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Brian LeSage, DDS, FAGD, FAACD

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I need a root canal on a porcelain veneer tooth

The pain that I thought was a sinus infection turned out to be a tooth infection. My dentist referred me to an endodontist for a tooth with a porcelain veneer on it for eight years. I am concerned that after the root canal, I will need to replace the veneer. Is the endodontist the right one to do the work without damaging my veneer or turning my tooth dark beneath it? Ji from NV

Ji,

An endodontist is a root canal specialist. And without root canal treatment, the infection will spread into your bone. We are concerned about how a porcelain veneer tooth got infected.

Porcelain Veneer and Root Canal Treatment

You might need root canal treatment on a root can tooth if the tooth becomes weak and stressed. Sometimes aggressive tooth reparation will make a tooth weak.

Conservative Porcelain Veneer Preparation

Depth-limiting diamond bur applied to teeth for porcelain veneer preparation

Minimal porcelain veneer preparation can prevent the need for root canal treatment

A dentist should only remove a half millimeter or less of tooth enamel when preparing for porcelain veneers. One technique, as shown to the right, uses a diamond bur that limits the depth of preparation. Half-millimeter grooves in the tooth are enough to ensure veneers fit well without making teeth look bulky. A cosmetic dentist uses a conventional diamond bur to remove the ridges.

Aggressive Porcelain Veneer Preparation

When a dentist removes too much tooth enamel, the dentin (layer beneath the enamel) is exposed. And the tooth is at greater risk of stress and needing a root canal treatment.

Tooth Color After Root Canal Treatment

A tooth turns dark after root canal treatment. And since porcelain veneers have translucence, the darkness will show through. An advanced cosmetic dentist can improve your tooth color with these steps:

  • Clean out the root canal filler material from your tooth
  • Place a flexible white fiberglass post into the tooth root
  • Fill the remaining space with a light-colored composite

Treatment like the above will prevent darkening for five to ten years.

If your dentist placed and bonded your porcelain veneer correctly, you should not lose it.

 

Dr. Brian LeSage, an accredited Fellow of cosmetic dentistry in Beverly Hills, sponsors this post.

How long do porcelain veneers last? Mine broke within two years.

Although my dentist told me that porcelain veneers could last about 20 years, I had a veneer break within two years. My dentist had a lab replace it, but the color is too light. The veneer is for my left incisor, so the color difference is noticeable. My dentist sent the crown back to the lab, and the tech baked a glaze onto it to make it darker. My dentist removed some of the glaze to get the shade right. But when I left the dental office and looked at my tooth in natural light, I can see that the tooth is still too dark, and the veneer is not as glossy as the others. I am not confident with all the changes to this replacement veneer that it will last any longer than the original one.

I have two questions: How long are porcelain veneers supposed to last? And if one breaks, can I expect challenges with getting the color to match the other veneers? Thank you, Gabriel from Reno, NV

 

Gabriel,

We hope you are receiving treatment from an expert cosmetic dentist, but your description creates concerns about your dentist’s experience. It is challenging to replace one veneer, manipulate the color, and achieve an exact match. A dentist needs advanced training and artistic ability to replace a veneer seamlessly. We will answer your question about how long veneers last and address the issues with your broken veneer.

How Long Do Porcelain Veneers Last?

Porcelain Veneers infographic from the AACD of which Beverly HIlls cosmetic dentist Dr. LeSage is a FellowPorcelain veneers can last up to 20 years. According to the American Academy of Cosmetic Dentistry, porcelain veneers’ average lifespan is about 12 years. But the long-term success of veneers depends on several factors, including:

  • Quality of the veneers
  • Skill of your dentist and ceramist
  • Your dentist’s tooth preparation and bonding techniques
  • How well you take care of your veneers and your oral health

If you want long-lasting veneers, it is essential to find a dentist with advanced cosmetic dentistry training who uses a lab and ceramist that focus on quality and high aesthetics.

When Porcelain Veneer Color Does Not Match

When porcelain veneer color does not match, the issue is often color metamerism—color changes in different lighting. Expert cosmetic dentists are aware of the issue and will check color shade in natural light near a window or use color-correct fluorescent light to ensure a match.

Although your dentist can brighten your veneer by polishing away more of the tint, if he is not careful to check the shade in different lighting, you still may not have a match.

A Few Thoughts About Your Dentist’s Technique

Your dentist’s technique is to remove some of the tint from the outer veneer until he achieves a color match. But most expert cosmetic dentists work with their ceramist using photographs and color descriptions to achieve a closer match. If additional adjustments are required, the dentist manipulates tints beneath the veneer instead of polishing away tints above it. It seems that your dentist is not familiar with the tinting process or does not stock tints to manipulate them beneath veneers.

When a Porcelain Veneer Is Not Glossy

If a replacement porcelain veneer is not as glossy as the others, a cosmetic dentist uses specific diamond polishing wheels and polishing pastes. Advanced cosmetic dentists extensively use these tools and understand techniques to return the glaze to the porcelain.

Sometimes, porcelain veneers are too shiny. But a skilled cosmetic dentist can correct that, too. For details, read our post: My porcelain veneers are too shiny. Is it too late?

Consider a Second Opinion

We suggest that you find an experienced cosmetic dentist—preferably accredited—to examine your veneer and explain his or her approach to achieving a color match. If you decide to switch to an expert cosmetic dentist, you will get a perfect color match with your replacement veneers.

