November 26, 2019
There are many misconceptions about porcelain veneers, but perhaps MOST common is that porcelain veneers ruin your teeth. To be fair, the short answer is “maybe”, and that is where it becomes difficult from a consumer standpoint. Yes, we are irreversibly removing “some” tooth structure (generally, as much as we need. Sometimes little to none, but sometimes ½ mm or more). Even if NO tooth structure is removed, if the decision to remove the veneers at a later date is made, the process to remove the veneers will remove some tooth structure as well.
Is removing tooth structure a BAD thing? Some dentists will passionately say yes, while others are more indifferent. If the REPLACEMENT of tooth structure is poorly done, then yes, I think everyone would agree that it was a bad thing. However, if done properly, well prepared teeth and well bonded porcelain veneers can last a VERY long time (perhaps a lifetime).
Proper Tooth Preparation for Porcelain Veneers
Less is more. That is a common phrase with many intentions. In THIS case, it simply means that the less tooth structure we must remove, the more we have later if we need to remake or redo the case. If a dentist is aggressive with removal of enamel and dentin, the NEXT dentist will have less to manage. It MAY even appear that the first dentist was “great” and the next dentist is “less than”, and it may be the opposite.
So how much enamel removal IS needed? If teeth are perfectly aligned, maybe none. However, the result MAY feel bulky. A more common approach is to remove 0.3-0.5mm of tooth, and the porcelain restoration would be the exact same thickness. This means “net zero” or no change in tooth size/thickness and would feel very natural.
As Much As Needed
Sometimes, the tooth itself tells us how much to remove. The most common way or reason is when the patient wants a bright white smile. If the natural tooth itself is very dark, then this color would “shine through”, so in order to get the desired color, we must remove MORE enamel/dentin to allow the restoration to be thick enough to block out the natural color.
Another reason is due to previous dentistry. It is very common that teeth have already “had work done” and the porcelain veneers are an upgrade of sorts. If a tooth already has a large filling, then the porcelain veneer, crown, or onlay will need to be larger than normal. If restored properly, this is not a significant issue.
Properly Bonded Porcelain Veneers
This is where it gets tricky. Every dentist has “their way”. It stands to reason that “their way” should be similar/identical to the manufacturer’s instructions, but that isn’t always the case. I will go on record and say that if you find a dentist that reads the instructions from the box that his materials came from, you likely have found a dentist that has work that lasts longer and is more comfortable than other dentists that do things “off label”.
Traditionally, the tooth surface is etched in order to accept the primer and bonding agent during the bonding process. Some more recent materials combine the etch with the primer, but these products may not last as long as more traditional materials. Get a group of dentists in a room, they will debate this step for years….!
The enemy to the bonding process is moisture. To a degree. Common problems are blood contamination, saliva contamination, and anything else that would spoil the bonding process. This is why a good dentist will use isolation to control the amount of moisture present. If moisture is the enemy, one would think that totally dehydrated teeth would be best; however, this isn’t true. We need the tooth “sorta moist”, so there IS a level of moisture needed to bond the porcelain veneer.
Disinfectants and Desensitizers
When the tooth is ready to be bonded to, it is common to place solutions that “soothe” the tooth and disinfect.
Not all dentists do this step, some claim it is not necessary, but I feel that the end result is more comfortable and longer lasting. With an investment like a porcelain veneer smile makeover, we do our best so that our patients get the best value, and part of that is that they last as long as possible.
It is not unusual for a patient to feel that they replaced all of their teeth and no longer need to brush or floss. “Why would I? My teeth are gone!”
This isn’t true. The teeth are still there, they are simply covered up, or partially covered. If you don’t want to have porcelain veneers ruin your teeth, be sure to brush, floss, visit your dentist as recommended and follow ALL advice from your dental office.
November 25, 2019
We have found that one of the best investments that people can make for themselves is the gift of a smile. I don’t mean “a healthy mouth” but an actual smile makeover that turns heads! But what does that MEAN?
I have found that the “perfect smile” means something different to EVERYONE
Did you know that there are at LEAST 50 shades of grey? And that the human eye can distinguish 500 shades? I’m not sure that I could PERSONALLY distinguish them, but that is what I am told….
So what about white? When people ask me for a white smile, what does that mean? How white do you want? Is it possible to be TOO white? The “right” answer is a personal opinion, as I have delivered beautiful smiles that for ME seemed too white, but my patient LOVED the result.
