X's Q & A

Q&A: Am I better to have bonding or capping done to improve a "gummy" smile?

Like the cuticles on your fingernails, the gums on many people can grow down over the teeth and make them look short, fat, and give the appearance of a gummy smile. Typically, the proper solution for a gummy smile is to first contour the gums, which reveals more tooth structure. This is usually a very quick and easy procedure for the experienced cosmetic dentist and simply places the gum line back where Mother Nature intended. Then, the underlying problems with the teeth can be addressed. Mishapen or twisted teeth are probably best addressed with porcelain veneers. They are thin shells of porcelain that are permanently bonded to the front of the teeth to give gorgeous, natural-looking results. A smile makeover of this type can be performed on many people in as little as 2 visits over a couple of weeks apart.

Q&A: Is it possible to get a crown that matches my veneers in color and finish?

The problem that you are having was caused in part by the type of crown that was placed. The crown you have described is called a porcelain fused to metal (or PFM) crown. Sometimes PFM crowns are fabricated where the metal margin shows at the gum line and this can give an unsightly aesthetic result. They also frequently lack the translucency and coloring of a natural tooth. If at all possible, an all-porcelain crown would be preferable from an aesthetic standpoint. An all-porcelain crown has the same type of material as was used in the veneers (porcelain) and therefore stands a greater liklihood of matching the veneers. Another problem that arisies in your case is that it presents more of a challenge to the cosmetic dentist and lab to match a single tooth color that is placed after the other restorations are already in place. To the extent that the lab, dentist, batch of porcelain, etc. are different, color and texture matching is made more difficult. Finding a good cosmetic dentist may appear difficult. This is partly because cosmetic dentistry is not presently recognized as a specialty branch of dentistry and many general dentists perform some types of cosmetic dental procedures. But, choosing one with the right education and experience that compliment your needs and wants is critical to achieving the most successful outcome. The best way to find an accredited cosmetic dentist is go to, which is the website of the American Academy of Cosmetic Dentistry. The AACD is the leading organization for cosmetic dentistry and it has a rigorous accreditation process whereby dentists must demonstrate their excellance in the art and science of cosmetic dentistry to a panel of judges. Good luck on getting a gorgeous smile!

Q&A: What is the pricing and the pain involved in get porcelain veneers?

Porcelain veneers are the premier standard in cosmeitc dental restorations. They are thin shells of porcelain laminate that are premanently bonded to the front of your teeth. When properly placed by an accredited cosmetic dentist, they can make stunning improvements in many peoples' smile. As for discomfort, the natural teeth only receive minimal preparation or reduction for the veneers. Usually, some reduction is required so that the teeth don't look bulky or unnatural. But, depending on how twisted or out of line the natural teeth are, the reduction may be only 1/2 a milimeter or so. The anesthetic devices that today's experienced cosmetic dentist use -- such as the computer controlled Wand delivery system and the Stabident system that gives virtually instant numbness -- makes this procedure virtually painless for many people. The cost varies by the number of veneers needed. For each individual veneer, the cost may range from $1 - 2,000. Many people say the cost is worth it as not only their smile has been enhanced, but their image, confidence, and love life has changed so dramatically, their only regret is that they wish they'd done it sooner!

Q&A: Are dental implants available for a patient who received oral and maxillofacial surgery 20 years ago?

The answer is generally yes, but you should go to a dentist that has performed a number of implants to see if you are a suitable candidate.

Q&A: Will I need braces and for how long if I have an overbite and gaps between my teeth?

The Internet is great in many respects, but it would be virtually impossible to accurately diagnose your condition and develop a treatment plan without having seen you or appropriate photos of your mouth. Braces may be appropriate, but you would need to be evaluated by an appropriate orthodontist to determine whether you are a suitable candidate, and to discuss the proper type of braces and the estimated length of your treatment. You may want to also consult an accredited cosmetic dentist about the possiblility of porcelain veneers. Sometimes this procedure is called "instant ortho" because it can have the effect on many people of transforming teeth with gaps into a beautifully straight smile in only a couple of weeks. Good luck!

Q&A: Can I have bonding put on my teeth to cover enamel loss and staining even if I will have braces put on?

You have indicated that some of the enamel is lost on your front teeth. The first step is to check with your orthodontist to make sure that the addition of bonding material will not affect his treatment. Generally speaking (and I say this without the benefit of having seen you), I see no reason why you should not be able to have some bonding placed on these teeth for protection and aesthetics. You will probably need to have the bonding replaced, perhaps with porcelain veneers after braces. So you should plan for this as well. Hope this helps.

Q&A: I would like to get some other opinions and pricing. Are the xrays mine to take to other doctors or do I have to pay for additional xrays each time?

As to the x-ray portion of your question, my informal survey of the regulations of many states call for the dentist to provide copies of the x-rays to the patient upon request. In my experience, most dentists will gladly do this regardless whether there is a legal requirement to do so. So, I would suggest that you simply ask your dentist for a copy. As for additional options for getting a great looking smile, I would also consider porcelain veneers. Sometimes the procedure is called "instant ortho" because it has the effect of giving many people with twisted and rotated teeth a beautiful straight smile in only a couple of weeks. Good luck!

Q&A: If I go to get tiny holes in my front,lower teeth filled, will it look like my real teeth and will the fillings last as long as my real teeth?

You should definitely be evaluated by a dentist to see what the holes are and possible causes. There are tooth colored materials now that can be used to restore teeth in a way that is virtually undetectable to someone just seeing you smile. Ask your dentist about these options. Hope this helps.

Q&A: Was my application of veneers abnormal because I had a lot of pain and still have sensitivity to hot & cold?

Sometimes veneers can be placed with little to no tooth reduction. Other times, a lot of tooth reduction is required. This is particularly the case when the natural teeth jut out, are twisted, or are rotated. Cases like this are sometimes called "instant orthodontics" because the end result looks like the teeth have been moved (but the illusion is due to porcelain veneers). In short, the more reduction that is required -- the more risk that it will be a painful experience and there will be root canals involved. That also provides part of the explaination why one person may have a virtually pain-free experience and another person may have a very different one. Some people just have a higher pain threshold than others. There are a variety of pain reduction devices (e.g., computer controlled anesthetic delivery devices) and techniques that are helping to minimize pain. At this point, however, pain is still a risk when teeth structure is reduced. Ususally, the pain subsides fairly quickly and the residual sensitivity to temperature goes away spontaneously. You should keep in touch with your dentist and have him check it out if the pain continues. You'll probably just be left with a beautiful smile and feel like it was well worth it.

Q&A: Should I have my wisdom teeth extracted because my teeth are overlapping after I had braces years ago?

Without the benefit of examining you, I cannot tell you what sequence of treatment you should follow. It may very well be that your wisdom teeth are forcing your other teeth together. Here is something else to think about --A lot of adults that do not want to undergo braces have opted for veneers, which give the appearance of perfectly straight teeth and what some call, "instant orthodontics." This is just one option that you may want to discuss with an accredited cosmetic dentist to see if it is a viable alternative for you. If you have unanswered questions, ask your current dentist or seek a second opinion from a qualified dentist that can examine you.

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