Archive for October, 2009

Black Rims around Porcelain Crowns and Porcelain Veneers

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Wednesday, October 28th, 2009

Question:

Dr. Sam, I am considering crowns and porcelain veneers. However, my friend had some done and now has black rims at the bottom of her teeth. This looks awful. Is this normal?  – From Linda, Santa Monica

Answer:

It is very unfortunate when there are black rims around porcelain crowns and porcelain veneers.  This should NOT happen! 

The black stain around the rim of the crown or porcelain veneers is contamination.  The bonding technique was a failure as there was something that was not completed thoroughly.  

In all fairness to the dentist, it is very difficult to bond porcelain crowns and porcelain veneers at the gum line.  Any tiny speck of blood or spit or fluid from the gums will cause the margin of the restoration to turn black. 

 How to Remove Black at the Gum Line

The only way to remove the black rim at the gum line is to replace the restorations.  It is unfortunate to have to start over, but it is the only way to remove the black rim.  The restorations must be removed, the teeth must be properly cleaned and the dentist has to meticulously bond each restoration perfectly.  The dentist needs to be using magnification.

Magnification to Remove the Black Line at the Gums

Magnification dentistry allows the dentist to see better than the naked eye.  I have been wearing powerful custom made telescopic eye-wear to visualize the most minuet details. 

The tiny bits of moisture or contamination at the gum line that are on the tooth cannot be seen with the naked eye, so black lines at the gums are the result of inadequate technique by the dentist.  It takes a special dentist to be able to use magnification properly and to be able to afford the very highest quality lenses and camera systems. 

The telescopic magnifying eye wear magnifies about 4 times but the tiny cameras that go inside the patient’s mouth magnify 25 times!  It is an instant improvement in quality if the dentist can successfully utilize the high tech magnification systems. 

Failure Rate and Magnification

Black lines at the gums as well as porcelain veneers and crowns that come off are a result of micro leakage.  The bond is supposed to stop leakage but must be perfect or leakage will occur at any area where the bond is inadequate. 

It has been estimated that 35% of American dentists will not be able to consistently bond dental restorations and American dentists are considered the absolute best in the entire world. 

Magnification dentistry reduces the failure rate but nobody is perfect.  The best multimillion-dollar baseball players only are successful at best, once out of three times at bat!  The best football quarterbacks make huge mistakes and throw interceptions or fumble the ball that loose championship games.  Dentists that use magnification will have a higher success rate then the best baseball players in history.

Considering Crowns and Porcelain Veneers

The most important choice is not if you choose crowns or porcelain veneers but the dentist that you choose. 

The dentist is by far the most important part.  They only way to choose a dentist is to look a photos of their patients that are enlarged.  You need to see at least 10 “before and after photos” of their patients, including full face photos that match.  Dentists that have the “before” photo taken with a cheap camera and the “after” photo taken by a professional photographer are NOT presenting their work in a valid manner. 

Dentists that have photos of the face in one position and have the “after” photo in a completely different position are not allowing you to honestly evaluate their work.  Avoid these dentists.  To see the best “before and after cosmetic dentistry photo gallery” ever presented by a dentist of his own work on his own patients, visit the galleries on our various websites.

Categories : Blog, Dental Crowns, Porcelain Veneers
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Lumineers vs. Custom Porcelain Veneers: Just Marketing?

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Tuesday, October 20th, 2009

Question:

Is there really a difference between Lumineers and your acclaimed custom porcelain veneers – or is it just marketing?

Answer

It is NOT just Marketing!

We keep getting patients that just had porcelain veneers done by a “coupon dentist” and got a cheap price that are extremely unhappy. They feel violated, they can’t smile, and they look unnatural and fake. These patients are angry and would rather go back to their natural teeth than keep the new veneers placed on their teeth.

See the Samantha Lumineers video at www.hightechdentist.com for a live testimonial about her experience with lumineers.

After practicing dentistry for over 30 years and having 25 years of porcelain veneer experience, I have developed a keen understanding of the level of care necessary to please our patients. The biggest problem with most types of lab processed “custom” porcelain veneers is that so many of them look fake. Patients that are considering porcelain veneers are postponing treatment because they did not like the work recently completed on their friend by some other dentist. I found that porcelain veneers made in a dental lab are just not good enough anymore for most patients. I had to go to another level.

Custom Porcelain Veneers

Everyone claims that his or her porcelain veneers are custom made. Lumineers, Da Vinci Lab and all of the other labs claim their porcelain veneers are custom made and technically they are custom. But, there is a big difference in the porcelain veneers I produce and that is, patient satisfaction.

Fake Looking Porcelain Veneers

Bad porcelain veneers are fake looking. They are square, bulky, and thick and lack natural coloration. Cheaper porcelain veneers fade over time and stain easily. Years ago, just about any cosmetic improvement with porcelain veneers was considered good cosmetic dentistry. However, today, patients are more demanding and far more sophisticated about their dentistry. Patients want a natural look created to their specifications. The standard lab made porcelain veneers are not good enough anymore for many people.

