August 15, 2018

Archives for March 2011

Replacing Old Dental Veneers That Don’t Meet Patient’s Cosmetic Expectations

ladera ranch dental veneers

Shelley asked us to replace her two old dental veneers that she was dissatisfied with. She said she wanted a "whiter, brighter smile" and more attractive smile. The new dental veneers we made for her "followed her smile line" (the curve of her lower lip when smiling) in addition to making her new veneers whiter and more rounded. The end result for Shelley was this terrific smile that met her expectations.

Shelley from Ladera Ranch didn’t like the dental veneers that her dentist made for her.  “They’re just ugly, I hate them, he didn’t give me a nice looking smile like I wanted,” were Shelley’s comments when she came to unhappy with her previous dental treatment.

When someone comes to us upset with their previous cosmetic dental treatment we’ve learned that one of the most important things we can do is just listen to the patient.  What is their story?  What don’t they like?  What would they like changed?  After the patient is able to verbalize their frustrations then that is the time for the cosmetic dentist to sit back, make sure that he/she really understand what the patient wants and expects, and then outline a plan that will reach the patient’s goals.  Sometimes it just a simple matter of doing a few things different in the treatment.  Other times it is outlining a completely different strategy.

dark teeth before new dental veneers orange county

When Shelley's two front teeth turned black after root canal treatment her dentist placed two dental veneers to try to cover up the color. The teeth still didn't look right to her. The roots near the gums were dark and showed through the veneers. After removing the old veneers and placing several new ones Shelley was pleased with the design of her new smile.

In Shelley’s case she told us that when she was younger she had decay on both of her front teeth and she didn’t see a dentist until it was too late.  When the decay finally gave her a tooth ache, she went to her dentist, and by that time she needed root canal treatments on both teeth.  She said that the root canal treatments worked great and relieved her of her pain, but that both of her front teeth turned black!

Upset about that, her dentist recommended doing two dental veneers on the black teeth, that the dental veneers would make her teeth look normal in color.  So, Shelley did exactly what her dentist recommended, and had him place the two dental veneers he recommended.

When the dental veneers were first done Shelley was happy at first because her teeth looked way better. But….the color of her teeth was still off, and over the next year she became increasingly unhappy with their appearance.  “I did what he said and I still don’t have a nice smile!” she said.

So, my next question to Shelley was, “Other than the front two teeth, are you perfectly happy with all the rest of your teeth that you see when you smile?”

Shelley answered, “No.”  After carefully looking at all her teeth, what she said she wanted was a “whiter, brighter smile.”  We talked to her about the shape and length of all her teeth, and Shelley realized that to get the smile that she really wanted that she would have to do porcelain veneers on several more teeth.

For Shelley, there were three main objectives:

  • make all the teeth she showed when she smiled whiter
  • make the four front teeth longer (they were too short)
  • make the shape of her four front teeth rounder at the edges (hers were to square, which gives an “older” and “more masculine” look)

When we looked at the edges of Shelley’s front teeth when she smiled they were flat straight across.  Relating the edges of her upper front teeth when she smiles to her lower lip is a concept cosmetic dentists often times use called “following the smile line“.  So for Shelley we recommended lengthening her front teeth a little, and curve the edges a little more to “follow the smile line“.  This would give her a more youthful, feminine and softer looking smile.  This, combined with placing dental veneers on a few more teeth and making hem all whiter should give Shelley the smile that she really wanted.  And, more importantly, would cover up the darkness under her old veneers (the two black teeth that had root canals).

Shelley accepted our treatment recommendations and multiple dental veneers were done all at the same time for her.  As we had planned, we “followed Shelley’s smile line” (her lower lip) with the edges of the upper front teeth.  We made the shape of her teeth a bit rounder, which gave her a more youthful, feminin and softer look (i.e. “enhanced smile style” from the tooth shape library).  She chose a BL2 color for her dental veneers from the tooth shade guide.

The end results for Shelley from Ladera Ranch was that by replacing two old dental veneers and doing several more was the difference between night and day.  We could control most all the variables and give her the beautiful, white, bright smile that she had always wanted.

