Archives for December 2019

Do I need a dentist to finish my Invisalign treatment?

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I’ve been doing Invisalign treatment and am almost done. Something came up with a family emergency and I had to make a last-minute move to my home state. My dentist provided me with the remainder of my aligners and told me she’d switch my records to whichever dentist I choose. My question is, do I really need another dentist if I am at the end of my treatment and already have the remainder of my aligners?

Candace

Dear Candace,

Invisalign aligner

This is an interesting question. If you don’t have any special things going on, such as buttons which will need to be removed or some shaping of the teeth to make room for the new position, then you could get away with just finishing your treatment without going to another dentist. While dental supervision is always the safest option, at this point in your treatment it may not be necessary.

I will say, you would only have a very nominal fee from any dentist who takes over because the bulk of the work is done and your dentist will transfer all the diagnostics and treatment notes. You could even call around and have some leverage on fees by saying what another dentist is quoting.

The Importance of a Retainer after Invisalign

One thing which will be absolutely necessary is a retainer after Invisalign. There are tragic stories of people who invested a lot of money to get their teeth in the correct position only to neglect their retainer and end up needing re-treatment. You don’t want to be one of them.

It is possible to use your final pair of Invisalign aligners as a retainer if you do it right. Here is how I would do that:

  • Wear them all the time for one month
  • Then wear them only at night for a month or two
  • From there you can try every other night

At this point, it is time for a quick check. If your teeth move during the two days you are not wearing your retainer, your teeth are not ready for you to move on and you will need to go back to every night for a couple of weeks and then check again. So, how do you know if they moved? If it is a little more challenging to put the aligners back in than normal, your teeth have shifted. If they haven’t moved, you can go onto the next phase.

The Final Phase

You can wear them once a week for a month and then go on to not wearing them at all. Just make sure you keep the aligners in a safe place to periodically check the teeth are retaining their correct position.

I hope everything turns out okay with your family.
This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Gums Inflamed After Porcelain Veneers

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I had two porcelain veneers done. They were placed on my two front teeth because one of the teeth had a chip and he needed to do both teeth to match them. Here’s the thing. Ever since I had the veneers placed, my gums have been inflamed and painful. I went back to the dentist and they insist they’ve never seen this before and accused me of not brushing them properly. That really annoyed me because I’m a grown woman and know how to brush my teeth. I’m especially careful to be diligent because these two porcelain veneers were quite expensive. I went back again and asked them to take a more careful look. At that point, he removed some cement that had been left. While that helped some, they still hurt. Do you know where I go from here?

Corin

Dear Corin,

A single porcelain Veneer being placed on a tooth

I’m pretty sure YOU are not the problem. In general, when someone gets work done on their teeth they are actually more careful about their oral hygiene, not less. It is more likely your dentist is the real problem here. I haven’t examined your porcelain veneers, so it would be difficult for me to diagnose the exact problem, however, I can give you some possibilities.

The first thing that springs to mind you’ve already have some evidence for— not cleaning off all the excess cement. At one of your checkups, you mentioned he removed some cement, so obviously this was at least part of the problem. All the cement he removed in your follow up visit should have already been gone when your veneers were originally placed. This is a common issue with inexperienced cosmetic dentists. Smile makeovers aren’t taught in dental school, so a dentist has to invest the time and training to develop the right skill.

The next two possibilities have to do with the margins. If the margins are uneven where the veneer meets the tooth it can cause issues. Sometimes the margin by the bottom of the gingival sulcus, can actually end up too far under the gumline. That would also lead to irritation.

An unlikely possibility, but still in the realm of possibility, is an allergic reaction to either the porcelain or ceramic used. These are rare but have been known to happen.

Where Do You Go From Here?

What you need is a second opinion from another cosmetic dentist. Don’t ask your dentist for a recommendation. Whoever he picks will be unlikely to want to say something against his peer. When you go, make sure it is a blind second opinion. Don’t tell them who did the work. Just tell them your problem with the gums and ask if they can see what is causing it. If they ask who did the work, tell them you want to know his diagnosis before you give that information.

The Correct Replacement for a Chipped Tooth

Before and after dental bonding

I want to mention one other thing. You said your dentist did this to repair a chip. Typically a chipped tooth would be repaired by dental bonding. This is what was done in the image directly above. My guess is your dentist recommended veneers because he doesn’t yet know the bonding procedure. It’s too late now, of course, but if this were to happen to you again, I’d want you to be armed with the right knowledge.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Problems with Dental Implant Procedure

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I wanted to get a single dental implant. My dentist felt there wasn’t enough bone in the area after doing his diagnostics and told me I could either get bone grafting done to have the implant or get a dental bridge. I really wanted the implant, plus I didn’t want to crown two healthy teeth so I opted for the bone grafting. We did that and after the healing time we went to do the implants. But, he told me the bone grafting didn’t work and is now suggesting I go ahead and get the bridge. Two surgeries later and I’m still without a dental implant. He actually has a good reputation for implants so I’m kind of surprised. Should I have gone to an implant specialist?

Stacey

Dear Stacey,

A dental implant diagram

Technically, there isn’t a recognized specialty in dental implants. It is up to the dentist how much training they receive as well as whether they’ll do the whole procedure or divvy it up with an oral surgeon. It is possible your dentist is very good with the implant procedure but just now learning how to do the bone grafting aspect. It is tricky and everyone starts somewhere.

What I like about your dentist is his integrity. Some dentists, with more pride than integrity, would have gone ahead and placed the implant so you wouldn’t have known they don’t have bone grafting down yet. Then, after a period of time, your dental implant would have failed and there’d be no way to tie it to his error. He kept that from happening to you.

Getting Your Dental Implant

You basically have two choices at this point. You can go ahead and get the dental bridge or you can do the bone grafting and dental implant procedure again. Getting a dental bridge is a perfectly acceptable solution. However, as you noted, it does require placing crowns on two perfectly healthy teeth in your particular case.

If getting the implant is important to you, I’d ask your dentist for a recommendation for a good oral surgeon to re-do the procedures for you. One word of caution. After your bone grafting procedure is done and healed, visit the dentist again for him to decide on the best placement of the implant. He and the oral surgeon need to communicate before the implant surgery in order to ensure it gets placed in the correct position.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.