Have YOU thought about a white smile, and WHAT white you would like? Is “mother of pearl” too yellow, or is that about right?
And for the record, there are 52 shades of white….
There is actually some math involved when designing a smile. I know, we all insisted (were maybe even CERTAIN) when we were in school learning Algebra that the real world would have no need. Yet, as we age, we see math EVERYWHERE. Case in point: smile design. Designing a perfect smile includes considering the overall face and looking for balance and symmetry. While NOTHING is perfectly symmetrical, we do our best to create symmetry whenever we CAN.
The lips ideally cover 1-2 mm of enamel at the gumline when smiling, the incisal edges of the two front teeth should be 21-25 mm from the bottom of the nose, the width of the central tooth should be 1.6 times as wide as the lateral, the height vs width should be 78%….
There are famous numbers that we were taught in life: Pi is 3.14, Avagadro’s number is 6.022×10^23, the Fibonacci Sequence or the Phi Matrix is 0, 1, 1, 2, 3, 5, 8, 13, 21, 34, …
The latter number is what trained cosmetic dentists use to create what is commonly called “Golden Proportions” or the “Golden Ratio”. The math involved is 1.6, shown here:
This is a common ratio we see all throughout nature:
It stands to reason that if we can design a smile with THIS math, our eyes/brain will see the smile as “beautiful”.
If we design a smile in advance, it will appear something like this:
From THIS starting point, we can personalize a smile and deliver the best possible outcome.
How much DOES a perfect smile cost?
Well, THAT is the $64,000 question, isn’t it? Ironically, it COULD cost $64,000…..
Most of the time, it won’t be THAT much. The vast majority of smiles deal with 8-10 teeth so the cost will likely be closer to $15,000 to $20,000 but each and every case is different.
There is NO substitute for a dental exam. This is not merely a conversation, but also a collection of diagnostic records, photos, and any necessary data to assess the situation and then render an opinion on what it would take to achieve YOUR goal.
August 17, 2018
Smile Makeover Requirements
by Lance Timmerman DMD
“I want a new smile, what will it take?!” Seattle cosmetic dentist Lance Timmerman in Tukwila gets this a lot. The challenge: an answer. If I asked you to paint my house, could you give a fee? Probably, but at first you may only give me a range and after you learn about the condition of my house you can give a better estimate.”
April 5, 2016
Choosing a cosmetic dentist can be tough. Times have become tough. With Photoshop, the internet, and items just about ANYONE could purchase, how can you find the right cosmetic dentist for you? It seems every dentist puts on his stationary “Family and Cosmetic Dentist”. To a degree, this implies that ANY dentist can give you that “red carpet smile”. To be honest, this just isn’t true. They aren’t lying, but the use of the term or the intended meaning is not established.
Quite often, if you asked many dentists what they mean by Cosmetic Dentist, they will say they do white fillings in addition to the mercury ones. Many of these dentists, when asked to give a perfect “Hollywood smile” will decline, or simply put off the patient (or worse yet, they will “try” and do their best, but in the end nobody is happy). They won’t make a referral of any sort, they simply find ways to discourage the patient from moving forward. Some will go so far as to say “what you are asking for just can’t be done…”
This can become very confusing for the consumer. If all dentists are NOT created equal, then how do you go about choosing a cosmetic dentist?
Unfortunately, this means the consumer needs to interview prospective dentists. Most offices will offer a free consultation to answer your questions. You should know that a consultation is NOT an examination. A consult is generally a “chat session” where things are discussed in general terms, perhaps visual aids or models are used to show a process, but it isn’t patient specific. If you are wanting to know what would work in your individual case, a clinical examination would be required, and all necessary diagnostic records would be taken. You should also expect a fee of some sort for this (but it won’t be much and often dental benefits pay most or all of the fee).
Find out from the prospective dentist how many cases they have done (you don’t want to be the first, right?). Find out how unique your specific case is (if you are an odd challenge, can they handle it?). Ask for photos of their own work (dentists can purchase books of beautiful cases that were done by someone else). Ask how they got trained in cosmetics (it is NOT a subject taught in dental school).
But in the end, you need to choose a dentist you can trust. With all the training in the world, fancy photography and cases under their belt, you need to decide if the person with the scary job is someone you trust. That is not an easy or quick decision.