Smile Makeover Archives - Dr. Duane Delaune's Blog

Why Did I Need Root Canal Treatments After Porcelain Veneers

Posted on June 4, 2021 by writeradmin.

I had ten veneers placed on my upper teeth and the same number placed on my bottom. During the diagnostic stage, I was told everything was fine and there were no real risks involved. Since the procedure, I’ve had a lot of pain. My dentist made a few height adjustments, but that did not seem to help. Then, two of the teeth developed an abscess and, when he did the x-rays, it showed my nerves have died, even though they were fine before. Now I have had to have root canal treatments. I’m still in pain and worried more of my nerves will die. My dentist said he’s never had this happen with veneer crowns. What is going on?

Jayla

Dear Jayla,

The first thing I am wondering about is whether you actually received dental crowns instead of porcelain veneers. There are a couple of things that make me things this. First, you called them veneer crowns. That is not a thing. Either you have porcelain veneers or you have dental crowns. There is not a combination. A second inconsistency here is the height adjustments that were made. That is something done with dental crowns. Finally, it is the damage to the nerves.

The Difference in Preparation between Crowns and Veneers

Tooth preparation for porcelain veneers

When a tooth is prepared for porcelain veneers, there is hardly any of the tooth structure removed. Here is an example in the image above. Notice only the surface is affected. Now contrast this with the image below.

Preparation for a Dental Crown

Notice with this tooth, much of the tooth structure had to be removed. It is a much more aggressive preparation and your nerves are at a greater risk as a result. I think this is the treatment you received.

One way to tell is by how far around the tooth your restoration is. With porcelain veneers, it just covers the very front of your teeth and will hug the sides slightly. But, with porcelain crowns, the restoration goes around your entire tooth, including the back.

If your dentist told you that you were getting porcelain veneers, but then gave you porcelain crowns, that is unethical. Plus, if the only reason for the restorations was a smile makeover, porcelain veneers are what you would do— not dental crowns. To be honest, I would tell your dentist he needs to cover the cost of the root canal treatments. I’m sorry this happened to you.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.
Click here to learn about our free virtual smile makeover consult.

Dental Bonding Doesn’t Match and Falls Off

Posted on June 1, 2021 by writeradmin.

I have tetracycline stains and my dentist said dental bonding would take care of it. It has not worked out at all like I wanted. First, the color doesn’t match and it is pretty obvious. Plus, you can still see some of the tetracycline stains through it. As if that weren’t bad enough, the bonding fell off after just three days. I went back for him to repair it. At the time, I told him about the color problem so he made them thicker, which looks weird in its own way. Now they have fallen off again just a few days later. I called him back and he said they’re not meant to be permanent so I should not have high expectations. However, I was told they’d last up to five years, this is like just a few days. What should I do?

Calorie

Dear Calorie,

As you can see from the image above dental bonding can blend in quite naturally with your teeth. I think the biggest problem you are facing is the skill and technical knowledge of your dentist. Both dental bonding and tetracycline stains are some of the most advanced procedures in cosmetic dentistry. You should be aware that cosmetic dentistry is not a recognized specialty. Any general dentist can call themselves a cosmetic dentist regardless of the amount of training they have invested (or not invested) in.

I think your dentist is in way over his head. Dental bonding should not fall off, especially after just a few days. As for the color, if he is an inexperienced cosmetic dentist, he probably doesn’t even have the colors and other materials necessary to make things blend well. An additional problem in dealing with tetracycline stains is making the teeth opaque enough to cover the stains, while translucent enough to look natural. That is not an easy accomplishment, even for a skilled cosmetic dentist.

Honestly, the better treatment for you would be porcelain veneers and not bonding. It is more permanent, decades rather than years. Plus, it is more stain-resistant. I don’t think your dentist is the one to do it. Here is my advice. Do not let him “fix” this. instead, ask for a refund. Then, we’re going to get you to a highly skilled cosmetic dentist.

Finding an Expert Cosmetic Dentist

Because there is not a recognized specialty in cosmetic dentistry it is hard for patients to know who has the skills and who doesn’t. There is a website that strives to help patients in your position. A retired cosmetic dentist runs the mynewsmile.com website. He prescreens all dentists that want to be listed on his site. They cannot purchase their way on. Instead, they have to show their training credentials, in addition to proving their artistry and skill on cases they’ve completed. Any dentist he lists can provide you with a stunning smile.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.
Click here to learn about our free virtual smile makeover consult.

