Can We do Veneers without Grinding away Tooth Structure?

August 24, 2013 alexnguyen

Depending on the condition of your teeth: Yes, we can. The answer is custom fabricated Prepless Veneers. A prepless veneer is a super thin layer of porcelain that can be bonded on top of your existing tooth structure to change shape, contour, and color of your teeth. In that sense, no tooth structure is removed. However, prepless veneers cannot be used when we are trying to change the shade of extremely dark teeth. Also, in some cases where severe misalignments of teeth are to be corrected, prepless veneers may not be the solution.

The best looking prepless veneers are fabricated via the hands of extremely talented and artistic dental ceramists. These artists must be able to envision how much porcelain is needed to create the proper form of the teeth. On another level, the ceramist must understand and envision how the colors of the natural tooth and the colors of the veneer will blend together to create the desired change.

To the untrained eyes, a piece of prepless veneer may look like it a cloudy white piece of glass, yet when placed on the tooth the restoration simply comes to life.

Outside the mouth, the prepless veneer is so thin it almost looks translucent. However, once bonded onto the tooth, the porcelain is extremely strong. One technical note that makes prepless veneers different is that fine adjustments of contours and shape are done after the porcelain is bonded in. The nature of the type of porcelain used in these cases allows the dentist to be able to make customized fine adjustments and to polish the porcelain to a super high luster finish.

Case selection and handling by the right clinicians is crucial. However, I believe that with the right combination of dentist/ceramist team prepless veneers offer our patient a fantastic treatment option to enhance the smile effectively and conservatively.

Below is a photo of a prepless veneer I recently placed.

Images of actual patients of Alex Nguyen, DDS are Copyrighted and Digitally Embedded to track Unauthorized Use.

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Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

How Come the Color Could Never Match For Crowns on the Front Teeth?

September 11, 2011 alexnguyen

The two front teeth are the most commonly restored teeth. They erupt into the mouth at about the age of eight, and being positioned in front of the mouth they often sustain the most damage. Color is not the only parameter required to match the two front teeth with the rest of the teeth in the smile. Among other factors, we have to also match contour, surface texture, and shade variations of different areas of the teeth. Matching the front teeth is like sculpting a portrait of what they used to look like. That is the only way they will blend in with the natural dentition. Furthermore, the two front teeth serve as a very important guidance for joint stability and function. We must approach the front teeth in more than one dimension.

When done correctly, restorations for the front teeth will disappear into the rest of the smile. Here is a testimony from a recent case I delivered last week.

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Email dated 9/09/2011

Dear Dr. Alex,

I want to personally thank you for the wonderful job you did on my case. Although it took longer than I anticipated, it was worth the wait and I am very pleased with the end result. You definitely have the knack for how teeth should look and function. I really appreciate your thoughtfulness and professionalism. ...Again, I want to thank you for a job well done.

P.S. you will soon have another positive review on Yelp :)

Sincerely,

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From a patient who moved to Hawaii

June 23, 2011 alexnguyen

Email dated June 23, 2011 to her parents. Aloha Dad and Momma,

Dr. Jonathan Kam is my dentist who went to college at UCLA and Stanford. He told me that he knew Dr Nguyen from conferences and his excellent reputation. In fact, when Dr Kam examined my fillings, Dr Kam asked me who did my fillings because they were some of the best fillings he had ever seen and reported he was a "filling snob." I told him Dr Nguyen in San Jose did my fillings and Dr Kam said, "Oh my gosh, I know him! He is an excellent dentist and one of the best." Dr Kam told me to tell Dr Nguyen what an excellent job he did with my fillings. So, That's the story:)

The waves were huge in Waikiki today! They were about 15 ft and yes, I surfed them! It was really fun and I had a great time surfing because it is very rare that Waikiki has big waves like today. I am really excited for Mom to come and wish you were coming too, Dad:( Hope you have a nice rest of the week and talk to you both soon.

I love you,

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Can a Smile Makeover be Done in Two Visits?

