Porcelain Laminates

[ilim01]

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Hello, I am a medical student and ususllay post in the allo forum,

I'm faced with a dilemma. I have gaps between my upper teeth and was considering porcelain laminates. The gaps do not really ruin my appearance and I haven't had much trouble attracting the opposite sex, but its just one of those appearance defects that I've recently wanted to improve.

i know that the procedure requires chipping away at the tooth's natural enamel and is irreversible. And there's always a chance that the dentist could mess it up.

Since many of you had experiences in dental offices or shadowed dentists, perhaps you mayhave some thoughts on the following questions:

Do you think its worth taking the risk of doing the procedure (considering that my current teeth do not really ruin my appearance, and the dentist could mess it up)?

Should I necessarily do it at a cosmetic dentist?

How can I find the best most competent dentist to do this procedure in my area (I live in NYC)?

thank you for the advice and suggestions. 🙂

One more question what is the difference between DDS and DMD?

 

[DDSSlave]

if you like the way your teeth look, consider pulling them together with braces. Realize that once you cut on your teeth and introduce an artificial margin like a veneer, there's no going back. The veneers will have to be replaced over time. You could go to the dental school and become a patient with an ortho resident for probably 1/2 the price of private practice.

To answer your other questions: there's no specialty "cosmetic" dentistry. It's just marketing. DDS and DMD are absolutely identical. Just a fluke in dentistry.

 

[DcS]

As the above poster pointed out, nothing is ever as good as your natural tooth structure, once it is altered there is no going back.

With that said, veneer preparations are some of the most conservative tooth preparations. If done correctly (assuming those teeth are healthy, which I assume they are) they should only remove a thin layer of the enamel on the front part of the tooth. It is ideal to have the veneers cement onto enamel, so really the dentist should do his best not to get all of the way to dentin (stronger bond to the enamel). Sorry to get technical, but really if you want the esthetic improvement veneers require pretty limited tooth prep. As I said, though, it is irreversible and you will have to get the veneers replaced over time as the porcelain wears.

Ortho as suggested above is an option but I'm assuming you didn't want to go through the time period associated with that tx.

As far as choosing a dentist, even though it's technically "illegal" to advertise one self as a cosmetic dentist, it wouldn't hurt to visit one that does list as that. The best piece of advice I would give you is to ask to see cases that the dentist has done. Any dentist who does a lot of cosmetic dentistry, who is worth a lick of salt will have photo documented cases of their work. Granted they could do ****ty work and only show their best, but I digress. Also, ask them if they wouldn't mind providing references, if some patients have ever allowed them to. This would give you a better idea.

I'm not sure if you've considered it, but depending on how big the space is between the 2 teeth you might actually need 4 veneers (your four front teeth up top, both central incisors and the lateral incisors, 7-10). Simply filling in the gap with bigger teeth could make you look like you have 2 chiclets in your mouth. That all depends on your case, and your dentist will be able to make the best judgement. I just thought you should know that for best esthetics it might be necessary.

There is 1 final thing you should consider, which is much more conservative and much much cheaper. I'm sure you're familiar with tooth colored fillings. Well, your dentist can use that material, resin composite, to simply build up each of those centrals to close the diastema. That would remove altering your teeth and can give you excellent results. Definitely explore that as an option, it's the most conservative, cheaper, and can look great.

Let us know if you have any other questions.


The last and best option in my opinion was the last one I mentioned. Go to this link it is a simple example of using composite. Go to yahoo and look up "diastema closure" and you will find examples of what I explained.

http://www.dtp-online.com/document/diastema.PDF#search='diastema%20closure'

 

[DcS]

Here is another very good example of diastema closure with composite.


Diastema Closure Example

 

[aphistis]

Here is another very good example of diastema closure with composite.


Diastema Closure Example

Ick, you think that's a good example? The contouring doesn't look very good at all, and the shade match isn't great either. Resin might work well for an isolated small diastema or two, but I think the case you linked is way too much for resin to address effectively.

(This opinion with a 110% money-back guarantee.)

 

[12YearOldKid]

I agree, Bill. It's not pretty at all, but it's probably about as good as you're gonna get with resin bonding. For the fee that they're getting, a private practice dentist doesn't have the time to spend making it perfect. In order of personal preference: I vote for ortho then veneers then resin-bonding then just letting calculus build up and close the gap.