Congenitally Missing Lateral Incisors – Treatment with Conservative Bonded Bridges

congenitally missing teeth implants bridges

Above, Allie with two conservative bonded lingual bridges. With this treatment none of the front surfaces of Allie’s teeth required any drilling or tooth preparation. Below, Allie before her bonded bridges were placed. Implants were ruled out as being an acceptable choice for her treatment.

Congenitally missing lateral incisors

Congenitally missing lateral incisors, both of them, Allie was faced with tackling a major cosmetic problem that affected her smile and her face.  Her orthodontist straightened her teeth and when her braces came off at age 14 he attached two “false teeth” to her retainer. Thus when she wore her retainer it appeared that she wasn’t missing any teeth, but that meant she also had to always wear her retainer. Her orthodontist’s strategy was that at an appropriate age Allie could get dental implants or bridges. Over the next three years Allie got very tired of wearing her retainer all the time.  The “false teeth”, although looking better than having no teeth there, didn’t look good.  It was obvious to those who looked at her that they weren’t her “real teeth.”

Finally, as a seventeen year old senior high school senior, Allie came to us to discuss what options she would have to give her some “permanent teeth” before she went away to college.  Along with her parents, Allie was thinking that dental implants would be the way to go to replace her congenitally missing lateral incisors. Unfortunately there were two reasons why dental implants would not work in Allie’s case.  First, there was not enough room in the bone to place a dental implant. The area between the adjacent teeth on both sides where the tooth was missing needed to be wide and thick enough for the implant.  It wasn’t!  The second reason is that her orthodontist could not confirm with certainty that all of her vertical facial growth had been completed. If an implant is placed and the patient is still growing, then the natural teeth and gums grow with the face, but the dental implant does not!  A horrible esthetic result could occur.  So dental implants was not the solution to correct Allie’s congenitally missing teeth problem.

congenitally missing teeth bonded bridge

Allie had beautiful looking teeth without any decay, fillings or defects. It would have been very hard to justify conventional bridges that require that the front of her anchor teeth be prepared to accept full crowns that anchor the false teeth. One of the main advantages of modern, bonded “lingually retained” bridges is that the fronts of her teeth do not require any tooth preparation (drilling).

Fortunately there was a permanent solution to Allie’s congenitally missing lateral incisors problem.  Since she was missing two teeth, she could have two dental bridges. The conventional type of dental bridge is a porcelain-fused-to-metal bridge, and this requires that her adjacent teeth be shaped to accept dental crowns that anchor the false tooth in place. Since Allie had beautiful teeth without any cavities, blemishes or flaws whatsoever, it would be very hard for both the patient and cosmetic dentist to justify shaping those teeth to accept crown coverings.

Conservative bonded winged bridges were the solution

But the great news is that in Allie’s case she did not have to have  conventional dental bridges!  She was a great candidate to take advantage of modern, ultra conservative bonded cosmetic dentistry.  Allie could get two bonded bridges that would not require that the fronts of the adjacent teeth be shaped or prepared in any way.  Other names for this conservative type of bonded bridge are “bonded winged bridges“, “non-metal Maryland-type bonded bridges” or “lingually retained bonded bridges“.

The main point here is that as an Orange County cosmetic dentist treating Allie with new techniques I did not need to drill any of the front surfaces of any of Allie’s teeth to accept the lingually retained bonded bridges.  These conservative types of bonded bridges can be done with just very minimal tooth preparation on the back sides (dental term “lingual”) of the adjacent teeth.  The new bonded bridges are made without any unsightly metal (as the old type of “Maryland bridges” were), and are fabricated completely from natural looking tooth colored materials which are bonded onto the back sides of the teeth with the dental curing laser.

congenitally missing teeth treatment

Allie’s beautiful smile with two conservative “lingually retained” bonded bridges. From the photo one can see that she got a superlative result and this was without drilling any of the front surfaces of her teeth.

Allie and her parents were excited that we could offer her this new strategy of conservative bonded cosmetic dentistry.  They absolutely loved the fact that her natural teeth didn’t have to be drilled (shaped) to accept crowns that covered the entire tooth. They also were thankful that we were able to give her a permanent solution and at the same time circumvent her treatment without the need for surgical dental implant treatment.

