen so quickly?

Priscilla

Dear Priscilla

Whether or not these can be polished to get rid of the stains depends on the nature of the staining itself. Unlike porcelain, which is hard and very stain resistant, composite dental bonding is fairly soft and is susceptible to two different types of staining.

Dental Bonding Staining One

an image of dental bonding on teeth stained by scratches

This first type of staining is surface stains. It happens because of tiny scratches on the bonding which allow it to pick up stains that are trapped there. You can tell these front teeth have been scratched because they’ve lost their glossy finish, instead they look matte. If you look at the adjacent natural teeth, they still have a gloss to them.

The good news is this type of staining can be fixed. If your dentist thoroughly polishes them, it will remove the scratches and stains, all while bringing the gloss back.

Dental Bonding Staining Two

Teeth with the two front teeth having stained dental bonding

Composite bonding is made from a solution of inorganic filler particles such as quartz or glass bound together in a plastic matrix. Because of that, it will absorb stains into its actual material. For instance, if you drink a lot of staining beverages, such as coffee or tea, it will penetrate the plastic and become a part of the bonding structure.

The picture above is a good example of this. Notice the two front teeth are much more stained than the surrounding teeth. This is absorbed staining. You can tell that (as opposed to scratch staining) because the teeth still have their shiny gloss. Notice the adjacent teeth, though stained, aren’t as stained as the bonded teeth. This is because your natural teeth are less susceptible to staining than composite bonding.

Unfortunately, this has to be re-done. There is no way to polish this out. Teeth whitening won’t work either. It will only whiten natural tooth structure. If that is the case, I’m going to highly suggest you switch to porcelain veneers on your teeth. Yes, veneers are more expensive initially. However, you are re-doing these every few years. Great porcelain veneers can last upwards of twenty plus years. They’re much more stain-resistant than bonding. In fact, they’re even more stain-resistant than your natural teeth.

Keeping Dental Bonding Stain-Free

1. Start with the right materials. You want to go to a skilled cosmetic dentist. They are more likely to stock microfill composite. This is possible to get polished completely giving it a high gloss and helping it resist stains.

Most general dentists just keep a generic composite which will never completely polish up to the gloss you need.

2. Avoid abrasive materials. I recommend anyone who has cosmetic work use Supersmile toothpaste. It’s specifically designed to chemically remove stains, instead of doing it with abrasives the way most toothpaste works.

3. Avoid staining beverages. If you must drink them, try not to let it sit on your teeth. Swallow immediately.

4. Make sure your hygienist doesn’t use anything like a prophy jet or pumice on your bonded teeth. It will destroy the glazing.

I hope this helps. Seriously consider switching to porcelain veneers.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Will Dental Implants Look Fake?

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My mother had dentures and, to me, they always looked fake. I now need to get my teeth replaced. I want to get implant-supported dentures and am hoping they look more natural these days. I’m rather young for dentures at 40 so I don’t want to look old before my time.

Pamela

Dear Pamela,

Implant overdentures

Implant overdentures are a combination of dental implants and dentures

First, I’m going to say you were wise to choose implant overdentures, especially at your young age. Once your teeth are removed, your body will recognize that and begin to resorb the minerals in your jawbone to use elsewhere in your body where it perceives it will be more useful. Eventually, you won’t have enough jawbone left to retain your dentures. This is known as facial collapse.

Getting implant-supported dentures, puts prosthetic roots into your jaw. This tells your body there are still “teeth” that need to be retained, therefore preventing facial collapse. You’ll also find it will improve your chewing capacity.

The Secret to Beautiful Dental Implants

Both dentures and dental implants can be made to look both natural and beautiful. That was true when your mother received her dentures. The beauty of dental implants is correlated to the artistic skill of the dentist. If you want a gorgeous smile, you need to find a dentist who creates beautiful smiles.

In your place, I’d look for a dentist who has reached accreditation with the American Academy of Cosmetic Dentistry (AACD) dentists have done extensive training and are the top cosmetic dentists in the country. They will give you a stunning smile. You’ll actually be thrilled to share your smile with the world.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.