Daron,
I’m not sure I’m understanding the configuration of this partial denture. I’ll guess that you have a removable partial replacing three teeth with two teeth on one side of your mouth, one on the other, and a bar connecting the two halves. And it’s on a metal framework and it’s that metal framework that has broken. If that’s the case, no, it isn’t repairable.

A conventional removable partial denture has a metal framework and has either acrylic or composite teeth embedded in a pink acrylic (plastic) base, and then there are usually metal clasps that attach to the teeth. If any of the plastic parts break or anything happens to any of the teeth, that is pretty simple to repair. Those plastic materials can be mixed and re-created and attached to the metal framework fairly easily. It’s even not too difficult to add a tooth to the partial. And if a metal clasp breaks off, it can sometimes be repaired by embedding a wire in the acrylic base and then bending the wire to clip around the tooth.

But if the metal framework breaks, it’s time for a new partial. There are two reasons. First, repairing the metal would involve welding the pieces together, and welding would require such a high temperature that the rest of the partial would melt. Second, it’s the framework that determines the positions of the teeth, clasps, and saddles. The impressions and the laboratory work required to re-create the positioning of all those parts would be as much work as starting over and making a new partial, so it simply wouldn’t be worth it.

An option, if it fits within your budget, would be to replace the removable partial with dental implants. They’re much more comfortable, more trouble-free, and the maintenance is easier.

This blog is sponsored by Naperville dentist Dr. David Newkirk

Dr. Hall

Gratefully,
Arleen from Michigan

Arleen,
Where you are in Michigan, unfortunately, you don’t have any really excellent cosmetic dentists that are too close, but if you’re willing to drive a little, there is an excellent one (name withheld).

And yes, the new Lava crowns are strong, but, while it is an all-ceramic crown, it isn’t the nicest looking esthetically, at least not in every situation. Whether that would be the best crown for your tooth would depend on the clinical situation. I would discourage you from picking the type of crown, because there are many factors that go into selecting the crown type, and no one crown is the best for every clinical situation. Additionally, Lava is only one brand of a new type of crown which is feldspathic porcelain baked over a zirconia framework. It is much better to find a dentist you trust and then allow him or her to recommend the type of crown that would be best for your situation, and also one the dentist is comfortable with.

For example, in our office, Dr. Newkirk works with a master ceramist who is so talented he can even make porcelain-fused-to-metal crowns look natural. In the hands of most ceramists, that type of crown looks opaque and fake, but he can create illusions that make them look translucent. The point is that the material that works the best in the hands of one dentist and one laboratory technician may not work the best in the hands of a different dentist. So pick the dentist that you know will do beautiful work and that you can trust. That’s the key.

This blog is sponsored by Naperville dentist Dr. David Newkirk

Robin,
To answer your question about your porcelain crowns cracking, I need to give a little background information.

There are two basic kinds of porcelain crowns, or caps as you call them, and then sub-categories. There are porcelain fused to metal crowns that practically never crack, and there are all-porcelain crowns which are strong enough for the front teeth but can crack sometimes when used on molars. But now, even with all porcelain, there are zirconia ceramics that are extremely strong.

And then there is a wide variety of patients, as far as the strength of their bites. There are some that I call “gorilla bites” that will break things in their mouth really easily. That happens with fewer than 1% of patients. Most practices will have a handful of those patients, and they can break a tooth clean off, but the porcelain fused to metal crown will stay intact.

What I want to say with all of this is that, even with good dentists, there is often a learning curve of dealing with real patients where they do what they were taught in dental school but the patient still breaks things. The way to tell if you have a good dentist or not is their attitude about this. If this makes them upset and they take extra pains to get it right and they fix things at their expense, then I would stay with the dentist. Maybe the dentist used all-porcelain and it really should have been porcelain fused to metal on this particular tooth. If I were the dentist, I would apologize for the mistake, and replace the crown, maybe waiving your portion of the cost if there is dental insurance involved, or even doing it completely for free. However, you seem to be saying that the dentist is trying to brush it off as normal, which makes it sound like this happens a lot with this dentist. If I were the patient, this would not be acceptable to me.