Just a note here: We are strong advocates of dental implants, use them often in our practice, as dental implants are in many situations the best treatment choice for the patient.  However,  most cosmetic dentists will agree with me that in Allie’s case it was not the best treatment choice.

And, the results for Allie congenitally missing later incisors treatment ?  Absolutely beautiful!  No description necessary, see the photos and see for yourself.  This beautiful young lady from Orange County is now away in college enjoying her freshman year without showing that she’s congenitally missing her lateral incisors.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of San Clemente, Laguna Niguel, Irvine, Newport Beach, Mission Viejo, Coto de Caza and Rancho Santa Margarita

Teeth Grinding (Bruxism) Can Destroy Teeth

teeth grinding

This 50 year old patient was a severe bruxer. His night time grinding wore away 50% of the original length of his lower front teeth above the gum line. Fortunately this was caught in time and there was enough tooth structure left to allow protective crown treatment. If more of the teeth had worn away this wouldn't have been possible and a denture, bridge or implants may have been the only treatments that could have been offered to him.

The silent killer of teeth is bruxism or teeth grinding.  For most people, this happens at night while they’re sleeping.  However, oftentimes the spouse or sleeping partner will hear the annoying noise of tooth against tooth wearing away.

Tooth enamel is the hardest thing in the human body, and yet it is not indestructible.  After years of attrition, or wearing down their teeth, the grinding patient eventually grinds completely through the white enamel and into the more yellow root dentin under it.  Unfortunately the root dentin is only about 25% as hard as the enamel, and thus the rate of wearing away of the tooth drastically speeds up once the enamel covering had worn a hole through it exposing the root dentin.  When you look down at a tooth that had been worn through the enamel it will be clearly obvious as there will be two layers, an outside ring of whiter enamel and a center portion of yellow root dentin.

bruxism treatment

Looking down at the teeth one can see the "bull's eye" appearance of severe attrition. Once the protective enamel has worn away the attrition greatly accelerates. Eventual tooth loss is the result in situations like this that do not undergo appropriate treatment.

But it doesn’t end here.  The damage to the teeth continue on over the years.  When several millimeters of teeth have worn away the teeth then start wearing into a third area of the tooth called the secondary or repairative root dentin.  This area is again a circular area in the center of the visible top of the tooth, but this third area is darker yellow or brown.  The give away that this point has been reached is that there are now three visible layers and the tooth will have the appearance of a bull’s eye with three concentric rings.

dental night guard appliance

A dental night guard is a custom made appliance of thin plastic that fits over the tops of the teeth to protect the damaging effects of tooth against tooth wear.

If you could go back in time, this secondary root dentin is the area that once was occupied by the tooth nerve and pulp in a younger, healthy tooth.  However, due to aging and trauma, the tooth nerve recedes away from the impinging trauma, and in attempts to protect or heal itself, the tooth puts up a layer of internal tooth.  It is this protective layer that is center of the “bull’s eye”.  Usually this means the tooth has lost at least 30-50% of the original tooth that first appeared above the gum line (dentists call this the “clinical crown”) when the patient was a youngster.

One can easily understand that the tooth will continue to wear down until there is very little tooth there and oftentimes dental patients waits too long before they finally decide to go back to their dentist and to do something about it, and then it’s too late.  If the tooth can’t be saved or crowned, then a denture, bridge or implant might be the only treatment left.

bruxism appliance

Most night guards are made to fit over the patient's upper teeth. This photo shows a night guard made on top of a model of the patient's upper teeth. The dentist will then fit the appliance to the patient's bite.

