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Cosmetic and
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dentistry

New Lumineers Over Old Ones

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When I first got my Lumineers my dentist knew that I wanted them to be whiter than they were made, but his lab guy said that it wasn’t quite possible to do them that white. They could only do what he called “natural” looking styles.  These days I see people with very white teeth and figure they are now able to do them whiter. Is it possible for me to have new Lumineers placed over my old ones so I can have the smile I really wanted?

Kelly

Dear Kelly,

a porcelain veneer being placed on a tooth

Should you place new veneers over old ones?

While it is possible for you to place new Lumineers over old ones, I am not going to recommend it. First, it is just as much work for the dentist to do that than to just provide you with a totally new smile makeover. to begin with. Second, it will be less secure. Porcelain bonds much better to natural tooth structure than it does to porcelain. That puts you at a greater risk of bonding failure for your new Lumineers, not to mention that you have double the risk because at some point your old Lumineers bonding could give out. I am going to recommend something completely different.

The first thing you should be aware of is that Lumineers is simply one brand of porcelain veneers. That particular brand is heavily marketed to inexperienced cosmetic dentists and I believe your dentist falls into that category. One reason I think that is he just agreed with the lab when they said your Lumineers could not be as white as you wanted. That was not true. Even then, you could get veneers of any brand as white as you wanted. The lab was wrong about that. That brings me to a second issue with Lumineers, which is their lab. The DenMat company, which owns this brand, insists you use their lab. They are not known for their artistic, quality work.

What I would like you to do is look for an expert cosmetic dentist and have them just re-do your smile makeover altogether. Do not be surprised if they suggest a completely different brand of porcelain veneers than the one you currently have. There are many brands that are far superior and will give more artistic results. The best cosmetic dentists are AACD accredited dentists. You can find them listed on aacd.com. They have extensive training and have passed stringent exams as well as proven their artistry before a board of examiners on a large number of their cases.

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

 

Jagged Teeth After Braces

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I am toward the end of my orthodontic treatment. While my teeth look straight, I have noticed the edges are jagged. I am hoping to fix this. After spending all this money to get straight teeth, I don’t want this one little thing to bother me. Is there a way to fix it?

Ellie

Dear Ellie,

Before and after with dental contouring

I’m glad you wrote. There is a procedure known as dental contouring that can solve your issue.  If the problem is minor, your orthodontist should smooth this out as a part of completing your case. If it is more substantial, I would invest in having an expert cosmetic dentist do this. Cosmetic contouring is a fairly advanced procedure and requires a cosmetic dentist that is not only technologically skilled, but artistic as well.

This type of procedure has to be done freehand. It is not something your average family dentist could do. In your place, to ensure you get a good result, you will need to check out the dentist’s smile galleries to make sure they get beautiful results with a variety of different cosmetic procedures. You could start by looking on the mynewsmile.com website to see if there are any dentists in your area they recommend. These dentists have already been prescreened for their training, technical skill, and artistry.

Often you will need some dental bonding done with the contouring. If you look at the before and after images above, you can tell right away that the sides of some of his teeth had bonding material added to them. You can also see that the teeth have varying opacities throughout the lengths of the teeth making them look completely natural and blending them seamlessly with the remainder of the teeth.

You won’t get this type of result with any dentist.

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

 

Why Has My Smile Makeover Lost its Shine?

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I am planning on asking my cosmetic dentist the same question I am asking you, but want to go into the appointment with as much knowledge as possible. Just over six months ago I had a total smile makeover done on my upper teeth with porcelain veneers. For the bottom teeth, we just did teeth whitening. I chose my cosmetic dentist very carefully and he is one of the tops in the field. The smile makeover itself was stunning and I was thrilled with the results. It cost me quite a bit of money, but I have looked at it as an investment. I’ve been very diligent with my oral hygiene as I want this to last for many years to come. My routine consists of brushing twice a day with Crest 3D Glamorous White Toothpaste, flossing once a day, and then rinsing with Listerine Whitening 6 in one with Fluoride. Despite all this effort, my porcelain veneers have lost their shine. Now they look quite dull instead of having the lovely sheen they had when I first came home with them. I went online where someone suggested I use baking soda. I did, but did not see any improvement. Can you help me here?