 

[DcS]

Ick, you think that's a good example? The contouring doesn't look very good at all, and the shade match isn't great either. Resin might work well for an isolated small diastema or two, but I think the case you linked is way too much for resin to address effectively.

(This opinion with a 110% money-back guarantee.)

It was good example of the procedure, is all.

 

[DcS]

Ick, you think that's a good example? The contouring doesn't look very good at all, and the shade match isn't great either. Resin might work well for an isolated small diastema or two, but I think the case you linked is way too much for resin to address effectively.

(This opinion with a 110% money-back guarantee.)

How can you judge shade when there is an operatory light on those teeth? Do you know if that is directly post-op? Because if it is, those teeth are dehydrated and the shade will most certainly be off. If you ask your patients to choose shade with an operatory light beaming on their teeth, good luck.

That case is a perfectly legitimate tx. In a case like that, if you do not offer that as a treatment alternative to your patient, that is not standard of care.

 

[DDSSlave]

I tend to agree with Bill. However, the color doesn't concern me near as much as the shape. Those teeth look awful. Look how huge they are. That's about as far off the golden proportion as it gets. And they still have a black hole between their centrals after all that. And it's asymmetric to boot. Having said that, it does look as good as it's going to get with resin buildups. I considered offering this as a suggestion to the OP, but if it was me, I wouldn't do it. Certainly not for someone going into medicine and interacting with patients as a professional all day. Get the braces while you're in school/residency and do it right the first time. To me, anything else is a compromise. And not offering ortho most certainly is below the standard of care whether you do them yourself or have them referred out, especially when the patient says he likes the look of his teeth, just not the spaces in between them.

 

[lnn2]

Hello, I am a medical student and ususllay post in the allo forum,
I'm faced with a dilemma. I have gaps between my upper teeth and was considering porcelain laminates. The gaps do not really ruin my appearance and I haven't had much trouble attracting the opposite sex, but its just one of those appearance defects that I've recently wanted to improve.

It's a "technical sensitive" procedure. The result can be estheticly pleasing if it's done correctly!

This was done by Ortho tx

i know that the procedure requires chipping away at the tooth's natural enamel and is irreversible. And there's always a chance that the dentist could mess it up.

Choose your dentist like you would choose a plastic M.D.! Esthetic dentistry involves experience, technical skill, knowledge of occlusion...you name it. It's not simply just drill and fill.

You have a few options (without an examination or a pic of your teeth):
1. Orthodontic tx (most conservative option)
2 Orthodontic tx then Whitening and Porcelain Veneers (if desirable)
3. Whitening and Porcelain Veneers
4. Do nothing!

I don't recommend Composite veneers or resin bondings. Although it's much cheaper than porcelain, it can be stained easily and structurally weaker.

Here's a good article
Another

 

[J2AZ]

As the others have stated the prep for veneers requires the removal of tooth structure. this tooth structure can never be put back. You will end up spending around $1500 and will most likely have to replace the veneers a few times during the course of your life time.

Your best bet is to be conservative. Go to a dentist and have some resin bonding done. This does not require the removal of tooth structure. The dentist will etch and your tooth and bond and bit of resin on each of your front teeth. He will then shape and smooth it. This should only cost about the same as two fillings $200 to $250. If done properly and considering the gap is not extreme, you will look great. In addition, this procedure is reversable so if you later decide you want ortho or veneers they will just pop the resin off and go from there.

If you dont want to do this I would seriously consider ortho. It is a one time cost and will most likely require you to where a retainer at night but you will maintain your tooth structure. Also, these days braces are cool.

As far a picking out a dentist I would recomend staying away from those who advertise. Your best bet is to go to an office with two dentists and when sch ask the front desk staff which of the two they go to. After all they see the dentists work and they know which is the better dentist.

Best of luck.

 

[DDSSlave]

Not to beat the subject to death, but I'd like to clarify that while resin buildups are very conservative to place on your tooth, you cannot simply "pop the resin off." The dentist or orthodontist would have to shave the resin down to what he thinks is/was your natural tooth. Sometimes easier said than done.