Smile Makeover Disaster

Posted on May 15, 2021 by writeradmin.

I need some serious advice. I went to my dentist with the intent of having my cleaning done and then getting a recommendation for an orthodontist. My four upper front teeth are crooked. He said he could make them straight with cosmetic dentistry and I would not have to worry about the inconvenience of braces. That sounded great to me so I agreed. He told me that two porcelain veneers and dental bonding would make my smile look completely straight. I was excited about the possibility of having a beautiful smile. When the makeover was “completed”, it wasn’t anything like he promised. The teeth are still uneven, the porcelain veneer is too small and you can see a gap between the veneer and my gums. He also charged me for reshaping my lower teeth which was never even discussed. I was quite upset and told him this wasn’t the outcome I expected. Then, he proceeded to tell me the only way to get the outcome I want is with four dental crowns. Of course, that will be an additional fee. Is this allowed? Can he get away with it?

Fanny

Dear Fanny,

No. Your dentist cannot get away with this. I would go back to him and ask for a refund. If he says no, remind him that he was the one who told you what this outcome would be and he didn’t deliver on his promise. On top of that, the porcelain veneer he provided for you has an open margin (what dentists call that gap you described). Open margins put your teeth at risk because it allows food and other bacteria to get caught between your teeth and the veneers, leading to decay. A second issue that can get him in big trouble is reshaping your bottom teeth without your permission. It sounds like this dentist was using you for practice. Let him know you will be taking this issue to the dental board and I think he will provide your refund.

Once you have secured your refund, you will want to get the smile makeover you wanted. Believe it or not, it is probably still possible to do with porcelain veneers. You just need a skilled cosmetic dentist to do the work. I would look for a dentist who is recommended on the mynewsmile.com website. Dentists cannot pay to be listed on this site. Instead, they are screened for both their technical skill as well as their artistry. Any dentist recommended on there will give you a stunning smile.

I will say, if you are planning on just getting four porcelain veneers (and it is okay if you are) then I suggest you have teeth whitening done first. Most patients smiles are six to ten teeth wide. Getting your teeth whitened allows you to have your non-veneered teeth blend in better than if you left them their current tone.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.

Gums Inflamed After Porcelain Veneers

Posted on March 18, 2021 by writeradmin.

I had two porcelain veneers placed on my front teeth. Since they were placed my gums have been painful and inflamed. The hygienist said she’d never seen that happen and wondered if I was brushing correctly. I’ve been brushing my teeth for several decades now, so…yeah, I’m pretty sure I’m brushing correctly. Actually, her response sort of ticked me off. Then, a month later I went in for a follow-up visit with the dentist and he removed some cement from the back of my teeth and smoothed down some rough edges. While that did help some, I am still in pain. They don’t seem to care, so I’m wondering what my next steps are.

Madeline

Dear Madeline,

I am sorry that this happened to you. It is infuriating when professionals blame others simply because they don’t understand their field well enough. My experience has shown that when people get a smile makeover, they usually care for their teeth even better than before, so no, I don’t think the problem is the way you were brushing.

This is especially true because of what you described in your follow-up visit. Not cleaning up all the excess cement is an issue we often see with dentists who do not place porcelain veneers very often. Those that do regular, advanced cosmetic work have a routine down to ensure this does not happen.

First, they will tack the veneer on the tooth by curing the cement in the center only.
Then, while the remainder of the cement is still soft, they will be certain to remove all the excess, knowing it is much easier to do while soft.

This did not happen in your case. While your dentist did remove some at your follow-up visit, it would not surprise me in the least if there were still excess cement lodged somewhere.

There is also a second possibility for what could be causing your inflammation and pain. If there is some unevenness where the porcelain veneer meets with your tooth (what dentists call the margins) this could lead to problems. Or your dentist could have placed the veneer too far under the gumline. If he did that and encroached on the gingival attachment, that would also cause the problems you mentioned.

Obviously, your current dentist is either disinterested or does not have the skill to recognize what he did wrong. You next steps, in either case, would be to see an expert cosmetic dentist and have them examine your porcelain veneers in order to let you know what went wrong, then you can formulate a plan based on the diagnosis.

