Veneers, Veneers, Veneers

Question:

I am in a good time of my life. Family raised and now I have time for myself. One of the things I have put off over my adult life is my teeth. They are still all mine, but they have never looked nice. I have been speaking with friends about my front teeth and have come away with mixed messages. One of my friends said, “You have to get veneers, they are the best.” Hers look great so I said, yes, that’s what I want. “Why did you have them done,” I asked? “My teeth were getting a bit dingy, I thought. They were straight, but I wanted a pop and that’s what I got. Do it,” she said, “you’ll love them.” “My teeth are a bit crowded and overlapped,” I said. “Will veneers still work?” “Oh sure,” she said, “get it done, girl!”

By chance I ran into another friend who also had veneers, but her experience wasn’t the same. When I asked her why she’d had veneers done, she said she was told they would straighten her teeth and look amazing. She said at first she loved them but after two weeks, she said they began to chip off at the edge. She said she was startled and went back to know what the problem was. The dentist said he didn’t know why. I asked what had to be done. He said he’d have to grind them off (the ones that broke) and make some new ones. “Won’t they just break again,” she asked? “They shouldn’t but I don’t know why they broke in the first place.” She said she consulted another dentist, and he said, “It’s your bite. You are a grinder.” “I know that,” she said. “Well, there’s a different standard of care for grinders,” he said. “Do all dentists know this,” she asked? “Apparently not,” the dentist said. She’s paralyzed now – she’s spent a lot of money and doesn’t know what to do. Everybody is talking about veneers but what of me, what do I do?

Answer: Porcelain veneers were introduced to the profession over forty years ago. As with all new technologies, there is the good, bad, and ugly. People with good bites and little parafunction (grinding and clenching) do well. Those with bad bite and parafunction often fall into the bad and ugly outcomes. Dentists trained in making poor bites good, know when veneers would work and when they are a risk.

Stronger white materials (stronger than porcelain) are now being used to better success but still there are problems with breakage when they are put in mouths that are subject to heavy grinding and clenching.

In your case, find an office that will take study models (moulds) of your teeth for analysis before beginning any work. Ask for reasons that support functional and parafunctional success of your treatment. Good analysis and planning will give your teeth beautiful and long-lasting results.

There is a saying in business that the customer is always right. Veneers are not for everyone so go with an open mind. Find out what is best for your mouth. A well-planned approach will give you both confidence and direction on how your teeth will best be treated so they will treat you in the same fashion for years.

Everyone Knows This

Question:

I’m the oldest of a family of four. All of us kids have health issues, so we watch out for one another. We’re close, but I’ve been out of the country, so when my sister said she was having all her teeth out, I said, “What!?” She said, “I’ve had bad teeth all my life and now I’ve got so much decay and abscessing, I have to get my teeth out.” I was aghast not knowing this about my sister. So, I said, “I’ll go with you. I want to be sure you’re doing the right thing.” “Well, what can you do,” she said. “I don’t know but I want to know more about this. I’ve got a friend who’s a dentist. I want to talk to him.” “Ok,” she said.

So, I talked to my dentist friend. He asked, “Is your sister having her sockets grafted after the teeth are removed?” “I don’t know,” I said. “Make sure that happens,” my dentist friend said, “because everyone knows that in the first year after a tooth is pulled, 50% of the bone dissolves so there may not be enough bone later on to put in implants.” So, I go with my sister and talk to the surgeon who’s removing my sister’s teeth. “Are you grafting the sockets,” I ask? “No,” says he, “but she’ll be fine.” “Really,” I say. “Yes.” “Ok, you’re the doctor.”

Four weeks later and my sister has no front teeth. I take her to my dentist friend. He takes 3D scans and shows me what’s left and tells me that after a year, she’ll have 50% of the bone volume she shows now. Why did the surgeon do that? How can everyone in the dental profession know the bone goes away and he cavalierly rips teeth out without grafting?

Answer:

Your question is a good one but many elements factor in. First is expense; grafting adds additional costs. Sometimes it’s not offered because it may delay needed treatment due to costs. Second, the procedure is technique sensitive and can be time consuming. Third, many surgeons like the gum to grow over the socket site before placing an implant. This technique works but timing is important. The patient needs to know that implant placement needs to occur (where grafting has not been placed) in eight to twelve weeks after extraction. Fourth, predictable grafting is about 30 years old. In other words, the right materials (bone, etc.), the right technique has been predictable for 30 years. I’ve seen it work in my hands since 1998. Having said that, it takes time for good things to take root (pun intended). In my view, if you remove teeth, your training and your delivery of those services should include bone grafting.

There are other reasons, of course, but a doctor must see the long view for the patient. If a patient says nothing is going in there (implant) for five years, that’s fine, but use the graft that will be there in five or ten years. Circumstances change. Attitudes change. Patients should be treated so that rehabilitation is always possible.

For you, your sister may be in that eight – twelve-week window where implant rehabilitation is possible. That will be your answer to help her out.