Now most dental insurance companies will not pay for a new crown if the old crown on the tooth is less than five years old. But a crown really should last considerably longer than that if it is done well – 10, maybe 20 years or even more.

And then, it isn’t that uncommon for a tooth that has a crown to also need a root canal treatment, either before the crown is done or afterward. But if this happened a lot to you and the crowns weren’t done for decay but as part of a bite reconstruction, then I would question the work.

This blog is sponsored by Naperville cosmetic dentist Dr. David Newkirk

Darl,
Your dentist is partly right but not exactly, and I worry about whether he would be the right person for this procedure. This isn’t a difficult procedure to perform and doesn’t require much artistic talent, but there are a couple of things that need to be done right or the result will look funny.

Dentists who aren’t well trained in cosmetic dentistry often think that spots on the teeth can be eradicated by bleaching the teeth. It never works. In fact, bleaching usually makes these spots more noticeable. The correct treatment for spots is direct dental bonding with composite, if they are limited in area, or porcelain veneers, if the spots are more widespread.

White spots on the teeth are usually very superficial, and for the result to look right, the spot should be ground out and replaced with a fairly translucent enamel shade of composite. And this composite should be a highly polishable microfill. If this is done in this manner, the repair will be undetectable. If the spot isn’t completely ground out, the dentist will have to use a more opaque shade, and it will look like a repair. If your dentist is saying that he is going to “paint over” the spots, maybe he is just trying to convey the procedure to you in a simple manner. But it may be that he doesn’t understand that he needs to use a translucent material here. And many dentists don’t have these translucent shades of microfill composite in stock because they don’t do that much of this kind of work, and they are less artistically demanding of themselves.

There are two layers to a tooth. There is an inner dentin layer, and an outer enamel area. The dentin is less translucent than the enamel. When an expert cosmetic dentist does direct dental bonding repair on a front tooth, say for a corner of the tooth that is broken off, he or she will use several different materials. There will be more opaque materials laid down first, and if an extensive area is covered, it will be shaded to have slightly more color near the gumline. This material is usually a hybrid composite, which is stronger than a microfill. Then a more translucent microfill is layered over this. This layer simulates the enamel. Besides being translucent, it is polished to a high luster.

If your dentist does this bonding and muffs it, it could hurt your relationship. If you have concerns about his expertise in cosmetic dentistry, I would suggest you go to the mynewsmile.com website and look for a recommended cosmetic dentist need you. This website screens dentists based on training and artistic ability, and recommends excellent cosmetic dentists all over the country. (Dr. Newkirk is their recommended cosmetic dentist for Naperville.) Then, if you like your own dentist, you could return to him for your regular checkups and maintenance.

This blog is sponsored by Dr. David Newkirk, who is also a Naperville implant dentist.

I questioned my dentist also about using my Sonicare going forward. He has never heard that this could cause the veneers to fall off. But I have read that it can. What are your thoughts? Thanks
- Monica from Maryland

Monica,
As far as the post-operative care for your porcelain veneers and what not to let the hygienist do – The most important thing is that your hygienist never use power polishing equipment like the Prophy Jet on you. That blasts a power spray of sodium bicarbonate on your teeth and it will remove the glaze on your porcelain veneers and make them so they will stain. It’s very damaging, and once that glaze is gone, your veneers will never be the same again.

There is a website that claims that a Sonicare or other sonic toothbrush will loosen the bond of porcelain veneers, but that is not true. The University of Missouri at Kansas City did a study where they brushed porcelain veneers for two years with a sonic toothbrush and confirmed that it does not weaken the bond strength of porcelain veneers. The Sonicare is an excellent brush – great at removing plaque, and I would encourage you to use it on your porcelain veneers.

A great toothpaste to use after you get your porcelain veneers is Supersmile. It’s available on the Web directly from the manufacturer, and it is also sold on the cosmetic dentistry website, mynewsmile.com.

This blog is sponsored by Naperville cosmetic dentist Dr. David Newkirk

I can no longer brush with regular toothpaste as this aggravates the two “exposed” teeth. I must use Sensodyne or it is really uncomfortable to the air–especially cold air. Sometimes I sleep with a blanket on my face to warm the air more as I sleep or it bothers me. The new porcelain veneers are a completely different shape from the original veneers that I was used to. They are give off this drab gray/yellow color not like my old veneers which had “umph” to them. These teeth look like stained teeth and do not produce the brightening effect I was after.