I would use one of the cosmetic dentists listed on the mynewsmile.com website. They are pre-screened for their technical knowledge and skill, as well as their artistry. They will have the knowledge to let you know what went wrong.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

Lumineers over Crowns

Posted on March 5, 2021 by writeradmin.

I have old dental crowns that look horrible. I’d like to get veneers and am told that the Lumineers brand can go over dental crowns. Would I be a candidate for this? How do I go about finding a dentist to do it?

Everett

Dear Everett,

Above you will see an advertisement Lumineers placed years ago marketing this very concept. While I am certain you will be able to find a dentist to do this for you, what I’d like you to do is go over the information I’m about to provide and ask yourself if that’s what you want. First, let’s talk a little bit about Lumineers. They are simply one brand of porcelain veneers. This particular brand happens to be highly marketed to inexperienced cosmetic dentists. As a result, those are usually the type of dentists you will find that place them.

Dentists with expertise in cosmetic dentistry almost always prefer other brands. This has more to do with the fact that the company that owns Lumineers, DenMat, requires dentists to use their lab, which is not known for its artistic results. When it comes to getting a beautiful smile, you are better served by finding an expert cosmetic dentist and letting them choose the best brand to give you the results you want.

Should You Put Veneers Over Crowns?

Problem One:

Placing veneers over crowns is going to be bulky looking. If you consider that many patients find Lumineers themselves too bulky, you may find yourself feeling like you have horse teeth.

Problem Two:

There will be bonding issues. It is much more secure when you bond porcelain to natural tooth structure than it is when you bond porcelain to porcelain. This means you are at a greater risk of bonding failure. Additionally, your crowns are getting old. What if the bonding for those fails? Now you have double the risk of bonding failure– One from your old crowns and another from the porcelain veneers being bonded onto the crowns.

The Solution to Old Ugly Dental Crowns

The best thing for you to do is simply replace the crowns you have. An artistic cosmetic dentist can give you a gorgeous smile with dental crowns just as easily as with porcelain veneers. I would look on the mynewsmile.com website and get one of their recommended cosmetic dentists to do this procedure for you. Most of them even have a beautiful smile guarantee.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

Too Much Shine on My Porcelain Veneers

Posted on February 20, 2021 by writeradmin.

I had a smile makeover done. I know the porcelain veneers should have some shine. However, these have so much shine on them that it is obvious they are fake. It’s almost like a shiny white piece of gum. Is there a way to take off some of the shine so they can look more natural? I paid a small fortune for these and I’d like to have something I can feel good about.

Laney

Dear Laney,

You’ve brought up an interesting point about cosmetic dentistry. I wish I had an image of your smile makeover results to give me a better idea of what you’re dealing with. Based on what you described, it sounds like your glazing was done in a flat, uniform type of design. If you look at the teeth in this photograph with work done by Dr. Delaune, you can see that teeth aren’t flat. They are textured. Also, the color is not uniform. Instead, they have varying degrees of opacity throughout the tooth. By the way, only one of the teeth above is “fake”.

The glazing on the tooth is what is responsible for the shine you are experiencing, especially if your dentist did not texture it. However, I am not sure you will want to remove that glazing. It is also what protects your porcelain veneers and makes them stain-resistant. Occasionally, we run into a new patient who had their cosmetic work done at another office. Because that particular office didn’t properly go over cleaning procedures for cosmetic work with their hygienist, she used a power prophy jet during cleaning, which takes the glaze completely off. Within a few days, that patient’s veneers began to pick up stains.

Hopefully, you have a dentist who cares about the patient’s satisfaction with their work. A true cosmetic dentist would never bond your veneers on until you had a chance to look at them with a temporary try-in paste and give your approval. If you weren’t thrilled with the results, they would go back to the lab. It doesn’t sound like you were given that option. That is likely the result of your dentist not having much experience with this yet and therefore doesn’t carry (or may not even know about) these try-in pastes. This is just one of the problems with cosmetic dentistry not being a recognized specialty.

My suggestion is you simply go back to your dentist and explain how you feel about your veneers. You paid for a beautiful smile and should get one. Some cosmetic dentists even have a beautiful smile guarantee. If he or she is not sure how to do it any differently, you can let them see this post.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune

My Lumineers Do Not Look Right

Posted on January 4, 2021 by writeradmin.

