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.

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Frequently Asked Questions about 6MonthSmiles (fast, invisible, adult braces)

The Most Commonly Asked Questions at a Six-Month Braces Consultation

These questions really aren’t surprising, and you’ve probably wondered about them already yourself if you’re considering this remarkable cosmetic dental option, so here are your answers:

1) Can you REALLY move my teeth that fast?

Yes, we really can.  I know it seems hard to believe, because most everyone thinks that you have to wear braces for 18 months to 3 years to get everything right.  You can take a look at this Smile Gallery to see a whole bunch of people who’ve had their front teeth straightened in 6 months or less.

2) HOW do you move teeth that fast?

It’s quite simple, really, and it’s not magic or rocket science.  Basically, since we’re really doing cosmetic braces, this is an alternative to porcelain veneers.  That means we are just concentrating on straightening the front teeth, NOT trying to correct major bite problems. Answer these 3 questions and you’ll know if you’re a good candidate for 6MonthSmiles:

• Do you have any jaw or muscle pain, or a history of headaches?
• Do you have any difficulty chewing or biting normally, or is your bite really “off” in the back teeth?
• Do you have some spaces in the front teeth you’d like closed or crowded front teeth you want straightened?

If you answered NO the first 2 questions but YES to the last question, then you are probably a good candidate for 6MonthSmiles!

3) WHEN CAN WE START!?

This is, of course, the most fun question.  It’s amazing how many times patients will want to start RIGHT NOW.  As in, before they’ve even left the Complimentary Consultation appointment.  And most of the time, we can accommodate.  Getting started is literally as easy as getting molds of your teeth, a complete set of photos, and a panoramic x-ray (this one goes around your head and records your entire jaws, joints, etc. to make sure there are no complicating factors).  We send the info to our 6 Month Smiles lab, which makes custom trays that let us put pretty much all the brackets on at once, just a couple of weeks later.  It’s much easier and faster this way, I promise.  And off we go!

Do you love to smile like Caroline?

One of my absolute favorite things to do, is to see patients for their Complimentary Portrait Session after they finish some type of cosmetic dentistry, whether it is Six-Month Braces, Porcelain Veneers, Teeth Whitening, or some combination of those.  There is such a level of satisfaction when a patient LOVES to smile for pictures instead of hide their smiles because they’re embarrassed.  Caroline is a perfect example of this; when she first came to see us, she was really unhappy with her crooked teeth.  Given what an amazingly cheerful person she is, hiding her smile was not something she wanted, but — like so many others — she assumed that braces would take 2-3 years, and as an adult, she simply was not interested, but she also didn’t want to have her teeth ground down for porcelain veneers, nor did she want to spend that much.  So, with a combination of Six-Month Braces, 2 Porcelain Veneers with our 1-Visit Crown system (CEREC), and Whitening Trays, we dramatically transformed her smile in about 10 months total.  Just look at her smile now!

This is really what Cosmetic Dentistry is all about, really — it’s about helping you feel good and confident about yourself, about your smile. If you would like to smile with the confidence that Caroline now does, give us a call at 704-364-7069 or Request an Appointment Online!

2.9 Month Braces by Charlotte dentist Dr. Payet

As much as people are often amazed at the idea that we can give them a straight smile with Six-Month Braces, there really are times when it doesn’t even take THAT long.  Take a look at Karim’s before and after pictures — literally, we put her brackets on back on September 9th, and we took them off today, November 24th.  That’s NOT EVEN 3 months with braces on, but look what a difference!  As she put it….”I love the results!”

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.

A new website with more info on Six-Month Braces for Adults in Charlotte, NC

I’ve been laboring to learn web design for about the last 6 months so that I could create my own sites to help spread the word on one of our patients’ favorite procedures, and I’ve finally published my first website, which is very exciting!  It’s been a lot of work, and there will be much more work to come in future months as I update it, add more Featured Cases, and expand the procedures that are covered.  For now, though, I hope you will all find it useful if you’re looking for a Smile Makeover here in Charlotte  with Six-Month Braces.

Does dentistry last forever?

This is a question I’m frequently asked, especially when a patient is considering a significant investment of time and money into some form of cosmetic dentistry, such as:

• Porcelain veneers
• Bonding (tooth-colored fillings)
• Porcelain crowns and bridges
• Teeth whitening
• Even Six-Month Braces

It’s a very understandable question, and the simple answer to the question, “How long will my dental work last, Dr. Payet?” is “It depends.”

Just like a car, your teeth and gums require regular care to ensure that they are working properly.  Sure, you can go 10-20,000 miles between oil changes given how improved cars are nowadays, but do you really want to take the risk?  Same thing with teeth……….some people go for 5-10 years with no dental check-ups and are fortunate when they come in to find no problems, such as cavities or gum disease. But it’s not many people that are so lucky!