Another problem is they smell like rotting teeth. My old veneers did not give off an odor, these do. I brush my teeth 5x a day now, floss 4x a day, and gargle Listerine as much as I can to hide this after brushing.

I am afraid he will not refund the money because I paid in full and this may indicate I accepted them completely. The only ray of hope is that he stated he was happy only if I was happy as I left. Could you please advise what is the proper way to address the situation? I used to smile a lot now I just hide it. I feel stupid for trusting him. I wish I had just kept the cracked veneers. Thank you kindly for your time.
- Eva from Boston

Eva,
The way you put the “get used to them” in quotes makes me wonder if this is what the dentist or the assistant told you when you weren’t happy with them. This is one of the hallmarks of poor quality cosmetic dentistry. The patient isn’t quite satisfied, and the dentist, rather than listen and take care of the problem, tries to sweep it under the rug, put it off to some future time, and assure you that you’ll “get used to them,” as if they are speaking from experience.

The true cosmetic dentist will be sensitive to even a hesitation in your voice and address your concerns. For example, the porcelain veneers are tried in and he asks, “How do you like them?” And you say, “Yes, they’re OK.” The true cosmetic dentist will say, “Why did you just say ‘They’re OK’? What is it that makes you hesitate? What don’t you like?” And then they will be sent back to the laboratory, if necessary, until you’re excited about how they look.

But what to do now? You’re kind of at the mercy of the dentist, who apparently wants to brush this under the rug, so I can’t see how he will willingly refund you anything or try to address your concerns. Yes, he did say he wanted you to be happy. But if he had been serious about that, the time to find out if you are happy or not is before the discolored porcelain veneers were bonded onto your teeth. Your best bet, at this point, is to go to a true cosmetic dentist and ask that dentist to help mediate a solution to the problem, if they are so disposed – to call the first dentist and see if he will compensate you for having the case re-done, or to see if there is some functional problem with the case that will make the first dentist legally liable.

There is a possibility that there are functional problems with the veneers that are serious enough to be able to bring pressure on the dentist to refund your money. You mentioned the tooth sensitivity. This could be from poor fitting of the veneers, not covering the entire prepared tooth. Also, the bad smell would most likely come from either overhangs – a ledge under the gum where the margin between the veneer and the tooth is. This margin should be smooth, almost undetectable. If there is a ledge there that traps food debris, not only will it smell bad but it will seriously irritate the gums and can contribute to gum disease.

This blog is sponsored by Naperville cosmetic dentist and Naperville implant dentist, Dr. David Newkirk.

Judy,
What your dentist is telling you may or may not be right, depending on what the actual situation is with your front teeth.

It’s not that you CAN’T put porcelain veneers over composite. Veneers are bonded to the teeth using a composite cement, so that can be done. But when a tooth is, say, half composite filling, it isn’t smart to put a porcelain veneer over it. By the time it has that much filling to it, it should be covered with a crown anyway to keep it from breaking off. And if there is a lot of filling in a tooth, that means that you’ve had lots of cavities in your front teeth. The porcelain crown is a much better protection against tooth decay than a porcelain veneer. And if you tend to get cavities on your front teeth, the margin of the veneer, where it meets the tooth, is a vulnerable place that would be very susceptible to more decay. So the crown is a better idea and would last much longer.

Having said that, if the existing composite on your front teeth is on the fronts of those teeth, then trimming that composite back and putting a porcelain veneer over it instead would be an excellent treatment. Most dentists are simply not very comfortable doing porcelain veneers, but all dentists are comfortable doing crowns. So I often get e-mails from patients whose dentist told them that they should have crowns when they really should have porcelain veneers. Without knowing your dentist and seeing the teeth you’re talking about, I couldn’t tell if that is the case. But I would advise you to be careful. An artistic dentist will be very proud of the appearance of his or her work, and will display photographs of that work. They may be on the walls of the office, or in photo books. Only 1-2% of dentists are artistically inclined like this. If this doesn’t describe your dentist, I would advise you to find an expert, artistic cosmetic dentist for this work and not use your regular family dentist.

