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Brian LeSage, DDS, FAGD, FAACD

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Archives for February 2021

Can I trust my dentist to redo my crown for the third time?

My dentist did a crown on my left incisor, but it did not match the porcelain veneer beside it. My dentist replaced the crown, but the color is still off. It is darker than the veneer and my other teeth. He told me that a perfect match is challenging, so I asked for a new crown that is whiter—not darker than my other teeth. I am not confident that my new crown is going to look good. How many times can I have a crown redone before my tooth starts to weaken? Thank you. Leila

 

Leila,

Although your dentist has not been able to match your crown to your veneers and your natural teeth, a perfect match is possible. An advanced cosmetic dentist has extra training to match the crown so well that you can’t tell the difference between it and your natural teeth.

But most dentists approach tooth restoration with the goal of fixing the damage, not achieving beautiful results. Tooth color and translucence are complex. Within a single tooth, color varies from the gumline to the edge. Matching a tooth includes matching tooth enamel and the dentin beneath it. So advanced training and technique are required.

Matching a Crown to a Porcelain Veneer

A single porcelain veneer held by dental forceps

An advanced cosmetic dentist can match a crown to your veneer and surrounding teeth.

Advanced cosmetic dentists do not bond on a crown without placing it on your tooth and asking your opinion. They pay close attention to if you are hesitant about whether it matches your teeth or porcelain veneers. If you are hesitant, the cosmetic dentist will redo it until it is perfect and you are happy with the result. An artistic dentist will never tell you that you won’t get a perfect result or that your smile looks great when you do not think so. Even if it takes three to four try-ins, a skilled cosmetic dentist will perfectly match the crown to your veneer and surrounding teeth.

Will Redoing a Crown Hurt Your Tooth?

Redoing a crown will not hurt your tooth if the dentist is careful removing it and preparing it for a new crown. It takes skill to repeatedly remove a crown and bond on a new one, and you should only trust an advanced cosmetic dentist to do it.

Unfortunately, it sounds like your dentist lacks experience in this area. We recommend that you get a second opinion from a dentist with advanced cosmetic dentistry training and experience.

 

Accredited Fellow of cosmetic dentistry, Dr. Brian LeSage sponsors this post.

Dentist over-prepared my teeth and veneers fall off

The past year has been an immensely frustrating experience with porcelain veneers that keep falling off. My dentist repeatedly bonds a veneer back on when it falls off, but it seems that another one falls off within a few months. This has happened three times. I suspect that before this year ends, all eight veneers will have fallen off at least twice.

When I received the veneers in the fall of 2019, my dentist said they would last 15 to 20 years. It makes me nervous to think that I will have this experience for the next 14 years. My anxiety level is high whenever I return to her office. When she removes a veneer, I can no longer look at the tooth behind it because the veneered teeth look like small pegs. Although my dentist said she wouldn’t take off much tooth enamel, I don’t think I have any enamel left.

My dentist prescribed ten Ativan tablets for whenever a veneer falls off. She advised me to take one about an hour before the appointment for anxiety. I am insulted that my dentist thinks sedating me is the solution to her sloppy work. It is probably time to switch dentists, but with teeth that are small pegs, I wonder if another dentist can do any better. What is the best way for me to handle this situation? Thank you. Huong from Seattle

 

Huong,

A single porcelain veneer held by dental forceps

Porcelain veneer

We are sorry to hear about your experience with porcelain veneers. It seems that you have realized that what is happening is not normal, and it is best to get a second opinion from an advanced cosmetic dentist. Your dentist’s approach is questionable in several areas.

Preparing your teeth for porcelain veneers

Advanced cosmetic dentists conservatively prepare teeth for porcelain veneers—removing a half millimeter or less of tooth enamel. Conserving tooth enamel for porcelain veneers has several advantages:

  • Smoothness – Conservative preparation avoids a bump at the margin where the veneer meets your gumline
  • Stability – Dental cement that bonds porcelain to your teeth adheres to tooth enamel better than dentin—the layer beneath the enamel.
  • Healthier – Bacteria more readily seeps behind veneers bonded to dentin and promotes decay

Careful preparation can affect how long your porcelain veneers last. For details, read our post: How long do porcelain veneers last? Mine broke within two years.

Preparing teeth for porcelain crowns

Although crown preparation is more aggressive than preparation for veneers, preparing teeth for crowns still requires a conservative approach. Otherwise, the crowns will not stay on. When a dentist prepares a tooth correctly, a proper retention form will keep it secure even with dental cement.

Your dentist’s aggressive preparation of your teeth was too much for crowns or porcelain veneers, so your veneers are loose and falling off. Looseness allows saliva and bacteria in, promotes decay, and can contribute to bad breath.

Sedation with Ativan

After 24 hours, half the dose of Ativan is still in your bloodstream. It can take a couple of days for your body to eliminate the drug. Many dentists commonly use Halcion for sedation, which lasts about three hours—enough time for a dental appointment. It seems that your dentist’s sedation techniques are also too aggressive for bonding a veneer back on.

Is your dentist liable?

Your dentist is legally liable for your veneers for these reasons:

  • Grinding your teeth down to numbs for porcelain veneers that will not stay on
  • Compromising your oral health—your teeth risk breaking
  • Providing unstable dental work—your veneers fall off

Some options are reporting your experience to the state dental board, consulting a malpractice attorney, and submitting negative reviews about your experience. But those actions will not restore your smile. You need help from an advanced cosmetic dentist.

Schedule a porcelain-veneers second opinion

We recommend finding an accredited cosmetic dentist for a second opinion, followed by an exam. The dentist will explain your treatment options for correcting your smile makeover. Your new dentist might be able to help you get a refund.

But your oral health and how you feel about your smile are most important. Search for accredited cosmetic dentists with a lot of experience. You can schedule two consultations if it will increase your confidence that you are choosing the right dentist. Ask each dentist how many cases like yours they have handled.

 

Before-and-after minimal prep porcelain veneers from Beverly Hills dentist Brian LeSage

With minimal preparation, Dr. LeSage’s patient received eight porcelain veneers

Accredited Fellow of cosmetic dentistry, Dr. Brian LeSage, sponsors this post. Dr. LeSage has developed and published a classification system for porcelain veneers preparation.

For more information on the dangers of over-preparation for porcelain veneers, see our post: I need a root canal on a porcelain veneer tooth.

 

Dentist over-prepared my teeth and veneers fall off

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– Thích Nhất Hạnh

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