I had porcelain veneers done almost 20 years ago. I loved them but it was time to get them replaced as they had started to show their age. My old dentist had retired and I used his replacement. I wish I had not now. It has been a completely different experience. First, even though I told him I wanted them to match my last porcelain veneers exactly, he made some changes. He used a different brand of porcelain veneers he called Lumineers because he said they were thinner and he was placing these over my old veneers. That sounded okay to me. But, then he also put a strain on the Lumineers, which he did not mention ahead of time. When they came in I told him I wanted whiter and he said to give it a couple of days and see what I think then. He felt they looked more “natural” this way. I did and still didn’t like them. He told me to come in and he would “fix” it, if that is what you would call it. His fix was to sand off the front which had the staining. Now I am left with this dull underneath. What do I do?

Lorainne

Dear Lorainne,

There are a couple of problems going on here. First, the fact that he put Lumineers over old porcelain veneers is a problem. Porcelain sticks much better to natural tooth structure than to other porcelain. Now not only will you have to worry about the bonding of your new veneers failing, but your old veneers are eventually going to wear down as well and he attached the new ones to them. It is just as much work to place new over old as it is to just do them over. It doesn’t make sense that he did it the other way.

I’m not surprised he placed a stain on them to “make them look natural,” nor that he told you to give it a few days and you would get used to it. What he really meant by that is he didn’t want to do this over and he was counting on you to give up. Most patients don’t have your courage to stand up for themselves. A true cosmetic dentist would not bond on your porcelain veneers until trying them on with a temporary try-in paste and then letting you see and approve them. If you weren’t happy with the color he would never ask you to give it some time, but rather would send them straight back to the lab to be re-done.

He never did this. He may not even have the experience to know about a temporary try-in paste. When he suggested Lumineers, I knew you probably were not getting a highly skilled cosmetic dentist. Cosmetic dentistry isn’t a recognized specialty. Any dentist can try the procedures regardless of their skill level. This particular brand of porcelain veneers is marketed to inexperienced cosmetic dentists as being easy to place.

Under normal circumstances, you would have no recourse. The standard of care in dentistry is functional. They don’t have to be beautiful, even for cosmetic work. However, once he ground down your Lumineers, they were no longer functional. He removed the glazing on them which is what protects them. Because of that, you have the right to ask for a refund.

Once that is secured, you can use that money and go to a true cosmetic dentist to have these re-done. Look for a dentist listed on the mynewsmile.com website. Each of those dentists are pre-screened for both their technical knowledge and artistry. They can not pay to be listed. Instead, they have to be skilled cosmetic dentists.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune. Click here to learn more about our cosmetic consultations.

Porcelain Veneer Fell Off Twice

Posted on September 26, 2020 by writeradmin.

I had six porcelain veneers placed by Dr. [name redacted]. After four days, the left incisor fell off. I was only eating bread. The tooth was super sensitive from the moment the veneer fell off so I got an appointment at his office as soon as possible. He said it fell off because my bite was off so he shortened the veneer and the tooth beneath it. Less than a week later it fell off again, this time when I ate a banana. I was none too pleased, and again he said the bite was off so he wants to do a porcelain crown instead. I’m having serious doubts about this. Do you have an alternate recommendation?

Patrice

Dear Patrice,

My first suggestion is not to allow this dentist anywhere near your teeth. He is in over his head and doesn’t have the integrity to admit it. First, he says your porcelain veneer fell off because your bite was off. As the dentist, it was his responsibility to notice things like that before he bonds them on and make sure the veneers are crafted in a way the helps that.

However, I don’t buy that excuse. When a porcelain veneer is properly bonded on, the result will be a chipped porcelain veneer if there is a problem with the bite. It wouldn’t just fall off.

Doing smile makeovers isn’t taught in dental school. Compound that problem with cosmetic dentistry not being a recognized specialty and it puts patients in a real quandary. Any dentist can call themselves a cosmetic dentist regardless of the training they received. To do it well requires significant post-doctoral training. I don’t think your dentist has that training.

Now the second bonding falling off he’s also blaming on your bite being off. But, didn’t he already adjust that? Now he wants to destroy healthy tooth structure to place a dental crown? I don’t think so. That is a massive overtreatment.