Patient Specifications for their Porcelain Veneers

Some patients like longer looking teeth or square looking edges to their porcelain veneers. Other patients want very white teeth that do not look natural to me but are perfect to the patient. Some patients want their teeth to look undetectable yet still make their teeth permanently whiter. While other patients want their teeth to be a little bit crooked because it is part of their personality. This is the type of customization necessary for the ultimate level of care with porcelain veneers. Sending an impression to a lab just does not produce consistent patient satisfaction. More customized individualization, better shapes, better sizing and better translucency had to be done.

The Ultimate Level of Porcelain Veneers

Patients have an idea of the type of look that they want. They bring in pictures of smiles or want the shapes to be a particular way. Some patients have said to me that I am the expert so go ahead and do the treatment. Even though I was awarded the “Master” and was picked the Best Dentist in Los Angeles, I have found that some level of communication regarding patient expectations was vital to making the patient thrilled with the results. See www.hightechdentist.com for photos of my work or www.faceliftdentistry.com for one of the highest quality photo galleries of “before and after photos” matched up so you can compare the results.

What are Custom Porcelain Veneers?

I used so called “custom-made” porcelain veneers from dental labs years ago. I did what just about every single dentist in the United States does today, and that is take the impression and send it to the lab. When the porcelain veneers come back, they bond them into position and sometimes their patients are very unhappy. The labs do the best that they can do but they are not looking at the patient, nor do they understand how to customized cosmetic dentistry to the specific patient. Dental Labs have a tendency to produce the same looking teeth for everyone. It is not their fault; it is just the level of communication between the dentist and the lab. There just is no substitute for the cosmetic and creative eye of the dentist.

What are the Best Porcelain Veneers?

The best porcelain veneers are hand shaped by a highly skilled cosmetic dentist. In my office, I have about 20 close-up photos and 20 full face photos from all angles of every patient in order to visualize my patient while I am shaping and truly customizing their porcelain veneers. I have talked with the patient, shown them photos of my patients that have signed model release forms so they may visualize all of the variables and help choose the characteristics that they like for themselves. I have all of the information and then work on every single patient personally to create the natural look, cosmetic vision and the best porcelain veneers customized to that particular patient. I cannot do this with Lumineers because their ceramists are too far away.

See the Porcelain Veneers in you mouth Before they are Bonded!

After creating the best porcelain veneers for my patient, we gently place them on the patient’s teeth without bonding them so my patients can see my work BEFORE IT IS BONDED. They can go outside with my assistants to see how they look in the sun, and go back inside the office in various lighting to see how they look in office lighting. At this point, we can still increase the intensity of the shade or lower the intensity. Only after seeing the truly customized porcelain veneers in you mouth cans you, the patient, make an intelligent decision. If necessary, I can also bring in my ceramist that works only 2 blocks away to visualize form himself the improvements that are necessary if big changes need to be made.

Our patient satisfaction level is so high that they sign the model release form without any compensation. These patients for giving us permission to show their full face “before and after photos” honor us.

Marketing vs Educating

I am trying to educate my existing and potential new patients about the advantages of getting their dental care completed in my office. It has taken me many years to develop my “eye” for the ultimate level of cosmetic dental health care. The photography of my work validates the quality and the high level of patient satisfaction makes my professional work experience very satisfying.

Categories : Blog, Lumineers, Porcelain Veneers
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Can Instant Braces Straighten Teeth – Or Is It A Cover Up?

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Friday, October 9th, 2009

Question:

“Dr. Sam, my teeth are very crooked. I understand that I can get “instant braces” porcelain veneers to make my teeth look straight – but is this a good solution as my bite will still be off – but covered up?” –  Angie, Los Angeles.

Answer: 

The Skill of the Dentist

All dentists are not alike and there is a huge range in skill between cosmetic dentists in Los Angeles.  Many patients may pick a “coupon dentist” because they get a discount, which has been a big mistake for so many patients.  The skill of the dentist will directly determine the quality of your work.  Poor quality porcelain veneers are far more dissatisfying than paying more to get fine quality. 

Correcting Bites with Porcelain Veneers

Some dentists have the ability to improve and in some instances correct the bite with porcelain veneers.  These dentists have reached technical skills that few dentists will ever achieve.  Theses dentists can improve your bite and give you “instant braces” at the same time.  Porcelain veneers can be made to lengthen the bite, reshape the teeth, build new cusps of the teeth, change the color of the teeth and provide smooth right to left guidance to the bite.  The ultimate level of dental care using porcelain veneers, “instant braces”, cosmetic dentistry and maximizing dental health is Face Lift Dentistry®.

Bad Bites Break Porcelain Veneers

If the “instant braces” make your teeth look straight and the dentist was unable to balance the bite, the end result is generally,  broken porcelain veneers.  Some patients need to wear a night guard to improve the bite while grinding their teeth at night and to protect the new porcelain veneers.  Porcelain veneers can be made to look natural and make the teeth look perfectly straight and yet not change the bite at all.  In these instances a night guard may be the best solution to protect the porcelain veneers from breakage.  However, bonding the porcelain veneers into position with better technique minimizes   porcelain veneer failures or breakage.  The worst thing that can happen is to have a porcelain veneer break just before a very important event in your life.  It is not a health risk but definitely embarrassing.