Fortunately for most patients who go to the dentist the damaging effects of bruxism can be detected early enough to treat.  Almost always the most preventive approach is to make a dental appliance to be worn over the teeth while the patient sleeps.  It’s called a “night guard” or “bruxism appliance.”  This slows down the process, but for most people bruxism cannot be stopped, and thus these appliances only slow down the process and doesn’t not cure it.  There are many instances where the dentist will determine that placing a protective crown on several teeth are necessary to preserve what is there and prevent further loss of tooth enamel and dentin.  Dental crowns seldom wear down, and if they do it is only the fraction of the wear that would occur if the tooth hadn’t received a protective crown.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita

Jagged Edge Teeth Transformed to Give Brandon a Handsome Smile with Porcelain Veneers Irvine

irvine porcelain veneers

Rather than having braces first, Brandon chose to do "instant orthodontics" by straightening and restoring his teeth cosmetically with porcelain veneers. He had Dr. Huefner place ten porcelain veneers on his upper teeth, creating an ideal looking smile, and his treatment was completed in less than a months time.

Brandon from Irvine is a middle level executive at a financial institution.  Ambitious, he wanted to get promoted.  He felt he was the best person for the job.  He had the right eduction and training, worked very hard, dressed well and his fellow employees and clients all liked him.  One day, he told us, he looked in the mirror and realized that there was something that he really needed to fix to look his best, his teeth.  He knew that appearance was important in the business world, and he wanted to whatever he had to move up to the next level.

Brandon came to our dental practice to see what cosmetic dentistry options were available for him?  We asked him a couple of basic questions that most all cosmetic dentists would ask their patients before recommending any cosmetic dental treatment:

  • What is it you don’t like about your smile?
  • What do you want changed?
  • What kind of teeth and smile do you want?
  • What do you think you need to have done to fix that?

After pondering the questions for a few minutes, Brandon answered that he really didn’t like anything about his teeth.  The front teeth were chipped with jagged edges.  His teeth were crooked, crowded, discolored.  What was there to like?  “I want a handsome smile,” he told us. “I want my teeth to be straight and white, and when people look at me I’d like them to think to themselves that I’ve got nice teeth.”

orange county cosmetic dentistry

Brandon's teeth were chipped with jagged edges. They were also crooked, overlapped and discolored. He realized that many people judged him based on his appearance and wanted a handsome looking smile.

Dr. Huefner told Brandon that based on his goals, he had two choices.  One, he could have braces first to straighten his teeth and then do porcelain veneers on his upper teeth.  Or two, we could skip the braces and do something called “instant orthodontics” by just placing porcelain veneers.  It was stressed, however, that it is ideal and preferable to straighten his teeth with braces first.  The main reason is that by doing orthodontics first we would need to do less tooth preparation.  Brandon answered that at his age braces were out of the question!  He needed to have a nice smile soon, not years down the line.

It was clear than Brandon wanted his cosmetic dentistry done soon and as efficiently as possible.  He began his porcelain veneer treatment on his upper teeth almost immediately, and had his upper teeth restored with porcelain veneers within the month.  He got a great result, the handsome smile that he wanted, and he was very pleased.

More Youthful Smile Makeover for Deb with Porcelain Veneers – Orange County

laguna hills porcelain veneers

Deb with her beautiful new smile with ten porcelain veneers by Dr. Huefner.

Deb from Laguna Hills is an interior decorator in Orange County, CA.  She is an artist who appreciates beauty and when someone comes to her to remodel their home or business she does an incredible job! Deb said, “My appearance and image are important to me. When new clients interview me I know they’re not only evaluating my work, but how I look.  Several times when I was speaking with them I could tell they were looking at my teeth!”

Feeling that her natural teeth were wearing down and showing the effects of age she came to Dr. Huefner to seek his opinion on if cosmetic dentistry might be able to help her. “I don’t like the way my teeth look anymore.  I’d like to have teeth that made my smile look more attractive, more youthful and more professional,” she said.

worn discolored teeth

Deb didn't like her smile primarily because her teeth had worn and were discolored. As a professional interior designer she felt that she should look her best and improving the appearance of her teeth and smile were important to her.

When we looked up closely at Deb’s teeth we were able to specifically determine several issues as to why she was dissatisfied with her teeth and smile:

  • her teeth were worn and had shortened over the years, giving a more aged appearance
  • the color of her teeth were no longer white
  • her gums had receded a little resulting in the “necks” of her teeth appearing V-shaped so that her front teeth didn’t have the “normal rounded rectangular” appearance
  • there was spacing between her front two teeth
  • her cuspids (eye teeth) were protruded out more than the rest of her teeth
  • her bicuspids (back side teeth) leaned in
  • she had crowns and fillings that didn’t match in color and “looked artificial”

Deb really wanted to know what it would take to give her a sensational smile?

