Can you floss between veneers?

Of course you can. Unfortunately… Not in this case though.

These veneers were done in a country in Asia. According to the patient, two of them fell off while the patient was still there. The veneers then were rebonded, and the patient was wondering why he couldn’t floss between them any more.

In the photos you can see the excess cement connecting all the porcelain together. I will not comment on the esthetic aspect, however… From a technical standpoint this case is a disaster waiting to happen. By being unable to floss, food and plaque will be trapped underneath and the gum inflammation will eventually lead to bone loss.

Many people travel to have dental work done. What do you do when there is a problem? Is it worth the savings and the risks ?

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What is a wax up?

Before I begin…It has been a whirlwind of a year due to my complex travel schedule. I spent this past Spring and Summer traveling to Germany twice, and most recently to Romania to stay updated on the world of implantology, digital dentistry, and dental photography. Most of the digital dental technology development and manufacturing begins in Europe, and I wanted to learn from the best resources available. I am back, and will continue to update this blog as well as my Instagram page to bring you the latest information on my work, in order to help you make confident decisions when seeking dental care for you and your loved ones.

I saw a patient for a cosmetic consultation this past week, and her question is the topic for this blog post: When do you do a wax up?

A wax up is a design of as little as one tooth, or as many as all the teeth in the smile. A wax up is done to modify the size, shape, contour of the teeth prior to prepping the teeth in the mouth for restorations. In the case below you will see a wax up of a design to replace old porcelain veneers and crowns that the patient wanted me to change out. In this particular case “length” was ok for the patient, so the wax up was done to refine shape and surface characteristics which are important in making the porcelain veneers look real. Natural teeth are not perfectly flat, and we need to transfer those details onto the final restoration.

The colors of the wax is the preference of the technician working on the case. Some prefer a white wax because they mimic white teeth. Some prefer colored wax because details show up very well with colored wax.

Depending on the needs of the case, the wax up will tell us how much tooth structure reduction is necessary to achieve the ideal out come of the case. For example, a tooth that needs to be brought out to be more even with the arch form would need less reduction than a tooth that is stuck out in the arch form and needs to be brought inwards. Sometime, by seeing the wax up, the patient can visualize why orthodontic would be an option to even out the arch form in order to minimize the need for more significant tooth reduction as well as to minimize the number of teeth that need to be treated.

Just as an architect would rely on a blue print to build a house, a wax up design is our blue print in dental reconstruction. In the future you will see more and more cases being done with digital wax up using CAD software instead of traditional hand waxing. I will post a digital wax up case later.

A wax up design to restore a previously done smile with 10 upper teeth and 6 lower teeth.

A wax up design to restore a previously done smile with 10 upper teeth and 6 lower teeth.

Note the details in the surface texture. They are very visually defined in wax, but in the final porcelain they are very subtle and so important in light reflection to make the restoration look real.

Note the details in the surface texture. They are very visually defined in wax, but in the final porcelain they are very subtle and so important in light reflection to make the restoration look real.

Enhancement of lower anterior teeth in wax.

Enhancement of lower anterior teeth in wax.

 

Different Veneers for Different Purposes

Veneers are commonly used to enhance people’s smiles. Some patients choose to have a full arch of veneers to help change their entire smile. Some patients choose only a select number of veneers to help restore teeth with imperfections.

In the case below we used only four veneers on the upper four front teeth to rejuvenate the smile and get rid of old broken down composite fillings and bondings.

Click on the image box below to view and before and after photos.

Modern Ceramics - Apple Watch vs Teeth

What do Apple Computers company and dentistry have in common?  The Apple Edition Ceramic Watch is made of Zirconia, a material commonly used in dentistry today. Zirconia undergoes a sophisticated fabrication process called sintering where its powder form is treated with heat to compact into a solid material of tremendous strength.  Zirconia can be shaped, layered with additional ceramics, or simply stained and glazed to create realistic details found in natural teeth.  The discovery of Zirconia allows dentists and dental ceramists to create beautiful restorations which can resist fractures.  However,  Zirconia is extremely technique sensitive in the lab.  Making Zirconia look good for front teeth requires the work of ceramists with meticulous artistic skills.

The first photo below shows the Apple Watch made out of Zirconia.  Note the highly polished glossy surface.  The Zirconia is so strong that a watch casing can withstand the stress of wear and tear.

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The second photo here shows a clinical case of upper and lower veneers we recently completed with Zirconia.  Note the detailed characteristics which give the veneers life.  By taking advantage of the strength of the material, and combining its scientific properties with the art of dental ceramics these veneers will out last those created by materials in the past.

AlexNguyenDDS.ZirconiaVeneers

Apple Watch photo courtesy of macworld.co.uk