February 14, 2011 alexnguyen

On December 19th, 2010 I posted a blog entry with a wonderful smile guide sent to me by a well-informed patient. Last Friday I delivered the porcelain restorations which completed his smile makeover process. I will still have to bring the patient back to fine tune and touch up some of the detail work. I could not have done the job in two simple visits like many advertisements claim to be able to do. The process cannot be done in two visits because a number of critical steps must be carried out:

- Diagnostic work-up of the case

- Laser contouring of the gum

- Equilibration of the bite

- Bonding of some of the teeth

- Preparation of the teeth for porcelain

- Working with the ceramist while the case is at the lab

- Tryin/delivery of the final restorations

Depending on what level of quality you are looking for, the process typically defines the end result.

Here is the feedback I received from the same patient today via email about his feelings regarding the end result of the case.

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From: S

Subject: teeth

Date: February 14, 2011 11:54:26 AM PST

To: Alex Nguyen

Hi Dr. Alex, just wanted to drop a quick note to express how happy I am with how my smile has turned out (the gums are much better and closer to normal now) The teeth are exactly what I wanted: shapes/edges are just as envisioned, and the whiteness and translucency couldn't be any more perfect. I noticed the very slight decalcification on the inciscor is exactly as I wanted. The bite feels solid and like my own teeth.

In short I can't stop myself from looking in the mirror and smiling :) Thanks for your hard work and attentional to detail. Looking forward to the fine-tuning and tweaking of the bicuspids and wrapping up the case.

See you soon

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Smile Makeover - From a Well-Informed Patient

December 19, 2010 alexnguyen

In a commercial market driven by advertisements and the desire for instant gratification, patients need to be well-informed about treatments involving cosmetic dentistry. A successful case must be built on multiple foundations which include: 1. Your bite

2. Esthetic principles

3. Your personal preferences

4. The science of today's materials and techniques

The following email was sent to me from a current case in progress. This patient has done so much research on his own that he knows all the details: from the tooth numbers, to the types of porcelain available, to the characteristic tooth shapes, etc. This is an example of what every patient should know before making a decision on important restorative treatments.

This type of clear communication enables me to coordinate the work with the ceramists who also need to hear the patient's concerns and feedbacks. I am privileged to have the opportunity to work with such well-informed patients.

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Email dated Dec 18, 2010

Hi Dr. Alex

Attaches is the "style guide" from where I took the smile that I showed you today.

None of the smiles match exactly what I'm envisioning, but a few come quite close: the Hollywood/Natural/Softened styles.

* Overall: something strong and youthful, but not overly aggressive or mature

* Central incisors: I like the shape/edges on the Hollywood/Natural (actually all three look the same)

* Laterals

* I like the shape on the Hollywood (similar to my current teeth), but they could go in (up) a little more deeper on the corners, especially the edges with the centrals. Actually, the right lateral (when looking at the photo, tooth #10) on the Natural is what I'm looking for. But I don't like the shape of the left incisor (#7) on the Natural--it's too round especially on the cuspid side

* I would play with the lengths of the central and/or lateral incisor to achieve an ever so slightly larger vertical difference (maybe 0.2-0.4mm more) so it looks like the Natural. What I said in the point above about the edges going up would probably achieve the look of more difference without really changing the lengths of the teeth all that much.

* Cuspids: I like the shape of the Softened: the Hollywood is too flat, and the natural too pointed/sharp. I also think the roundness on the Softened would fit in better with the shapes of my Bicuspids

* Bicuspids: I know we only discussed bonding only on #12 for now, but my thinking is that they would end up similar to the ones seen here (they all look more or less the same in all the styles)

I understand it needs to be customized for my mouth/face shape and my bite, but wanted to share my thinking/vision on some details of the cosmetics. Let me know if you have further thoughts/questions. I know its hard to discuss some of these details through email, we can also look at the image when I come in for the next appointment, if its not too late in the process then. I can also stop by sooner if you feel that would be helpful.

Have a good weekend!

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