 

[aphistis]

How can you judge shade when there is an operatory light on those teeth? Do you know if that is directly post-op? Because if it is, those teeth are dehydrated and the shade will most certainly be off. If you ask your patients to choose shade with an operatory light beaming on their teeth, good luck.

That case is a perfectly legitimate tx. In a case like that, if you do not offer that as a treatment alternative to your patient, that is not standard of care.

I simply observed some of the potentially significant flaws in the case you linked, to point out the limitations of treating major diastema cases that way. Call off the dogs, buddy.

 

[DcS]

I simply observed some of the potentially significant flaws in the case you linked, to point out the limitations of treating major diastema cases that way. Call off the dogs, buddy.

I was posting the link to provide help to the OP, I wasn't posting it to do a case study. Just didn't need the comment captain obvious...if every member of this board can't tell that looks like crap they shouldn't be a dentist.

 

[DrJeff]

For the fee that they're getting, a private practice dentist doesn't have the time to spend making it perfect.

I am the only one who thinks that this statement is ridiculous 😕 As one of those private practice dentists getting the fees when I do a composite veneer, you can be sure that I'm doing everything possible and taking as much time as I need to get them as good as the materials will allow them to be. After all, if they end up looking like cr$%, then you can be sure that that patient will tell atleast 10 of their friends that it's my work they're looking at(not exactly the referral base I want to happen), whereas if I get them looking great, they won't tell anyone unless asked about it. Rule of thumb is if you do some that looks bad, the patient will tell everyone, if you do something that looks great, they'll tell almost nobody unless asked.

Plus, as for veneers and todays porcelain technology, you can often do what is classified as a "no prep" veneer. Where this applies is if alignment with respect to rotataion and/or buccal/lingual placement is appropriate and you're looking to either close a diastema or just achieve a new appearance to the teeth. In situations like this, all I do is simply take final impressions and a bite registration of the teeth to be veneered and their opposing teeth, and fill out the lab Rx and send the case out. No prepping of the teeth! When the veneers come back, all I need to do is just simply cement them(if their is any existing composite restorations I'll roughen the surface of the composite with a sand paper disk prior to bonding the veneers to the teeth.

While in diastema closure cases, ortho tx is the desired way to go about 99% of the time, if the no-prep veneer is a clinical possibility then you can achieve the cosmetic results the patient desire without having to remove ANY underlying tooth structure, and then when the veneers reach the end of their functional lifespan and need to be replaced, you're starting from the exact same tooth enamel situation as the day they were cemented. A win/win situation 👍

 

[DcS]

Plus, as for veneers and todays porcelain technology, you can often do what is classified as a "no prep" veneer. Where this applies is if alignment with respect to rotataion and/or buccal/lingual placement is appropriate and you're looking to either close a diastema or just achieve a new appearance to the teeth. In situations like this, all I do is simply take final impressions and a bite registration of the teeth to be veneered and their opposing teeth, and fill out the lab Rx and send the case out. No prepping of the teeth! When the veneers come back, all I need to do is just simply cement them(if their is any existing composite restorations I'll roughen the surface of the composite with a sand paper disk prior to bonding the veneers to the teeth.

Have you ever taken one off or had one fall off after being on for a decent span of time (couple years)??? I'd be curious to hear what the tooth looks like after the veneer being on a few years.

 

[DrJeff]

Have you ever taken one off or had one fall off after being on for a decent span of time (couple years)??? I'd be curious to hear what the tooth looks like after the veneer being on a few years.

If the patient has been maintaining things properly via diet and hygiene (and often if these patients will do so since they've paid top dollar for their veneers) the tooth structure underneath the veneers will look just the same as enamel that's been under properly cared for orthodontic brackets/bands (i.e. perfectly normal looking enamel)

The majority of the time if you have a veneer "failure" its not because of decay, but because of occlussal trauma. So even in a tradional veneer where you're prepping tooth structure, if that veneer comes off and/or gets cut off after a few years, the enamel/dentin(yes I said dentin because often with a tradional veneer you'll end up prepping into dentin if you have a deep discoloration or a moderate/severe rotation that you're trying to correct) will look EXACTLY as it did the day you bonded the veneer onto the tooth.