After carefully listening to Deb, giving careful consideration to everything she said, Dr. Huefner recommended cosmetic dentistry with porcelain veneersPorcelain veneers would allow him the most control in creating the attractive, more youthful and professional smile that she was asking for.  This would also allow him to create the best color, length, shape and position of her teeth.

laguna hills porcelain veneers

Deb got a terrific result with her new porcelain veneers. The color, shape, length and position of her teeth were all designed specifically to give her the best smile possible.

Excited about achieving the end result that Dr. Huefner spoke about, Deb started her porcelain veneer treatment, which was completed in three dental appointments in a three week period.  She chose an “enhanced” smile style from the tooth shape catalog.  Regarding the new color or shade of her porcelain veneers, Deb chose BL2 from the tooth shade guide.

The results?  Deb from Laguna Hills said she loved her new smile with porcelain veneers and that now she could smile with confidence in her business and social life!

Dr. Norman Huefner

Replacing Old Cosmetic Dentistry to Enhance and Soften a Feminine Smile

non-metal bridge and porcelain veneers

We replaced Roxanne's old porcelain-fused-to-metal bridge (she had a bridge because she was missing one front tooth) with this non-metal bridge and porcelain veneers. "Gull wing" lateral incisors (i.e. shorter than the adjacent teeth) and more rounded shaped teeth gave her a much softer and more feminine smile.

As a young lady Roxanne from Irvine lost one of her front tooth in an auto accident. Her family dentist placed a 4-unit porcelain fused to metal bridge to solve her missing tooth problem.  She was happy because he gave her back a front tooth and saved her smile.  Based on the technology at that time her family dentist did an incredible job.

However over the years Roxanne became increasingly more observant concerning teeth and smiles, both hers and others.  A decade went by and as cosmetic dentistry got better she realized that her smile didn’t look as good as it could.  One day Roxanne came to our office for a cosmetic dentistry consultation and specifically wanting to know what we could do better today to improve her smile by replacing her old 4-unit porcelain fused to metal bridge.

orange county cosmetic dentistry

When Roxanne was young she lost one of her front teeth and her family dentist made her a porcelain-fused-to-metal bridge. Over the years she became dissatisfied with its appearance and wanted her old dentistry replaced with newer materials and techniques it that would give her a better result.

In answering her question there were two areas that we had to address. The first was difference in materials and the other was advances in design, artistry and cosmetic dental techniques.  With regard to the former, we explained to Roxanne that today we didn’t have to limit our material to a porcelain fused to metal bridge, which oftentimes is very opaque and appears “lifeless” and unnatural.  This is because the underlying metal prevents natural light transmission through the bridge.  However with natural teeth, which is semi-translucent, some degree of light is able to pass through.  To replicate that property we could make her more natural looking  dentistry by utilizing some newer materials that allow light to pass through in the same way that it would with natural teeth.  Two materials many cosmetic dentists use today are Porcelain on Zirconia or IPS E-Max.   We suggesting one of those two techniques for her new dentistry.

metal bridge

As you can see the back surface of Roxanne's old bridge was an unsightly silver metal. The metal was obvious and showed when she opened her mouth wide. Also because of the opaqueness of porcelain-fused-to-metal bridges the color did not look very natural.

With regards to the techniques and artistry, cosmetic dentists do considerable training in smile design, which incorporates  the many characteristics of a natural smile such as length of the teeth, shape of each tooth and proportions of each of the teeth to the rest.  In Roxanne’s case her family dentist made her four front teeth all exactly the same length at the edges.  But today many cosmetic dentists trained in smile design would consider that a more masculine smile.  By meeting Roxanne you would realize quickly that in no way was she masculine and this is the last thing we would want to do, either intentionally or unintentionally.  Thus, to soften and feminize her smile we recommended making her lateral incisors (the lateral incisor is the tooth next to the front tooth) a little shorter than her central incisors (front two teeth) or her canines (eye teeth).  That is a concept called “gull wing incisal edge effect“, which in our opinion would greatly enhance her smile.

old pfm bridge

The edges (margins) of her old bridge did not fit well around the gum line. Also the edges of all four front teeth were even and squarish, both characteristics of a more masculine smile. Roxanne wanted a softer, more feminine smile design.