Samantha

Dear Samantha,

Woman with a beautiful smile

I am delighted to hear that you were satisfied with your smile makeover and that you are striving to take such good care of it. Let’s start with what you are using to care for your smile. Both the toothpaste and the mouthwash you are using can cause some minor damage to your porcelain veneers. Nothing to the extent you are describing, but they will contribute. Typical whitening toothpaste at the stores rely on abrasives to remove the stains on your teeth. With porcelain veneers, these abrasives will scratch the veneer and eventually, leave it very susceptible to staining. Listerine, like most mouthwashes, contains alcohol. This will also damage the veneer, but it mostly damages the bonding materials.

As I mentioned before, this isn’t really enough to lead to the amount to anything significant this quickly, I can think of two things that would result in the damage you are describing. The first is if your dentist provided you with composite veneers instead of porcelain veneers. While porcelain is extraordinarily stain-resistant, even more so than your natural teeth.  Composite, however, picks up stains quite easily. You said you researched your dentist quite carefully, so I am not inclined to think this is the issue. It would take a very unethical dentist to place composite veneers but call them porcelain.

A second possibility is that your hygienist used something on your porcelain veneers that damaged the glazing. A couple of things you need to avoid during your cleaning/checkup appointments are the power prophy jet and the acidulated fluoride. If you go to a practice that does a lot of cosmetic work, the staff should be well trained enough to know this, but it is always possible you had someone new.

Your dentist can repair this. He should do so at his cost. Once they have that shine again, I want to make sure you have the right toothpaste to care for them. If you want a whitening toothpaste, the only one I recommend for people who have had any type of cosmetic work, especially a complete smile makeover, is to get SuperSmile Toothpaste. This is specially formulated to work with cosmetic procedures. There are no abrasives at all. Instead, it uses knowledge of chemical binding to remove the stains on your veneers. It is 100% safe. As for mouthwash, you can forgo it altogether or look for one that does not contain alchohol.

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

 

Dentist Placed Implant and Now Wants to Remove It

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I paid in full for a dental implant. Before the surgery, my dentist said that I was good and ready to go. When I woke up he told me that after he got in there the situation was different and I didn’t really have enough bone to support the implant. He went ahead and placed it but said he would prefer to remove it and give me a dental bridge. I have a couple of questions. First, should I be entitled to get some of my money back seeing as he is just going to remove it? I feel like he put me through unnecessary surgery and I have nothing to show for it. Second, am I really stuck getting a dental bridge? I would prefer a dental implant if that is even a possibility any more.

Ellie

Dear Ellie,

Illustration of a dental implant next to a natural tooth

You should not only get a partial refund but a full refund. I cannot think of a reason your dentist would think he could get away with this. When you provide a procedure, especially something as invasive as surgery, there is an implied warranty that you have a belief in its success. He placed it knowing there would be failure. That is malpractice.

Additionally, if he would have done adequate diagnostics this would never have happened. He should have done a number of x-rays and, preferably, a CT scan. The reason for the latter is the fact that doing dental implants is a 3-dimensional procedure and really requires a 3-dimensional map. Not to mention the fact that if he’d done these diagnostics, he’d have known right away that you did not have enough bone support, thereby protecting you from the hassle of a surgery bound to fail. Obviously, he did not do his duty with this either.

I would start by demanding a refund. You are certainly entitled to one. From there I would find a great implant dentist. You will not have to settle for a dental bridge. You need a dentist who has significant post-doctoral training. Take a look at the training Dr. Weiss has to give yourself an idea of what type of dentist you will need. In addition, however, you will need a bone grafting procedure in order for your implant to have a chance of succeeding.