This blog sponsored by Naperville cosmetic dentist Dr. David Newkirk

Jake
You have an interesting way of reasoning through this issue and part of what you say makes sense. But your conclusion isn’t correct. Let me explain.

On a front tooth, if you had bonding there on the very biting edge, the reason you may need to be careful with a filling like that doesn’t have to do with the strength of the material but with the strength of the bond to the tooth. The filling on the back tooth is a totally different situation.

Here’s a way to understand it – if you compare it to gluing pieces of wood. If you take two dowel rods and glue them end to end, well it will be hard for that glue bond to hold. This is like bonding a composite to the biting edge of a front tooth. But now take a drill and make a three-inch-deep hole in a piece of wood and glue a three-inch-long piece of dowel rod in that hole, and you’ll have a hard time getting it out. This is like the composite filling in a back tooth.

Silver amalgam is a metal and the material itself is very strong. But it doesn’t bond at all to the tooth. The composite is strong, and while it doesn’t have as much crushing strength as amalgam, it has enough to easily withstand biting pressures. But because it bonds to the tooth the whole tooth is stronger and much more resistant to breaking than your tooth would be with the silver amalgam filling.

I’d say to bite as hard as you want. Don’t bite off bottle caps, but you’re fine with any food or normal chewing.

This blog is sponsored by Naperville cosmetic dentist Dr. David Newkirk.

Kwan,
I’m not sure what you mean by “commercially available bleach products.”

If you’re talking about whitening toothpastes, most whitening toothpastes would not be effective at all at removing stains at the margins of your porcelain veneers. Those margins are bonding resin, and ordinary or whitening toothpastes tend to be abrasive and thus hard on that bonding resin. Supersmile toothpaste is great for that. It’s effective at removing stains but is non-abrasive.

Tooth bleaching systems that are used in dental offices, such as Nite White, Zoom, Sapphire, Boost, Kor, Opalescence, etc., are all safe for using with porcelain veneers, but they will selectively whiten the teeth and not the veneers or the bonding resin.

I would not use any over-the-counter whiteners, as you could risk damaging your teeth or your porcelain veneers.

The best prevention for those stains at the margins of porcelain veneers is for the dentist to make that margin as undetectable as possible. If the tooth is prepared slightly with a slight edge at the margin of the porcelain veneer, then when the porcelain is bonded to the tooth, the dentist can create a flush margin that is perfectly smooth. Simple flossing will then keep this clean. This is one disadvantage to Lumineers when the teeth aren’t prepared at all – the dentist ends up with a little bump where the porcelain meets the tooth, and that attracts stain.

If those margins become stained in spite of using Supersmile toothpaste and in spite of being made smooth, I would ask your expert cosmetic dentist to have his hygienist polish those with ultra-fine polishing strips.

This blog is sponsored by Naperville cosmetic dentist Dr. David Newkirk.

My question is if you file a porcelain crown and do not polish it, will it stain from drinking green tea? I like my dentist, but I didn’t pay 1000 for something I would have to still cover my mouth for. Any advice and information you could give me on this is greatly appreciated.
- Tammy from Texas

Tammy,
When a porcelain crown is made, it has a glasslike glaze baked onto the surface of it. This glaze is very stain-resistant, as you know, because you’ve had these other crowns for 25 years and they haven’t stained at all. But if a dentist has to grind on the front surface of a porcelain crown, that removes the glaze. The best practice when this happens would be to send that crown back to the dental laboratory and have a new glaze baked onto it. Otherwise, there are special ultra-fine diamond polishers that can be used on the porcelain to give it a glaze-like surface.

If neither one of these things has been done, then yes, the porcelain surface will feel a little rough and it will pick up stains easily.

If I were you, I would go back to my dentist and insist that this front surface be polished, because, yes, it will stain and will look bad. If your dentist doesn’t know how to polish porcelain, he can easily find out. A dental company called Brasseler makes excellent porcelain polishers, and he could just call the sales rep who would be happy to supply him with everything he needs as well as instructions in how to use them.

This blog sponsored by Naperville cosmetic dentist Dr. David Newkirk