We asked Roxanne about the color she wanted and she said that she really would like her teeth to be whiter, but they had to look “real”.  A solution to that was in addition to replacing the 4-unit bridge to place porcelain veneers on four of Roxanne’s other teeth, her canines and first bicuspids.  Thus when Roxanne smiled she would show eight beautiful teeth, all of the same color.  By softening the edges of her teeth by rounding them slightly, and incorporating the “gull wing” effect, Roxanne would have an amazing smile, youthful and feminine.

Roxanne accepted our treatment recommendations and proceeded with her treatment, we placed a new non-metal porcelain bridge and four porcelain veneers.  She chose a BL1 shade from the tooth shade guide and an “enhanced” smile style from the LVI Smile Catalog. For this great lady from Irvine the difference in new materials, techniques and following smile design concepts took her from having just an “OK” smile to having an amazing smile!

Stunning Smile Makeover with Gum Reshaping, Teeth Bleaching and Porcelain Veneers

porcelain veneers laguna niguel

Connie got a stunning smile makeover with laser gum reshaping, teeth bleaching and porcelain veneers.

Connie from Mission Viejo came to our cosmetic dental practice because she wanted “a nicer smile.”  When we photos of her smile and looked at them together her critique was that she had a gummy smile and her teeth were discolored.  She said that if we could correct those two things for her that she would be happy.  We also discussed with her doing “ideal cosmetic dentistry” with porcelain veneers, which would enable us to get a much whiter shade and improve the shape and position of her teeth. However, Connie said that she really didn’t want to do porcelain veneers.

So for Connie we had very conservative recommendations:

  • We would reshape her gums with the dental gum laser
  • Then we would whiten her teeth with teeth bleaching
gummy smile treatment dental laser

At first Connie's main concerns were that she had a gummy smile and discolored teeth. Initially she wasn't interested in porcelain veneers, but ultimately she changed her mind and had porcelain veneers to give her much whiter teeth and as well change the length and shape of her teeth.

The gum reshaping procedure with did for Connie with the dental gum laser went great!  It was a minor cosmetic procedure that required a minimal amount of local anesthetic (Novocaine), but did not require any stitches and had almost no pain or bleeding.

Immediately after Connie’s gums were healed,which was in less than a week’s time, we started Connie on with her teeth bleaching.  Within two weeks she was done and was back saying how happy she liked “her new smile.” However, we were very surprised to hear what she said next!

“You know Dr. Huefner,” said Connie, “I love the improvement you did for me but now I’ve been rethinking what you were suggesting about porcelain veneers.  I really appreciate how what you’ve done so far has improved my appearance, and now I think I’m mentally ready to go to the next step an do porcelain veneers.”

Before beginning Connie’s porcelain veneer treatment we discussed three other elements in smile design:

  • the length of the teeth
  • the shape of the teeth
  • the color
orange county gum reshaping and tooth bleaching

The first phase of Connie's treatment was to just reshape her gums and bleach her teeth. She was pleased with the huge improvement but decided she wanted even more enhancement of her smile and had Dr. Huefner place ten porcelain veneers for her.

Connie said that she liked how much whiter teeth bleaching made her teeth look, but that with her new porcelain veneers she wanted them to be whiter still.  She chose a BL2 color from the teeth shade guide.  With regard to the tooth length, she said she felt that her teeth were a bit too short and would like them just a little longer.  Also, she felt the shape of her teeth was too round with too much space between her teeth.  Thus we looked at smile styles from two different tooth shape libraries and Connie chose the “enhanced” smile design from the LVI Smile Catalog.

Shortly thereafter Connie returned and we placed ten porcelain veneers following the design that she had approved.  For this Laguna Niguel lady it took us a little longer than usual to get to the final result, but we achieved a terrific smile for her and she was extremely appreciative of all our patience and efforts.

