Six-Month Adult Braces + 2 CEREC Porcelain Veneers equals one happy patient!

Ever since we started doing six-month braces about five years ago, the number of smile makeovers that we’ve done with porcelain veneers has dropped dramatically. This is because we can create beautiful smiles much more conservatively with six-month braces than we can with veneers, simply because there is no drilling on the teeth. There are times however, when porcelain veneers are an excellent option. Caroline’s case is a perfect example of how the two can work together: we first used six-month braces to straighten her teeth, then whitened them.  Finally, we used our CEREC CAD/CAM machine to make to 2 porcelain veneers right in our office, in a single appointment to complete the smile makeover by matching her peg lateral incisors to match the rest of her smile.

If you are interested in learning more about either porcelain veneers or 6MonthSmiles, please contact us at either 704-364-7069, or Request an Appointment Online.

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Complete Smile Makeover with Porcelain Crowns

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.

Cosmetic Dentistry in Charlotte: Correcting a Gummy Smile with a “Gum Lift”

Smile Makeovers can take many shapes and forms, and it is so important IMO for a dentist to be fully informed and trained on DIAGNOSING all kinds of smile problems and knowing the APPROPRIATE recommendations to make, because if an improper diagnosis is made, then the wrong treatment can easily be chosen, which will only result in a less-than-satisfactory result and an unhappy patient.  Here’s a perfect example:

Mia first came to my office in March of 2007 to ask if Porcelain Veneers could give her the smile she’d always wanted.  Her complaint was that her teeth were too short and square, and she hoped that veneers could make them longer.  However, the problem was NOT that her teeth were too short; the problem was that she had too much gum COVERING her teeth, making them appear shorter than they really were.

Mia’s Smile Before

Smile Makeover to Correct a Gummy Smile - BEFORE picture

As it turns out, Mia also had old dental crowns and bridges that were in need of replacement.  Unfortunately, the dentist who had placed them 20 years ago did not recognize the excess gum problem (turns out there was also excess bone covering the teeth, but you probably don’t want to see the surgical photos, right? 😉  ), and so he placed the edges of the crowns and bridges too far under the gum, resulting in chronic gum irritation.  The human body simply does not like it if you put dental materials (gold, amalgam, porcelain, composite resin, doesn’t matter) too close to the bone and too far under the gum, so the gums get irritated and will always bleed when brushing and flossing, sometimes even just to the touch.  We’re replacing the existing dental work over time, but we were able to do the right side work at the same time as the “Cosmetic Gum Lift,” which really made a big improvement.  (When looking at the photos, it’s on the left side of the pictures.)

So after plenty of consultation, Mia decided to go with the corrective gum surgery.  The technical name for this is “Esthetic Crown Lengthening,” which simply means that we are making the teeth look prettier (esthetic) by making them look longer.  She told us beforehand that she felt very nervous, but afterwards said that it was much easier and  less uncomfortable than she’d expected, and her healing was much easier than she’d thought.  Usually the only discomfort is some gum soreness, really.

Mia’s Smile After

Mia tells us she is simply THRILLED with her smile now, and it’s easy to see why!

Smile Makeover to Correct a Gummy Smile - AFTER picture

And for Mia, one of the best parts of the whole treatment was that we were able to do everything right here at Smiles by Payet Dentistry, with no need to refer her to a specialist.  I really loved giving Mia the smile that she’d always wanted, with no unnecessary drilling for porcelain veneers that would not have solved her problem in the first place.  We did also replace her old crowns and bridge on the upper right, and with the excess gum tissue removed there, too, now she has no problems keeping the area clean, and her gums don’t bleed when she brushes or flossing.  Next will be the upper left side.

Not all dental crowns are metal-free, even for cosmetic dentists doing Smile Makeovers

While many cosmetic dentists claim to be “metal-free” dentists, too, I do not make any such claim.  Why not?  For a few simple reasons…..

1. Gold onlays and gold crowns are still the strongest and longest-lasting ways to fix broken teeth or teeth with cavities currently available, and if that’s what you want, then you want gold.
2. Teeth stained by the antibiotic tetracycline can be so dark that is extremely difficult to  bleach (whiten) them, except with Deep Bleaching (TM), and even porcelain veneers may have difficulty covering such dark tooth stains,  so Porcelain-to-Metal (also known as Porcelain-to-Gold) crowns are sometimes the best choice.
3. Bonding (tooth-colored fillings) usually does not hold up very well if you grind or clench your teeth intensely, as they aren’t hard enough to take that much force, so silver (amalgam) fillings are often a better choice.

Here’s a case from a few years ago where the patient was really unhappy with his old, yellowed, kind of ugly old Porcelain-to-Metal crowns, partially because of the dark grey line at the end of the crowns where the black metal underneath the porcelain was showing as his gums receded.  He only had crowns on the top 6 front teeth (a bad idea), and he wanted all of his teeth bright white, and he’d gotten the crowns initially because of severe Tetracycline staining of his teeth.  They were the darkest teeth I’ve EVER had to treat.  I’ll post something soon about how to create a beautiful smile despite tetracycline-stained teeth, but for this I simply want to show that dental crowns that are used to create a Smile Makeover can be just as beautiful and natural-looking as all-porcelain crowns.

Replacing ugly old porcelain-and-metal crowns with a dark grey line at the gums with porcelain-to-gold crowns that look beautiful, natural, and white - to cover tetracycline-stained teeth.