What’s Your Smile Story?

Hello Ryan,

the choice of the lab is very important.
I have tried many different dental labs throughout the years. The most valuable labs are the ones that are willing to communicate and try to understand what exactly is needed and wanted.
Every business owner determines the value of his services. It is determined by expertise, expense, and time devoted for a client. The level of communication is proportional to the quality of the final product.
A dentist who strives for the best communication possible with both, the patient and the dental laboratory, establishes realistic expectations and delivers the best possible solution for a given situation.
The work of a dental laboratory is only as good as the information it receives. This includes study models, images, treatment plans, requests for specific techniques and materials, and a very specific language. Both, the dentist and the lab technician, need to understand that language. The more differentiated a dialogue is, the more predictable the result will be.
Last but not least, the dental technician/ceramist needs to be a master in his craft. There are many master technicians, but only a few are willing to communicate and invest the time necessary to truly understand the patient’s goals. The goals for aesthetic elements vary from patient to patient and need to be carefully duplicated. The dentist is the quarterback that communicates the patient’s goals to the ceramist. A system of consecutive steps needs to be established that guide the patient to be involved in every decision and to communicate that decision to the dental technician. The time involved in the entire process (besides expense and expertise) determines the fee for the service.
The amount of tooth structure that is removed depends on the current dental condition and the desired outcome. Please feel free to watch a series of videos that I published on YouTube describing this issue in detail. You can find the videos by searching for my name on YouTube.

Dr. Rabanus

Hello Curtis,

thank you very much for your picture. Many patients with diastemas (gaps) benefit from porcelain veneers and/or orthodontic treatment. The possibilities are best studied on study models of your teeth. It appears that your camera took the picture with a slight “fish-eye” effect, which distorts the true proportions of your teeth and spaces.
Do you live in San Francisco? Feel free to contact me directly if you want to come in for a consultation.

Best regards,

Dr. Rabanus

Hello Verce, it looks like cosmetic dentistry could easily address your aesthetic concerns about your smile. Do you have any specific questions? Do you live in San Francisco?

Dr. Rabanus

Hello Mary,

thank you very much for your picture. It shows very well a situation that often can be corrected with porcelain veneers. When teeth are too small, orthodontic treatment does not correct their size, but will move them together. This will often create a flat profile or other aesthetically compromised situations.

Multiple spaces such as yours are often caused by small teeth. Veneers are the appropriate treatment for those cases. Porcelain veneers close spaces while making timid looking teeth larger and more vivid. In very challenging situations, limited tooth movement (possibly with Invisalign) may be necessary before placing porcelain veneers.

Dear Marcia,

thank you for sharing your concerns on this blog.

Your pictures show clearly what you are describing. I can see the cant of the smile line as well as the cant of your mandible. Was this the result of your orthodontic treatment? It seems like you have had a retainer at the back of your bottom teeth, which would indicate that your lower teeth have not changed much in the last ten years. I would have expected a better outcome. However, you may have some skeletal asymmetries that could not be handled with orthodontic treatment at all.

I would gladly take a look at current x-rays of your jaws (panograph) to get a better idea about your overall situation.

I do not want to exclude any treatment option without having seen your teeth how they relate within your mouth. This is usually done with mounted models of your teeth.

I am going to send you an e-mail to which you may respond directly.

Thank you very much again for sharing this interesting situation.

Dr. Rabanus

Hi Jessica,

Your teeth and your smile look great. I don’t think that you need any enhancements. Do you have any specific concerns? If so, I would like to recommend a higher magnification of your teeth that clearly shows the area of concern, okay?

Take care.

Dr. Rabanus

Hi J.,

thank you for your picture.

Canted teeth may be caused by a combination of things. It may be caused by skeletal asymmetries and by severe misalignments of teeth. It may be a combination in your case. However, your left lateral incisor is much higher than all you other teeth. If it was as far down as its counterpart on the right side, your smile would appear much less canted. Please also note that the line that connects all incisal edges of your upper teeth is quite parallel to the curve of the inner border of your lower lip. This means that it is not as bad as you may believe.

Please feel free to send me more images of your mouth via e-mail and I will be happy to give you more feedback.

Dr. Rabanus

Hello Leila:

Thank you very much for your picture. It shows your smile very well. Thank you very much.
It looks like you received at least 6 upper veneers/laminates. They seem to be very long. Are they longer than your natural teeth used to be? How long ago did you receive them? The left central incisor seems to be longer than its counterpart on the right side. Does your lower lip sometimes get trapped under your laminates?

Hello Scott,

you certainly have had your share with dentistry. And the fact that your teeth have continued to wear makes it appear like a a never-ending experience. I understand that you are worried about the future of your teeth. There is only so much tooth structure available. While nightguards are an option to reduce the destructive aspect of grinding teeth, it is not treating the cause of the problem. There are a few possible reasons why you wear your teeth. It could simply be neurological based on hyperactive muscles, but it could also be caused by interferences in your bite. Another reason may be a “consticted envelope of function,” where your front teeth do not give your jaw musces the space that they want. This often occurs after orthodontic therapy.

I would like to suggest that you see a dentist close to you who does a few diagnostic checks to determine, what the cause of your dental wear is.

I hope this helps.

Dr. Rabanus

Hello Scott,

this is a great picture of your teeth. I see that you have significant wear and many old restorations (composites and gold). I have a few questions:
Are you aware that you grind your teeth?
Have you seen a dentist to discuss your current dental condition?
Do you have any discomfort when you chew a small piece of gum?
Do you have any discomfort when you eat bagels?
Have your teeth changed significantly in the last few years?
Do you have more than one bite?
Do you move a lot when you sleep?
Your answers to these questions will give me some idea about the possible causes of the significant wear of your teeth.
Dr. Rabanus

Here is my picture. Sorry, my computer did not cooperate.

Hello Scott,

could you send a picture of your teeth/smile to allow me to get an idea about your current dental condition? Thank you very much.
Dr. Rabanus

Dear Jim:

Thank you very much for your image. I see what you are talking about. My answer to your (picture-less) question that you submitted earlier still applies.
I could give you more specific feedback if you submitted a larger close-up image of your teeth

It looks like you have a certain kind of veneers (lumineers) that are placed on unprepared teeth. This is one of the problems that can occur with them. Teeth may become overcontoured (bulky) and the darker shade of the tooth structure may show through as in your case.

Hello Jim,
thank you very much for your question. It is of concern to many people. So, here it is:
First of all, every dental condition is different and therefore dictates the final treatment plan. It would be great if you could send a close-up picture of your teeth. This would give me a better idea about your crowding.
Veneers and orthodontic treatment are two valid treatment options. However, many of my patients are at an advanced age and have a lot of social and professional interaction. They cannot imagine walking around with braces for more than a year. They may either decide to get veneers (if the clinical situation allows) or to get Invisalign.
Invisalign is much much more comfortable than braces for several reasons. It still has the drawback that once the teeth have been repositioned, they will have to be retained in that position with an appliance. This is not necessary after placement of veneers.

Thank you for your submission. Do you have any questions?