My Teeth Make Me Look Like I’m Getting Old – How Porcelain Veneers and a More Youthful Smile Helped Randy and His Dating

laguna niguel porcelain veneers

Randy's new smile with porcelain veneers by Dr. Huefner. We learned that his main motivation for getting cosmetic dentistry is that he wanted to look younger and be more attractive to the women he wanted to date.

Randy from Laguna Niguel had pretty healthy teeth, but he didn’t like the way they looked.  He had been coming to our dental practice for years and one day after having his teeth cleaned he said, “You know Doc, I just don’t like the way my teeth look any more.  What can you do to make my teeth look better?”

Before recommending any cosmetic treatment it is always best to first determine what the patient means when they said they “don’t like their teeth?”  Three important questions that cosmetic dentists usually asked their patients are:

  • What is it you don’t like about their teeth and smile?
  • What is it you want changed?
  • If you could have an ideal smile, what would that look like?
laguna niguel cosmetic dentistry

Randy thought that the appearance of his teeth made him look older. He said his teeth had discolored and chipped over the years. He was also concerned about the cavities around the gum line of his side teeth and that they appeared so dark because of the old amalgam fillings he had as a youngster.

In Randy’s case, he said the two things he disliked the most were the color of his teeth, which had darkened over the years, and his front two teeth that had chipped.  But he could also see some problems with his side teeth.  He had some gum line cavities that were quite yellow and a couple old amalgam fillings that had discolored his teeth a grayish-black color.

On the surface, from above information one might think the cosmetic dentist would have enough information to make the recommendations Randy was asking for.  However sometimes the motivation for cosmetic dentistry is as important as what the patients wants changed.

It took a little while but Randy finally felt comfortable enough to share with us his real motivation.  He felt he was starting to look older.  Also, he was single and dating and felt a nicer, younger looking smile would make him more attractive to the women he was interested in.  Now knowing this, we could make  recommendations to Randy about the most appropriate treatment to achieve his goals.

Dr. Huefner recommended that he place ten porcelain veneers on Randy’s upper teeth, the teeth he showed when he smiled.  He would make Randy’s new teeth whiter, a shade BL2 or BL3 from the tooth shade guide.  Also he would make the teeth longer, the length they most likely were before they wore down and shortened over the years (see tooth length).  In addition, Dr. Huefner would give him a smile design that was younger, which recall was one of his major motivating factors in getting cosmetic dentistry.  A younger smile design pertains to the individual shapes of each teeth and how they relate to each other.  Dr. Huefner showed Randy numerous smile styles from the smile libraries he has for his patients and together Randy and Dr. Huefner chose the LVI “softened” smile style.

Randy’s treatment went very smoothly and was successfully completed in less than three weeks time.  One might argue that success is dependent on the results, and shortly after his smile makeover Randy from Laguna Niguel seemed to be very happy and by the smile on his face we guess is doing quite well with the ladies.

Dental Implant or Porcelain Bridge When Missing a Front Tooth?

missing tooth dental implant

John broke his canine tooth and had to have it removed. Into the space where the root was a dental implant was placed. During this time John wore a "flipper" as a temporary so that he wouldn't have to face the world missing a front tooth.

John from Irvine had to have his canine (eye tooth) removed because the root had broken below the gum line and there wasn’t enough tooth to place a new crown. Very frustrated because he didn’t want to go around missing one of his front teeth, John came to Dr. Huefner’s cosmetic and general dental practice in Laguna Niguel wanting to know what his options were?

He basically had four choices:

  • dental implant
  • 3-unit fixed (meaning not removable) porcelain bridge
  • removable partial denture
  • or nothing

“Nothing is not an option, ” John said.  I have to have a tooth there.  Which of the other three is the cheapest solution?

dental implant abutment

After the dental implant healed and fussed to the bone an implant abutment was attached to it. This will now enable a porcelain crown to be placed over the abutment.

