August 15, 2018

Questions and Answers about Cosmetic Dentistry

If you have a question about cosmetic dentistry or porcelain veneers, I will do my best to answer it for you.  If appropriate, your question and our answer may appear in this blog Q & A section.
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Q: Is this proper procedure to grind down parts of the crown & remove some tooth material to fit a crown?
When dry fitting a new gold crown it was too tight to the adjacent teeth & was sitting too high. After grinding the crown & my teeth didn’t fix the problem new impressions were taken, it was returned to the lab. I don’t know what to expect when I return this week (to my current dentist) for the second fitting. If there are any further issues I may have to consult another dentist to understand the subject. Should any grinding of teeth be required in order to fit a crown?

Dr. Huefner’s answer:
Ideally, no adjustments of your crown or teeth would be necessary.  However, there are many variables in making a crown that in some instances dictates that the dentist adjust either or both, the new crown and opposing teeth.
In some instances it is actually preferable to adjust the opposing teeth,  Specifically, some teeth have an extra long cusp, called a “plunger cusp” or a tooth that has “supra erupted”, making it longer than all the adjacent teeth.  So, in those cases it is often preferable for the dentist to adjust the opposing teeth more than the crown.
In general, little adjustments of either the crown or opposing teeth have little significance.
In my practice, if I feel it is in the patient’s best interest that I adjust the opposing teeth, I will tell the patient in advance and get their permission.  My patients almost always trust my judgment and follow my advice when I explain the reason why, in advance of the adjustments I’m recommending.
However, if you distrust your current dentist, and you have little faith or confidence in him/her, then maybe it’s time to find another dentist?

Q.  I’ve worn my front teeth down pretty short and my dentist has tried twice to make them longer with bonding.  Both times they broke off in just a couple months and my dentist said I must be grinding my teeth too much to try to bond again.  What can I do? J.M.

A.  Composite bonding is a great technique for more conservative dental problems and you dentist may be correct that it won’t hold up in your case if you’re a heavy bruxer (i.e. you grind your teeth, which in most bruxers happens most often at night time).  I recommend that you have your dentist very carefully check your bite.  If you are hitting wrong on just one tooth this may be perpetuating your grinding habit.  Many times a careful bite adjustment and wearing a bruxism appliance at night (also called a “night guard”) will minimize the detrimental effects of bruxism.  The other treatment that might be much more successful in your case is having your dentist place porcelain veneers, or possibly even porcelain crowns, in place of the composite bonding.  Both of those options generally provide a much stronger and more long lasting solution than composite bonding in cases of severely worn teeth.

Q. How much do veneers cost? Connie

A. Connie, this is probably one of the most frequent questions we’re asked.  But before that can be answered there are some things than have to be addressed.  First, what type of veneers are you referring to?  Hand sculpted composite (plastic) veneers or porcelain veneers?  If the former, are you needing a veneer on just one tooth, custom matching all the other teeth, or multiple teeth and choosing a color from the tooth color shade guide?  If the latter, again, are you referring to just one tooth and requiring that the ceramist custom match your adjacent teeth, or again doing multiple teeth and choosing a standard shade?  Another question is are you referring to no-preparation veneers like Lumineers, minimal preparation veneers, standard preparation veneers or moderate-plus preparation as would be necessary when there are large cavities or fillings or the teeth are significantly out of normal alignment?  Are you referring to feldspathic veneers or stronger and generally longer lasting veneers like pressed-ceramic Empress veneers? Other questions are what are your expectations and how difficult will your treatment be?  How skilled is your dentist and in what city are you located? Are you wanting your treatment to be covered by insurance or is this elective cosmetic dentistry? Which lab will your dentist be using?  A lab with considerable experience that specializes in cosmetic dentistry and veneers, a general lab or a discount lab?  I’m sorry to ask you so many questions before answering yours, but the reality is all those things go into consideration when dental fees are determined for cosmetic dentistry.  The range of fees is considerable, and we’ve seen dentists advertise veneers for as low as $300 and some of the “experts” in major metropolitan cities are charging as much as $3,000 per veneer.  Obviously the two are not the same.  My point is that “a veneer” is like many other purchases you will make, like a TV or a car.  It can be high end, in the middle or low end economy.  The most important thing is that you get the results you want and that you’re given a fair fee based on the time, effort, training, expertise, skill level and final results from your cosmetic dentist.  I suggest that you not make your decision as to the dentist on fee alone.  In our cosmetic practice at least one-third of all the cosmetic dentistry we do is REDOING work done by other dentists that have not achieved the results that they patient wanted or expected.  Many of these patients based their initial decision on fee alone, and were subsequently disappointed.  Thus, first interview your cosmetic dentist, explain your goals and expectations, have him/her evaluate your smile and discuss with you the proposed treatment, answer many of the questions I’ve previously asked you, and give you an estimate of the fee.  Good luck, and again, sorry to give you such a long-winded diatribe to what at first would seem to warrant a one-word answer.

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