I’m going to recommend you look on the mynewsmile.com website. The dentists listed there are prescreened for their technical training, skill, as well as the artistry of their work. Any one of them can properly bond on the veneer that keeps falling off.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

Finding a Cosmetic Dentist on Yelp!?

Posted on May 4, 2020 by writeradmin.

I have chipped a few of my teeth due to teeth grinding. I’m going to get a smile makeover and am thinking of dental bonding because they’re likely less expensive than porcelain veneers. I am aware they take an expert cosmetic dentist. I’ve been going through Yelp! and found two in my area with very high ratings. Is there something else I should be looking for to help me choose between the two?

Jennifer

Dear Jennifer,

It is great that you are trying to do research for you cosmetic dentist but I don’t think Yelp! is the way to go for this particular thing. It is a great resource for finding a decent dentist, but based on the research I’ve done, it doesn’t appear their algorithm judges based on the types of procedures. So they may have a lot of high ratings, but it has nothing to do with their ability to do beautiful cosmetic work. Those high rankings could be simply because they are a friendly office.

Before we go into a better way to find a great cosmetic dentist, though, I want to go over your procedure. You said you wanted a smile makeover which I’m assuming you mean to cover the tooth the way porcelain veneers would. Dental Bonding is much better for small amounts of work, like fixing a chipped tooth (as the images above show).

If you’re looking to cover the tooth the way porcelain veneers do, you will find that it will end up costing you more. Dental bonding is done freehand, which would take forever over larger surfaces. In fact, very few dentists will even do it. So depending on what you’re going for, you may want porcelain veneers.

Whichever procedure you choose, you will need to get a nightguard. This will protect your new dental work from the grinding you do at night. Without that, it will damage your veneers or bonding just like it did your natural teeth.

Choosing Your Cosmetic Dentist

There isn’t a recognized specialty in cosmetic dentistry. That makes it hard for patients to know who is good and who isn’t. One way to help with this is to go to the mynewsmile.com website. This is run by an expert cosmetic dentist who is retired from practice. He screens dentists who want to be listed for their training, technical skill, and artistry. A dentist can’t just pay to get listed on his site.

Any dentist recommended there can give you a gorgeous smile and are among the top cosmetic dentists in the country.

This blog is brought to you by New Orleans Cosmetic Dentist Dr. Duane Delaune.

why won’t my dentist do all-on-4 dental implants?

Posted on November 10, 2019 by writeradmin.

I want to get dental implants but have lost some bone. My dentist says I need to have bone grafting done before I get the implants. I read that you can do all-on-4 without bone grafting. When I asked him about it he said that isn’t a good fit for me. Why not? Because the other way means an extra procedure and extra money for him? Should I go to another dentist who will do it?

Adam

Dear Adam,

illustration of the position for all-on-4 dental implants — All-on-Four Dental Implants

I wouldn’t necessarily assume that your dentist is opposed to the all-on-4 dental implants because he wants to make more money. There can be a few reasons.

First, all-on-four dental implants procedure requires additional training as it is done differently than traditional dental implants or implant overdentures. It may be that your dentist simply doesn’t do that procedure. Not all implant dentists do.

A second possibility he is saying no could simply be that you’re not a good candidate. While it was developed to help patients with less bone still get dental implants, it really will depend on how much bone you’ve lost. Maybe your dentist said it won’t work for you because you’ve lost too much bone for this to be a viable procedure.

The first thing I would do is simply as him why he says it won’t work for you. If you are not satisfied with the answer, then getting a second opinion would be a good idea.

Options to All-on-4 Dental Implants

Before making any decision, you should know all the facts. While there have been improvements doing all-on-4, you should be aware if one part of the procedure fails or is damaged, you’ll have to replace the whole unit.

If you are not a candidate or decide you want to go with something else, then implant overdentures will be a great option. Though, as your dentist mentioned, it will require some bone grafting. The good news is this is an outpatient procedure

Getting a Smile You’re Proud to Share

This is your chance to not just get functional teeth, but an attractive smile. The way to do that is to be certain the dentist who does your procedure is not just a trained implant dentist, but is also a skilled cosmetic dentist.

To find one, I suggest you look on the mynewsmile.com. They screen dentists who wish to be listed for both their technical training as well as their artistry. Any dentist they list will be able to create a stunning smile for you.

This blog is brought to you by New Orleans Dentist Dr. Duane Delaune.