A Full-Mouth Smile Reconstruction
Quite some time ago, I showed this case as an example of how badly teeth can be damaged by grinding them, whether at night, in the daytime, or both, and why something as simple and inexpensive as a nightguard (my recommendation is a NTI-tss). It is especially inexpensive in comparison to the cost of rebuilding a smile that is so broken down. This gentleman came to us in 2008, looking for options to feel good about his smile again for various reasons. After plenty of discussion, we agreed that the only option that would truly give him the smile that he wanted was a Total Smile Makeover/Reconstruction with porcelain crowns. After showing the Before-After pictures of his smile, I’ll discuss some of the issues you need to consider if you are thinking about significant cosmetic dentistry for yourself.
Frequently Asked Questions about Smile Reconstruction
When rebuilding a smile such as this, it is crucial to establish a proper bite relationship of the top and bottom teeth. Sometimes this can take a little while to figure out, because – when the teeth are so worn, the patient has long since adapted to a very bad bite relationship. The muscles have to be relaxed, accurate records taken, and excellent communication is necessary among the patient, the doctor, and the lab, to ensure that the crowns are made to look good, feel good, and last a long time. However, in severe wear cases, we always remind the patient that s/he already did a pretty good job destroying their natural set of teeth, so a nightguard is an absolute requirement as “insurance” to protect their investment, and even then they are more likely to break or chip the porcelain than others who don’t have that history. Simply put, these cases are far more complicated and require a great deal of time to get right, so you need to be absolutely committed to proceeding and working closely with your dentist to get a good result.
How Much Does a Smile Reconstruction Cost?
It’s not unusual for a patient to ask why it costs so much to do a Smile Reconstruction like this; it often seems like there should be a “volume discount,” so-to-speak, when doing a lot of crowns instead of just 1 or 2. The difference between such scenarios is the amount of time involved, the skill, training and experience required to successfully diagnose, complete, and treat, and that your dentist will have to work with a highly knowledgeable lab to make the crowns to not just look good, but fit properly and work smoothly in eating motions. Your dentist will likely spend at least a couple hours just in the planning stages! It’s usually a case of “You get what you pay for.” IOW – if you want a cheap smile makeover, you should reasonably expect a cheap outcome. To get excellence……it won’t come cheap. Depending on various factors, a case such as this will be the equivalent of buying a fairly nice car. The main difference, of course, is that you should expect to be “driving” your smile for a lot longer than most people keep a car!
- How Long Will This Take to Finish?
When doing so many teeth, you need to plan on a minimum of several appointments that could take 1/2-day to a full day each, as well as several other appointments to refine, modify if needed, polish, etc. From beginning to end, if everything goes perfectly, you might be done in as little as 1 month. That would be somewhat rare; more likely, you should plan on the entire process taking at least 2 months, and maybe many more. Extremely complex cases that involve implants, different specialists, and very complicated lab work may take a year or more due to the time needed for healing, verifying each stage is correct, and even just the time needed for lab technicians to do the custom work.
- What kind of Crowns will/should you get?
Due to improving materials and with the right techniques, in most cases nowadays you can have all-porcelain crowns made to rebuild a smile. The crowns used in this case are made of E.max porcelain, which is extremely strong and resistant to breakage. Numerous studies now show that this type of porcelain will likely last for 15-20 years, and quite possibly longer. For certain cases, though, and for patients who are even worse grinders than this gentleman was, gold crowns might still be necessary for the back teeth, simply because they are the strongest, longest-lasting crowns available. They can also take more abuse than any other material. Porcelain-to-metal crowns are also an option and have a long track record, but it is very important for the lab to be highly skilled so that you don’t see dark grey lines at the gum from the metal showing through.
- How Do I Choose the Right Dentist?
This is one of the trickiest questions, because the public doesn’t usually know enough about the training necessary beyond dental school that trains dentists to handle complex full-mouth reconstructions with skill and confidence. But here’s my recommendation: ask to see pictures of their other cases that might be similar to yours. That’s one of the reasons digital photography is such an instrumental and daily part of our dental practice – you will be able to see similar cases and know how the outcome will be before ever committing. The large majority of dentists who are well-trained in these cases also use digital photography, both for communicating with you as well as for documenting and tracking their own work over time. If you meet a dentist who can show you pictures of cases that were completed 5-10 (or longer) years ago AND s/he has recent follow-up pictures to show how well it has held up, THEN you should feel very confident that your dentist can take good care of you.
And then start imagining how much better you’ll feel when you can smile like Wayne does now!
Please feel free to ask questions or post a comment below, or to share with your friends! If you’re interested in a Complimentary Consultation in our office, please call 704-364-7069 or Request an Appointment Online.