 

Porcelain veneers before and after photos from Beverly Hills cosmetic dentist Dr. Brian LeSage

A cosmetic dentist’s skill can affect how long porcelain veneers last.
Photos of Dr. Brian LeSage’s patient

Accredited Fellow of cosmetic dentistry, Dr. Brian LeSage of the Beverly Hills Institute for Dental Esthetics, sponsors this post. Dr. LeSage is an international lecturer and trainer of cosmetic dentistry. Check out Dr. LeSage’s smile gallery.

 

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.

 

Is a crown the only solution for a dark, front root-canal tooth?

Last summer, I fell and knocked out my left front tooth. My dentist saw me right away, put the tooth in the socket, and bonded it in place. He also did a root canal on the tooth. In a few months noticed that my tooth was getting dark. When I saw my dentist in December, he said that I might need a crown. After doing some online research, I wonder if a crown on a front tooth is wise. Is there an alternative to doing a crown? I wouldn’t be so fussy about this, but I completed Invisalign treatment in 2017 and got my teeth whitened. And it’s a front tooth that’s affected, so I am more concerned than I would be with a side or back tooth. Thanks for your suggestions. Khalid from Lincoln, NE

 

Khalid,

You were wise to research before agreeing to a dental crown for a front tooth. Although a crown can strengthen a front tooth against chipping, it will make the tooth more susceptible to lateral stress. If you have a heavy bite, it increases the risk of the tooth breaking off.

Minimizing Tooth Discoloration After Root Canal Treatment

After root canal treatment, a tooth may discolor. But before treating the discoloration, a dentist may x-ray the tooth to check for external root resorption, which can occur with tooth trauma.

What is external root resorption?

External root resorption is a condition that occurs when blood vessels and connective tissue from surrounding structures invade and damage your tooth roots. If you are experiencing external root resorption, your dentist must treat the issue before proceeding with cosmetic treatment.

Correcting tooth discoloration

If your tooth roots are sound, a highly skilled cosmetic dentist can minimize the tooth discoloration.

One treatment method includes these steps:

  • Clean out the crown and remove root canal filling materials and cement
  • If the tooth has begun to discolor, treat it with internal bleaching
  • Fit the tooth with a flexible fiberglass post and seal the opening
  • In a few years, if the tooth begins to discolor, use a single porcelain veneer to conceal the discoloration and match the color, translucence, and gloss of your natural teeth.
A single porcelain veneer held by dental forceps

A single porcelain veneer may conceal front-tooth discoloration

Your tooth requires aesthetic training and experience that most general dentists do not have. Schedule a second-opinion appointment with an accredited cosmetic dentist. He or she has proven skill in advanced dental aesthetics and passed rigorous oral and written exams. The cosmetic dentist will eventually need to examine and x-ray your tooth before explaining your treatment options.

Best wishes.

 

Accredited Fellow of cosmetic dentistry, Dr. Brian LeSage of the Beverly Hills Institute for Dental Esthetics, sponsors this post.

 

Painful deep cleanings and deep pockets that won’t go away

Before my hygienist did a deep cleaning two years ago, I had a one-year plan to get porcelain veneers. My plan failed because, since the cleaning, I have deep pockets that do not heal. I’ve switched dentists since then, but I still have pockets in my gums. My teeth are so painful and sensitive that I canceled my last cleaning appointment. I didn’t have any significant problems with my teeth before the deep cleaning. I want porcelain veneers to close a front gap and make my teeth look uniform, but my teeth were healthy. I was advised to ensure my teeth and gums were healthy before I received porcelain veneers. So, the hygienist did a deep cleaning, and now my mouth is ruined. Who can help me? Thank you very much. Kanai

Kanai,

Thanks for your inquiry. You have aggressive gum disease that the team at your dentist’s office is not controlling well.

Is a Deep Dental Cleaning Painful?

When a dental professional completes a deep cleaning correctly, it can be painful. A local anesthetic is used to numb your gums. When gums are inflamed or infected, it requires cleaning your teeth to where teeth and gums attach. After the cleaning, you might have some swelling and minor bleeding.

What’s Causing Your Tooth Sensitivity and Pain?

The tooth sensitivity and pain you describe have a source other than deep cleaning. You probably have an aggressive infection. Sometimes, deep cleaning can provoke an existing infection, and based on your description, you probably have a flareup.

What can a dentist do to help?

  • Antibacterial agents can help.
  • A dentist might prescribe antibiotics while you have deep cleaning appointments.
  • Your dentist can schedule four or more appointments, if needed, within two or three weeks.

When Your Dentist Can’t Control Your Gum Disease

When a dentist can’t control your gum disease, we recommend that you find another dentist. The problems you describe are appropriate for a periodontist (gum specialist) to evaluate. Although your teeth and gums might have been healthy in the past, you now have a severe gum disease that must be treated to prevent tooth loss.

Talk to the periodontist about:

  • Your oral health history
  • Your experiences with your previous dentists and the type of pain you feel
  • Your goal for a smile makeover with porcelain veneers. Although it might take some time to realize that goal, the periodontist will explain when you can expect to reach it.
A single porcelain veneer held by dental forceps

Healthy gums contribute to healthy porcelain veneers

As you get closer to restoring your oral health, look for advanced cosmetic dentists, and schedule two consultations. A highly trained and experienced cosmetic dentist will design a smile with veneers and ensure it is healthy. They will bond your veneers without irritating your teeth or gums. When your periodontal treatment is complete, you will have already found a dentist to complete your smile makeover.

Best wishes for a steady recovery.

This post is sponsored by Dr. Brian LeSage, an accredited Fellow of cosmetic dentistry in Beverly Hills.

Painful deep cleanings and deep pockets that won’t go away

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– Thích Nhất Hạnh

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