We explained to John that the least costly alternative would be a removable partial denture, either an extremely inexpensive temporary all-plastic “flipper” or a better fitting, stronger and more comfortable removable partial denture with a cast metal substructure.  When John learned that either of those options meant that the replacement tooth is something that he has to take in and out and was the least comfortable and least esthetic of all the treatment options he decided that the “cheapest solution” was not for him.

“Well, I guess it’s between an implant or a bridge.  What is the difference in cost between those two choices?” John asked.

“These two options cost about the same,” Dr. Huefner explained.”The 3-unit porcelain bridge would mean placing porcelain crowns (caps) on the two teeth adjacent to the space of the missing tooth and then the new false tooth (called a pontic) would be attached to the those two porcelain crowns, making a total of three teeth all joined together, thus the name 3 unit bridge.”

John said that he understood the concept of a 3-unit porcelain bridge, as years ago he had a missing lower back tooth that was treated that way.  He also said that he had already had a very nice crown that was recently placed on his lateral incisor (the tooth directly in front of the missing canine tooth) that he didn’t “want to mess with.”

dental implant irvine

John was fully restored when Dr. Huefner placed a porcelain crown over his implant abutment.

Thus it was starting to appear that by process of elimination John would want to have his replacement tooth done with a dental implant, so Dr. Huefner went on to explain the process:
After the root of the fractured tooth is removed a dental implant will be placed into the space where your root was.  You won’t see the actual dental implant, as it will be below the gums.  We need to wait a couple months for the dental implant to fully attach to the bone and the gum area around it heals up.  Then, into and on top of the dental implant I will place an “implant abutment“, which is attached to the dental implant below by means of a specialized dental implant screw.  The dental implant abutment will be either gold, silver, gray or white (zirconia), but that isn’t really any important consideration because I will make you a porcelain crown will cover the implant abutment and complete the process.

After understanding the entire process of how the dental implant treatment is done and comparing it to the other choices John chose the dental implant.  It took a couple months to complete the treatment, and in that interim we made John a temporary flipper so that he would have a replacement tooth and not to go around as he had feared, missing a front tooth.  The final results of the dental implant treatment were great and John from Irvine was very pleased with how we restored his smile!

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita

Yellow Brown Teeth – Most Predictable Way to Make Them White and Beautiful

yellow brown teeth before porcelain veneers

Tom had yellow brown teeth and said compared to his co-workers, he had the worst looking teeth. He said he really wanted a nice smile with white teeth. Dr. Huefner explained to Tom his teeth were so dark that in his case he didn't have confidence that teeth bleaching would whiten his teeth enough to make a significant difference in the color. Dr. Huefner recommended placing eight porcelain veneers which would give him the most control in achieving the color Tom wanted along with the best shape, length and position of his teeth.

Tom from Rancho Santa Margarita had extremely yellow brown teeth.  “My teeth have always been pretty dark,” he said, “but over the years they have really started to look horrible.  When I’m around my colleagues at work I feel like I’ve got the worst looking smile.”  At a point in his life where he wanted to upgrade his appearance, Tom wanted to know what could be done for him?

When we measured the color of Tom’s teeth with the dental shade guide he was off the chart!  A shade C4 is the darkest color on the shade guide, but the color of his teeth  was more like a shade A6, which is several shades darker and rarely seen!

yellow teeth with porcelain veneers

Tom got the whiter, brighter smile that he had always wanted with eight porcelain veneers.

“Tom, you really have just two choices,” Dr. Huefner said.  “You can try to bleach your teeth to make them whiter and then replace the bonding on your front tooth.  It will certainly look better, but your teeth are so dark I don’t have confidence that teeth bleaching will get your teeth as white as you want.”  Continuing on, Dr. Huefner said, “If you really want your smile to look great, to give me the most control over giving you the color you want, and also improving the shape, length and position of your teeth eight porcelain veneers would be the treatment of choice for you.”

After much discussion and thought Tom said that at this time in his life he didn’t want to waste a lot of time and effort on fixing his teeth, so if porcelain veneers would look the best than that is what he would do.  Skipping forward three weeks, Tom had eight porcelain veneers and got a terrific result!  He chose a BL2 shade from the tooth shade guide and an “enhanced” LVI smile style from the tooth shape catalog.

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