Interestingly, this porcelain crown was done on the same patient as the last gold onlay that I posted. So why a porcelain crown on this tooth instead of gold? Simple — this one is more visible in his smile, and he wasn’t interested in having “bling” in his smile. LOL Given that strength and durability of his porcelain crown is also very important, as is obvious by his choice of gold for his second molar on the other side, we did use what is currently the strongest porcelain crown available today, whether made by a lab or with our CEREC, and it is called Emax. This ceramic is incredibly strong, far superior to the old Porcelain-Fused-to-Gold (PFM) crowns that have been used for decades. And, of course, we did it in a single appointment.
Just to review the advantages of CEREC 3D CAD/CAM Porcelain Crowns, and why we’re proud to offer them at our Southpark Charlotte NC dental office:
- Just 1 Appointment
- No temporary (provisional) crown
- No worries about the temporary crown falling off
- Incredibly strong
- Very natural-looking and blend in beautifully
- LESS sensitivity afterward because the tooth is immediately bonded and sealed
If you need a crown and are looking for the convenience and excellent result we can provide with our CEREC 1-visit crowns, call us or visit our website:
Baby Boomers – get your teeth fixed before you retire when you still have dental insurance and flex plans to help pay
Old silver fillings with cavities and cracks that could turn into root canals and crowns or extractions
The teeth around the old silver fillings may have cracks that could lead to broken teeth
Gum (periodontal) disease
Ugly old crowns that could be replaced for a nicer smile in the golden years
Replacing missing teeth with dental bridges or implants so you can eat the foods you want
Etc etc etc……
This gentleman hadn’t been to the dentist in a number of years but knew that he was approaching retirement, so he wanted to come in, get a cleaning, and find out if he needed to take care of anything while he still had dental insurance. Turns out that many of his 30+ year old silver fillings were in really bad condition, with pieces chipping off, cavities forming around the edges, teeth cracking, and gum disease to boot.
While the total treatment that he needed involved some gum surgery (not needed for everyone, obviously), the primary issue that we addressed was to clean out the old fillings and cavities, then rebuild the teeth with all-porcelain crowns on several teeth, 1 tooth got a tooth-colored filling, and 1 tooth got a gold 3/4 crown (most of the tooth, but not the whole tooth is covered by the crown).
He can now rest assured that all of the problems with these teeth are fixed, and it’s likely he will not need any of them ever worked on again as long as he takes good care of them.
One of my very favorite people is a simply AMAZING woman named Terrie Reeves. We first met at the Charlotte Yoga studio near Park Rd. & Woodlawn Rd. about 5 years ago, when she was an instructor and I was a student. Shortly after that, we got to talking about her smile and that, while she liked it ok, she would like it brighter and to fix the chips in the front teeth, and she’d noticed that it seemed her front teeth were getting thinner and more see-through. So after a thorough dental exam and long consultations, we decided on a Total Smile Makeover for Terrie that would be completed with 16 porcelain veneers. The top veneers were completed first, then the lower ones made to match, and ever since then, Terrie has absolutely loved her smile! And if you’ve ever met Terrie (which I highly recommend), you will understand when I say that her smile truly matches HER. She is filled with more energy than any 10 people have a right to, and she has to be one of the happiest people I’ve ever met.
If you’ve seen the portrait of her below before……don’t be surprised! After Terrie saw her post-Smile Makeover Portrait Shoot (on the side, I am a professional photographer as well), she asked if she could use some in her Wellness Coalition of America promotional materials; how could I refuse? 🙂
It’s been reported by the media recently that some dental crowns, made in China, have been found to have excessively high lead content. Generally, these crowns come from very low-priced laboratories, but the full extent of the problem is not yet known.
However, I want ALL of my patients (and potential patients) to know that we do not use any labs in China, and in fact, we rarely use crowns that have metal in them. That’s not to say that we are a “metal-free” dental office; by no means! There are a number of very good reasons to use gold, silver, and mixed metals for different situations, but none of those require that we use cheap crowns from cheap labs that might put you at risk.
In fact, my patients can be reassured that they aren’t getting any metal the huge majority of the time because of our CEREC 3D CAD/CAM system that allows us to make incredibly strong, very natural-looking, beautiful crowns in just 1 appointment. You can literally watch your crown being made!
In those instances that we do have to use a dental laboratory, we can still avoid metal most of the time, but even then……all the labs that we use are proud to say, “Our dental lab work is made in the USA!”
Just so you know it’s perfectly safe to make an appointment for a crown with us, knowing there’s no chance of lead in your crowns or bridges.
Another exciting technology that we offer is the CEREC CAD/CAM system. Very simply put, with CEREC we are able to design, mill, glaze, custom-stain, and bond an all-ceramic crown or onlay IN JUST ONE VISIT. That’s right – no temporary crown or onlay, no second appointment to get numb, no worries about the temporary falling out. When you come in, you need the crown done, and when you leave — it’s DONE. Finito. Finished. Complete……….you get the idea. 😉
Sylvia’s case this morning, an old silver filling that had cracks in the tooth around it, new decay forming at the edges, and discomfort when biting, meaning the tooth was truly starting to crack and might have broken apart.