Crooked Teeth and a Bad Bite

Is it a good solution to get instant braces and yet still have a bad bite?  Yes it is a good solution because having straight teeth is a very comforting and a very confidence building procedure.  Some patients may not be able to afford to change their bite but still want straight looking white teeth and for these patients “instant braces” are a great ideal.

We have had senior citizens or baby boomers want whiter teeth even though their bite is bad.  They get the white teeth and just live with the bad bite.  Others prefer to fix their bite and leave the teeth crooked, as their primary purpose is health.  The goal of the patient determines the level of care. 

Bulky Fake Looking Porcelain Veneers

There are so many fake and bulky looking porcelain veneers being placed on patients that many other people that are considering getting “instant braces” are turned off to the idea because of the bad porcelain veneers placed on their friends.  Patients get the wrong idea that porcelain veneers do not look natural.  The dentist just lacks the ability to deliver natural looking porcelain veneers and is just doing their best.  There best is not good enough and unfortunately, porcelain veneers and “instant braces” get a bad reputation.  Nothing can be further from the truth.  Porcelain veneers can be undetectable from natural teeth.  They can look incredible if the right dentist is doing the treatment.

Categories : Blog, Instant Braces
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Implant vs Bridge

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Thursday, October 1st, 2009

Question:

Dr. Sam, a few months ago I had a root-canal done on tooth #3.  The dentist applied a temporary filling and said I should come back for a crown. I did not understand how important this was and the tooth cracked down into the roots. I just had it removed. What do I do now? As both adjacent teeth need crowns, my dentist recommends a bridge. The oral surgeon that removed my tooth said I should definitely get an implant. How do I decide?

Answer:

The key factors in deciding on a dental implant or dental bridge are the following:

Amount of Jaw Bone Remaining After the Extraction – Dental implants require healthy jawbone in order to last.  The bone has to adapt to the implant and the more bone available the better.  Patients that have jaw bone that is wide and deep and are physically healthy are good candidates for dental implants.

Esthetic Zone – Where is the dental implant going to be placed?  Is it a front tooth or a back tooth?  Front teeth require thick gum and papilla between the teeth to look natural.  Otherwise, the metal implant may show through the gums and look very unsightly.  Sometimes the papilla, (the tiny triangular piece of gum that fits between the teeth) is missing leaving a hole between the teeth.  Dental implants may not be the best choice if the papilla are missing or the gum is thin. 

Neighboring Teeth – The teeth next to the extracted site may already have big fillings or crowns.  In that case, the neighboring teeth can be treated and the missing tooth replaced in one procedure.  Dental bridges work very well and last for many years.  I have patients that have had dental bridges for over 30 years and forgot that they were even in their mouth because they were so comfortable. 

Cost – Generally, dental implants cost more than a dental bridge.  A bridge can be completed in just a couple of weeks but a dental implant can take months to heal in order to be serviceable.  For patients on a budget, dental bridges may be their only choice.

Engineering – Dental implants are a great choice because the missing tooth is effectively being replaced with another tooth.  All of the teeth are working.  A dental bridge requires two teeth to do the work of three teeth, which makes the engineering or foundation of a dental implant superior to a dental bridge.

Dental Bridges and Dental Implants both stay in the mouth are and not removable by the patient.

Time – For patients that have limited time, dental bridges can be completed quicker in most cases unless the patient has very strong jaw bone.  In that case, the implant can be placed and the crown can be placed immediately.  “Implants in an Hour” can be very tricky.  The patients want fast results but if the biology is violated, the patient can be in for many months of surgery and discomfort. 

Decay – Dental implants do not decay and are not hot or cold sensitive.  A dental bridge that is completed by a talented dentist will not decay nor be hot or cold sensitive either.  However, both dental implants and dental bridges fail for a variety of reasons.  The bite can be bad, the patient’s dental hygiene could be poor or the work was not completed by a highly talented and skilled dentist.

Dental Hygiene – Dental implants and dental bridges both require consistant maintenance (brushing, flossing and water pik) at home and cleaning in a dental office.  The patient can have a gum infection around the dental implant and can loose the entire implant if it is not treated early.  Gum infections around implants are generally painless, so the patient is unaware of the problem until it is too late. 

Conclusion – There are a variety of reasons why a dental bridge would be superior to a dental implant and there are also a variety of reasons why a dental implant would be superior to a dental bridge.  These reasons and particular to each individual patient and the condition of the jawbone, neighboring teeth, esthetics and dental health are the most important.  My suggestion, is to seek the advice of a third dentist, take your x-rays and get the opinion of a experienced dentist to give you the best possible choices and recommend the best dental care for you.

Categories : Dental Bridges, Dental Implants
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News and Awards

Dr. Sam Muslin received the 2009 "Best Cosmetic Dentist in Los Angeles" award from LAs Best, featured in the Los Angeles TImes.