If you have any trouble getting that refund, just mention you are going to take a little trip to speak with the dental board. That should sober him up a little.  I am so sorry this happened to you. Most dentists are not this irresponsible.

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

Dental Bonding Disaster

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A couple of years ago, I had dental bonding done for a chipped tooth with a dentist from another city. This year, I relocated. A few months into the move, the bonding started to have some discoloration. So, I asked my new dentist to fix it. She said she’d need to bond both teeth for it to look right. I thought that was odd because my last dentist did not have to do that, but decided to give her a chance. I wish I hadn’t. The color doesn’t match my teeth at all, there is now a gap between my teeth that wasn’t there before, and now one tooth is longer than the other! I asked her about the gap and she said that is a common issue with bonding. Then I asked her to file down the long tooth, so it could be the same size as its partner. Finally, when I asked about the color, she said natural teeth aren’t all the same color. Her suggestion is that I wait a week and see if I change my mind about its appearance. Then we are supposed to meet again and determine if there is anything I still want her to change. Should I wait and give her a chance to fix this or just ask for a refund. She is nice, but honestly, my smile is worse than it was before.

Cadance

Dear Cadance,

before and after dental bonding

I think you need to ask for the refund and then find another dentist to do the work. Here’s the problem you are facing with this dentist. Cosmetic dentistry is not taught in dental school. She may have learned how to repair teeth, but learning to make them look beautiful and natural is a skill set they have to invest in during a post-doctoral course of study.

Dental bonding in particular is one of the most challenging of the procedures because it has to be done free hand. Additionally, they have to understand all the materials, such as colors, textures, and translucencies, and which ones go together in order to sculpt a true replica of the tooth. I don’t think this skillset is going to magically appear in a week.  In fact, I would not even wait the week. Call the office, tell them you want the refund and start your search for the dentist who can do this right.

Which Dentist Can Do Dental Bonding Well?

My first suggestion is that you look for a dentist who has reached accreditation level with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country. They have the technical knowledge, skill, and artistry to create a beautiful result for you.  It is sometimes hard to find one, depending on where you live, but it will be worth it even if you have to travel to a nearby city or state.

If that proves impossible for you, your second option is to look on the mynewsmile.com website. They recommend excellent cosmetic dentists by zip code and the distance you are willing to travel.  The site is run by an AACD accredited dentist and he personally screens each dentist he recommends. A dentist cannot just pay to be listed on his site. Many are on their way to accreditation, which is a process that takes years.

One other thing I will mention. You may not even need this, but if you’ve been considering teeth whitening, I suggest you do it before having the bonding placed. The color of the bonding will mot respond to whitening agents, only your natural tooth structure will. If you try to do that after, you’ll end up with two different colored teeth.

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

 

 

Cavity on Tooth with Porcelain Veneer

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I have porcelain veneers and one of my teeth has a cavity. My dentist wants to remove the porcelain veneer, treat the cavity, and then replace the veneer with  a dental crown. I am not too keen on this idea and wondered if it was the standard operating procedure for someone in my situation? It is a front tooth, so it is important to me it looks good.

Malorie

Dear Malorie,

 

a porcelain veneer being placed on a tooth

 

If I were in your place, I would recommend you get a second opinion. A crown is a much more aggressive treatment than I think you need. Your cavity would have to be rather substantial in order to justify it. I would think you would need about 1/3 of the tooth to be overrun with decay in order to make it a valid treatment option. If it is just some small decay, why would he recommend a dental crown instead of a porcelain veneer?

Generally, when a dentist is suggesting a less than ideal treatment, it is because they are not comfortable doing the better option. Unfortunately, this does not directly translate to them being able to provide you with a beautiful dental crown that matches your porcelain veneers. In fact, I would estimate that only 1-2% of dentists are actually able to match a single crown to the adjacent teeth in a way that looks attractive and blends naturally.

