Cosmetic Dental Makeovers

A Cosmetic Dental Makeover can enhance one's smile, create self confidence and improve self esteem; however, choosing the wrong dentist can be disasterous. Finding a knowledgeable and skillfull dentist is important to achieve a great smile.

May 24, 2004 -- Cosmetic Dentist Dr. MitchellA. Pohl in conjunction with DaVinci Dental Lab (from ABC's Extreme Makeover) has created many glamorous smiles. In discussing a smile makeover with Dr. Pohl, we find that some can be simple and others can be quite complex. However, the most difficult cases that he has encountered were re-making bad porcelain veneers. The popularity of dental makeovers as a result of ABC's Extreme Makeover has created a market for porcelain veneer makeovers and consequently, a rush of dentists with different experience levels looking to fill that need. Unfortunately, the lack of experience and poor lab work can leave a patient with an undesirable result.

Some of the more common problems that Dr. Pohl has seen have been:
-Poor bonding of the veneer to the tooth, resulting in delamination and decay.
-Excessive removal of tooth structure.
-Monochromatic porcelain with no vitality.
-Porcelain veneers which are poorly shaped and tilted.

What should patients do when looking for a qualified cosmetic dentist. Well, Dr. Pohl says the most important factor is experience. How many cases has the dentist restored and does he have the photos to back that up. While there are several excellent training courses for dentists to attend, nothing replaces experience!

Below is a web page with actual case histories of bad porcelain veneer experiences.

http://www.bocaratoncosmeticdentist.com/failing_porcelainveneers.html

Failing Porcelain Veneers

Why and How Dental Veneers can fail
The following questions have been posed by actual patients who came to Dr. Pohl for retreatment.

1. How long will veneers last?
Porcelain veneers were first being used as a cosmetic restoration in the 1980's. Several factors can affect the longevity of veneers, such as: the effectiveness of the bond to the tooth, the patient's bite, and inappropriate use of one's teeth. Under ideal circumstances veneers can last a long time. I personally have patients who still have veneers in good condition since 1989. With the advances made in dental adhesives, very tenacious bonding of porcelain to tooth structure has been achieved. Realistically speaking on average,(taking into account all levels of technical ability) it is not unreasonable for one to expect to replace some or all veneers after ten year period. Done properly, I personally feel they can last much longer.

2 .My veneers feel and look too thick. Is that normal?
Porcelain veneers do not need to nor should they feel thick if made properly. Either the dentist did not reduce the tooth enough to allow room for porcelain or the dental lab made them too thick. Usually it is because there was poor planning and the tooth was not reduced enough. Working with a good lab and doing a diagnostic wax-up of the proposed veneers will help to achieve a more ideal outcome.

See examples of our porcelain veneers used in Extreme Makeovers

3. I had veneers done recently by a dentist and they look awful. How difficult is it to have them re-done?
Some of the more challenging cases which I have had were fixing someone else's mistakes. Unfortunately, there are dentists who do not have the skill level to treat simple or moderate to advanced veneer cases and consequently end up with less than acceptable results.

To answer your question, yes. Old veneers can removed, but is very tedious if they were bonded correctly. The question is how well were the teeth prepared prior having the veneers bonded? I have seen cases where an excessive amount of tooth structure was removed and ultimately can compromise the longevity of the teeth and veneers. Make sure the dentist that you are using can show you ample photos of cases he has done.

4. I have veneers that have fallen off, is that normal?
No. If teeth are properly prepared and the veneers have been correctly bonded, they should not fall of as long as there are no problems related to your bite.

Oftentimes it is usually a failure of improper bonding. Bonding porcelain to teeth is a technically sensitive procedure.

If the surfaces are not properly treated and free of contaminants such as oil, water or saliva, there will be a bond failure.

In the adjacent photos the patient had composite bonding to close a midline space and then had two porcelain veneers placed over the front teeth. Poor tooth preparation and planning led to this failure.

All six anterior teeth needed to be involved in order to proportionately distribute the space. Porcelain needed to fill the midline spacing rather than a combination of composite and porcelain.

A total of six porcelain veneers were placed to produce the results the patient was seeking.

5. I have discoloration at the margins of my veneers where they meet the tooth and I can see my old tooth color between my teeth. Is there anything I can do?
It sounds like the veneers were not bonded correctly. Either you have resin cement that has discolored or there is a gap and stains are getting into the margin. The fact that you can see the color of your original tooth probably means that the tooth was not reduced properly so that the porcelain would cover that part of the tooth.

More case studies - Failed Dental Veneers
The photos below provide examples how some veneer work may "appear" satisfactory, initially. Read Dr. Pohl's narratives to learn more about how to assess porcelain veneer dentistry procedures.

Testimonial
This patient had her upper anterior veneers replaced by her family dentist. When she questioned him about his experience, she was told that he did thousands. When she asked to see pictures, he replied that he was too busy to take photos (red flag). She proceeded and was heart broken with the results.

The left (before) photo reflects the problems that were evident.
- midline is slanted and poorly positioned
- teeth are tilted
- poor bonding of right canine causing significant undermining decay
- excess bonding resin was not removed causing gum inflammation
- porcelain is monochromatic and poorly finished (no luster)
- improper length, overjet, and bite

The right (after) photo reflects the patient's new "natural" smile. Using a diagnostic wax-up we were able to improve the esthetics and bite relationship. When she saw her new teeth she burst into tears because she felt "they were more beautiful than she expected."