I always remember a quote from some lecturer at a dental conference years ago telling us his response whenever a patient asks the question, and it’s really the most honest, best answer that can be given, “Clearly the teeth that God gave you haven’t lasted your entire life, and since I can assure you that my work is not nearly as good as God’s, unless you die first, the work I do (no matter how excellent) will not last forever either.”

So what can cause your dental work to fail?

• Grinding your teeth — when the human jaw clenches, it can create an amazing amount of force, and over time, enough clenching will cause teeth to crack and break.
• Acidity — anything that increases the acidity in your mouth is good for the bacteria that cause cavities in particular, including Acid Reflux, Sodas, Power drinks (Monster, Red Bull, etc), Sports drinks (Gatorade, Powerade, etc).
• A very sugary diet — the bacteria that cause cavities love sugar.  High sugar content means the bacteria feed like crazy, produce acid, and the acid is what eats away the teeth to cause cavities.
• A compromised immune system — your saliva contains important antibodies that help keep the cavity-causing bacteria under control.  If your immune system is knocked back due to a disease or some medication, those antibodies will be decreased, allowing the bacteria to grow uncontrolled.
• Decreased saliva (dry-mouth syndrome) — again, due to medications or illness, the amount of saliva may be decreased.  With less saliva, there is less “washing” action of the teeth.
• Trauma — obviously.  LOL  One of my patients a few years ago fainted and fell face-first into a brick wall, shattering a front tooth.  Another ran into a pole, shattering another front tooth.  Clearly, if you are injured in such a way that your natural teeth would break, any dental work will break, too.
• Bad habits like chewing hard candy or ice regularly — hard candy and ice are just that — HARD!  Ice, in particular, is easily as hard as your enamel and as porcelain or bonding.  So if you bite down on ice frequently enough and/or hard enough, you can break your teeth and dental work.

That covers most of the major causes of dental work failing.  With regular care, use of appropriate mouthrinses and toothpastes, proper brushing and flossing, regularly scheduled check-ups and dental x-rays, using a nightguard, and being aware of diet, etc, your dental work can and should last a very long time.

But always remember — my dental work isn’t as good as the natural teeth God gave you, so my work probably won’t last forever either.  😉

Updates on Invisalign

ALIGN Technology, the company that makes Invisalign orthodontic aligners, has not yet made any indication that they will be reversing their decision on June 1st to require dentists and orthodontists to do a minimum of 10 cases each year and complete 10 hours of their Continuing Education courses each year.  The backlash among dentists and orthodontists, however, continues to get stronger, as this is a fairly blatant move by a for-profit corporation to intrude on a doctor’s autonomy and decision-making rights as to which cases are appropriate for Invisalign and which are not.  Several professional organizations, including the Academy of General Dentistry and the New York State Dental Association, are already responding with letters to ALIGN Technology’s Board of Directors and President, stating that there is simply no evidence that the so-called “proficiency requirements” have any basis in science, and unless they can come up with something to substantiate the claims the company is making, they should immediately withdraw the requirements.  If ALIGN Technology continues on this course, patients should fully expect to see an enormous drop in the availability of Invisalign as more and more dentists and orthodontists simply drop their service.

The good news is that there are alternatives to Invisalign, and they work as well or better, AND they’re even less expensive!  For some info and examples, check out our Six-Month Smiles in Charlotte!  Then you can Request a Complimentary Consultation to see how fast you can feel good about your smile again with straight, white teeth!  And if you’re concerned about cost, if you sign up for our Dental Discount Plan or choose Interest-Free Payment Plans with Care Credit, you can save some real money, too.

A Complete Smile Makeover with Porcelain Crowns for Teeth Damaged by Bulimia

There are many reasons patients come to see me for cosmetic dentistry.  One of the most common reasons is because their teeth are badly worn down from grinding, often in combination with acid erosion that has eaten away at the enamel.  Treating these cases can be complex, because if we don’t properly diagnose and solve the problem that caused the worn, eroded teeth in the first place, then any cosmetic dentistry is sure to fail very fast.

When Jenni (not her real name, as she prefers to stay anonymous) first came to see me through a referral back in 2005 for a Smile Makeover consultation, she admitted that she had suffered from bulimia as a teen, about 20 years prior.  She had recovered from this debilitating disease and had been leading a healthy, normal life for many years, but her teeth had been so eroded that she was extremely self-conscious and embarrassed by her smile.

Since Jenni’s original issue had been addressed medically, we were safe moving forward with a greatly decreased risk of acid erosion causing problems again, although bulimics are at a much higher risk of GERD/acid reflux, so she is monitored regularly by her physician, and she uses a prescription strength fluoride rinse daily to help protect the teeth under the porcelain.

Due to complicating factors, Jenni’s case was just completed this year; however, I think you’ll see why Jenni is now happy with her smile again, although she doesn’t want everyone to know what she had done,  so she has asked me to not use her portrait.

Cosmetic dentist Dr. Charles Payet, of Charlotte NC, performed a Smile Makeover with Porcelain Crowns to Restore these Teeth Damaged by Acid Erosion/Bulimia

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.