Getting a Second Opinion

When you go to get that second opinion, you want make certain of two things. The first is that the dentist you go to for your second opinion is in that 1-2% category of dentists who can provide a beautiful result and have the skills to do things well. In order to find a qualified cosmetic dentist, I would look for someone who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the best cosmetic dentists in the world.

The second consideration is that it is a blind second opinion. Many dentists know each other. They are peers. You don’t want the dentist who is giving you the second opinion feel conflicted because telling you the truth would mean saying his friend is wrong.

Because of that complication, I always recommend you ask for their opinion without them knowing who it was that did the work to begin with or what their diagnosis was. Be open with them about wanting an unbiased opinion if they ask who your dentist is. They should not have a problem with that.

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

Zoom Whitening and Uneven Teeth

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My daughter got her braces off not too long ago and there were a bunch of white spots around her teeth. The orthodontist said this was fairly common in teenagers and that our dentist could take care of it. When we went to see our dentist, she suggested we try Zoom Whitening. She had just gotten the equipment and would even give us a discount as her first patient using it. I liked the idea of getting a discount for the treatment that she would need anyway and agreed. When we were done, the teeth seemed worse, not better. Is it possible because this is a new thing for our dentist she did something wrong?

Sally

Dear Sally,

Patient under a zoom whitening light

 

I am very glad you wrote and believe I can be a great help to you and your daughter. Zoom Whitening is an effective teeth whitening procedure that can produce remarkable results in just one appointment.  The problem wasn’t with her not understanding how to do Zoom Whitening. The real problem was her not understanding the principles behind how teeth whitening works.

No matter what method of teeth whitening you do, it will always whiten the teeth evenly. That means the white spots will get whiter along with the remainder of her teeth. The good news is there is a solution.

The white spots your daughter is dealing with are actually decalcification spots. Decalcification is a precursor to decay. My guess is your daughter used traditional wire and bracket braces. Those can be very hard for patients, whether adults or teenagers, to really get in there and brush well around all the metal clutter. This leaves food and other bacteria trapped, which in turn leads to the decalcification which your daughter is dealing with now.

There are two possible ways to fix this. One only works sometimes but is less expensive, so I’ll make sure you know about it in case it works for her.

Repairing White Spots on Teeth

The first thing I would try is a product called Tooth Mousse. This is applied topically and can sometimes remineralize the teeth.  You can purchase it over the counter. It doesn’t always work so if you don’t start seeing results, I would move on to the next option before decay sets in.

The second solution is dental bonding. This needs to be done by an expert cosmetic dentist. I’ll tell you how to find one in a moment. With this repair, the dentist will gently remove the decalcified spots and then fill in the area with the composite bonding material. The dentist will use a variety of colors, textures, and translucencies to match her tooth structure and appearance perfectly.

As I mentioned, she will need an expert cosmetic dentist. This has to be done freehand and is one of the most difficult cosmetic procedures. I cannot stress enough that I do not think your current dentist is up to the task. In your place, I would look for an AACD accredited dentist or one who has been recommended on the mynewsmile.com website. Any of those dentists will be able to give your daughter a beautiful result.

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

Dental Implants for Hockey Players

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My son lost a tooth in a hockey game. Our dentist suggested we get him a dental implant to replace it, but his coach said that is a bad idea because of the chance of re-injury. What is the right choice? I want to do what is best for him, but the mixed messages are confusing.

Kami

Dear Kami,

Hockey player with a missing tooth

 

In a way, they are both right. Dental implants are the absolute best tooth replacement option. However, there is a risk for re-injury if he is continuing to play hockey. A dental implant consists of a prosthetic root form and a dental crown bonded on top of it to serve as the visible part of the tooth. If he is re-injured with both parts completed, there is a good chance he will lose some bone with the injury (and possibly even some of his jaw).

Here is my recommnedation. First, get the implant placed, but just the implant. This will allow him to get the benefits of the dental implant without having to worry about extra damage being done in case the tooth is lost again. You won’t want him going “toothless” in that area, so I suggest an inexpensive temporary restoration, such as you would get with a dental flipper. This gives him the best of both worlds.

