Why can’t my dentist get these porcelain veneers right?

Hi.
Over the very long and trying course of visiting a dentist for the past 3 years, I have now have a complete mouthful of full porcelain restorations. I am not happy with the results. They are puffy, the upper incisal edge cuts into the mucosa of the area below my bottom front lip. I had temps that I loved and was assured that the lab would create almost exact replicas. Instead, I got large, thick and cushiony appearing upper teeth. My cheeks have lines on them from where they suck up into the space formed by what I believe is an overjet. My dentist and his devoted staff tell me they look good yet they have been doing lots of “in office” recontouring of several teeth. Even after all of that, they still appear puffy and now it seems like they are less white than the bottom row that has not been recontoured in office. As well, they seem to have lost any translucency they had from the lab. The dentist says that they lab may have tried to make the finals the same as the temps that were sent to them but that in the design, they may have ended up needing to add more porcelain to ensure strength. I am not buying. He and his staff are extremely polite and spend a bunch of time with me yet I’ve been going for almost 3 years and I definitely don’t have what I requested or what they agreed was possible. A main concern of mine was not having my front teeth “protrude” as I already had naturally large teeth. To ensure that my natural teeth weren’t a problem, I had root canals done all the front 4. What is going wrong?
– Hillary from Florida

Hillary,
It sounds like your dentist and his staff have the best of intentions, but that you have the wrong dentist. Unfortunately, at this point, it looks like you’re just going to have to have the porcelain crowns and porcelain veneers re-done.

It gets at this question, what makes a dentist a true cosmetic dentist? Your dentist may promote himself as a cosmetic dentist, but he doesn’t understand a couple of basic things that any true cosmetic dentist would. For example, his blaming the lab for making them too thick, with the idea that the lab felt they needed to be stronger. A true cosmetic dentist would have the confidence to know as much about the subject as a laboratory technician, would have checked that issue before ever bonding the veneers and crowns on your teeth, and would have known that a porcelain veneer gets its strength from being bonded to the underlying tooth structure, so it doesn’t matter how thin it is. He would also have known that grinding down the front surface of the porcelain on both the crowns and veneers would remove the glaze and make the porcelain rougher, make it lose its luster, and make it susceptible to staining.

This situation, where someone has teeth that protrude too far and need to be brought back, is advanced cosmetic dentistry, and should have been approached with great caution. It sounds like your dentist got part way there because you had temporaries made and you were happy with them. But he lacked the skills and the confidence to translate that into the final product.

There is an interesting website that has extra information about the expertise required to do beautiful porcelain veneers. Check the porcelain veneers page of Dr. Arthur Chal in Phoenix. And if you look further into his site, you’ll see information about his credentials. You’ll see similar results in the smile gallery here on Dr. Newkirk’s site and evidence of his extra training and credentials. This sort of thing simply isn’t taught in dental school, and you need a dentist with advanced training in aesthetics.

What I would do at this point is consult the a website where they link to a directory of expert cosmetic dentists. In Phoenix, they recommend Dr. Chal. In Naperville, they recommend Dr. Newkirk. They have a number of dentists they recommend all over Florida, and you can probably find one close to you.

This website is sponsored by Naperville dentist Dr. David Newkirk.