Having the root form placed, ensures his jawbone can stay healthy and will not suffer any effects of the structural loss that normally occurs when you lose or remove some teeth. Having a dental flipper means if he is hit in the mouth again, the flipper will come out with ease and he won’t risk additional injury.  When he is done playing hockey, that will be the time to have the permanent dental crown placed on his implant.

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

 

Dental Bonding Versus Porcelain Veneers

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My daughter has two lateral incisor peg teeth that we are ready to repair. Our dentist wants to do four porcelain veneers on her teeth to have them match. It was quite pricier than we expected, so he suggested he could do dental bonding for 1/5 of the price. This sounds like a great solution but I heard they don’t last as long. Should we do the cheaper one and just plan on re-doing it more often?

Millie

Dear Millie,

before and after dental bonding to repair a chipped tooth

I have some concerns here. First, the fact that he has to do four teeth instead of the two peg teeth tells me he is not comfortable with his skill level. He does not feel like he can match the lateral incisors to the front teeth so he wants to do all four which will make it easier for him. However, that doubles your cost and is totally unnecessary. A second thing that worries me is the cost he quoted you.

In reality dental bonding is best used for small repairs such as the one above for a chipped tooth. If a dentist tries to do it over the entire surface area of the tooth it would actually be more work than doing veneers. This is because composite bonding has to be done free hand. It would actually cost close to the same amount or possibly even more than the porcelain veneers.

My suggestion is that you want to get her teeth done you do it right. I would go to an expert cosmetic dentist and let him or her do just two porcelain veneers. Look for someone who are accredited by the American Academy of Cosmetic Dentistry. The accreditation process requires true technical expertise and artistry to pass. They are in the top 3% of dentists.

You didn’t mention how old your daughter is. If she is young, her teeth probably are not very stained. However, if she’s an adult, she will have developed some surface stains on her teeth which is a natural result of living. If that is the case, I would suggest you get her teeth whitened before you have the veneers done on her teeth.

Porcelain veneers can be made to any color, but once they are made the color is permanent. If she decides to whiten her teeth a few years later, her natural teeth will whiten but not her veneers. It is more financially responsible to whiten ahead of time. If you don’t the veneers will have to be replaced.

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

Botched Implant Case

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A little over a year ago, I had four dental implants placed after a car accident left me with a lot of lost teeth. Since then, the crowns have broken or fallen off and the implants themselves are there but I don’t know how healthy or secure they are. I tried calling the office for quite a few weeks and they kept giving me the run around. Now I have discovered this dentist has left the country and no one can reach him. At first, I was worried about him, like maybe something happened to him on vacation, but it turns out he literally skipped the country. He’s emptied the practice account and they are closing the doors. What do I do now?

Andrew

Dear Andrew,

woman covering her mouth with her hand.

 

I am sorry this happened to you. First, the accident and then an unethical dentist. In all honesty, the only thing you can do now, is to have someone who is skilled with dental implants to look at your case and see how stable the implants are and what went wrong with the dental crowns. Hopefully, the implants themselves are fine and the dentist who did your case just did not bond them on properly.  Then, you will only have to replace the crowns. If it does turn out that your implants are poorly placed and at risk, you will have to replace them. Unfortunately, that will also mean getting one additional procedure, known as bone grafting, so that you will again have enough bone structure to retain your new dental implants.

There is an upside to these tragic circumstances. First, you can make any changes you want. If there was something you didn’t like about the earlier results, now is your chance to completely remake your smile. Make it gorgeous. Another opportunity is for you to whiten your teeth. If you decide to do that, do it before your new crowns are made. Whatever color they are fashioned with is permanent.

A second upside is that I am willing to bet that most dentists who hear the series of events that happened to you will be more willing to work with you on paying this out instead of having to pay up front, which is the typical requirement.

Again, I am sorry this happened to you. Hopefully, this next dentist will be just what you need!

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