Thanks. I appreciate your helpful info.
I wonder if you could give me your thoughts on the treatment options, if I described them. Mostly your take on whether any of what's proposed are bad techniques, or not durable, or whatever. I think I have found a great dentist, and what he's proposed makes sense, but I would feel much better if I could get some objective comments. I know you can't judge appropriate treatments without examining my teeth, but I'm sure you could tell me if his proposed treatment sounds like good dentistry. I have been to a number of dentists, and they all come up with very different treatment plans.
I'm happy with your answer above, and happy to pay. If I click accept, will that pay you and still allow you to let me know if I could follow up? I'm not too sure how this works.
thanks. gums ok. bone ok they say 70%. proposed: pulling two teeth that have really deep decay, though no pain so far / root canal and crown on one tooth / veneers (porcelain or polymer ceramic, my choice (?) on 4 teeth 4,5,12, and 13 to reshape the upper arch (those teeth are too far inward), four front crowns replaced with porcelain on zircon crowns, "reobturation of old silver fillings on upper posterior teeth", a few composite resinn fillings, and "onlays" on lower osterior teeth to reposition occlusion.
I had never heard of onlays - are they a quality treatment?
So, I understand you're not in a position to know if this is appropriate, but I would ask - are these all legitimate, good quality procedures and materials?
And, also, do most dentists provide photos somehow of the expected results before any work is done, since this will supposedly improve appearance and smile greatly, or is it just hoping that the aesthetic result looks great?
ps what happens now - do I pay you again, or ?
thanks very much. I should have mentioned that, first, my wisdom teeth have never erupted, so that's four teeth that are not part of any treatment plan. The onlays, as I understand it, will restore part or all of the height of the lower teeth so that the bite or whatever it's called - the way the teeth come together - is more natural, as it is currently very unnatural - requires the jaw to go way back and way up for the teeth to meet. Does that explain the onlays?
Sorry, as to the teeth that have deep decay and recommended to be extracted, I forgot that that was the recent opinion of a different clinic, not the dentist whose treatment plan I'm describing for everything else. so, the dentist whose treatment plan I'm focusing on saw me 10 months ago, and of these two teeth, #15 was not to receive any treatment unless it was one of the "reobturation of the old silver fillings" and #12 was to receive a veneer. Possibly the "deep decay" was not as severe when he saw me 10 months ago, so I guess I would ask him to re-evaluate those two.
One thing that this dentist said was that he felt his treatment plan, with the onlays and veneers, is better than crowning all the teeth, because crowning requires the removal of such a large part of the natural tooth. Is he on the right track there?
Sounds as if the choice between crowns vs veneers for #4, 5, 12, and 13 is a judgement call - I believe the price is about the same. He said that those teeth are so far inward that the veneers cannot bring the face out as far as would be ideal, but that they would certainly help.
For what it's worth, his prices are $500 for crowns / $500 for porcelain veneers / $253 for polymer ceramic veneers / $253 for onlays. If you wanted to see more about this particular dentist, for your own info or whatever, his website is http://www.pvsmile.com.mx/ Dr Noel Rivas in Puerto Vallarta, Mexico - his office is as new, modern, and up to date (at least as far as I can tell) as any I've seen in the US and is located in a new hospital - I was told that if his office is in that hospital, he must be good.
Is there any way for a patient to know if the doc is using a good lab?
so, you've been very helpful. if you could reply to this, I'd appreciate it so much. I'll punch in another $15 right now if that seems reasonable.
Thanks again - you are certainly helpful and I understand what you say pretty well.
Is Zircon a "high noble metal"?
Since I visited Dr Rivas last March, I know that it's not a case of just a fancy website with pictures of someone else's office, and he seemed absolutely professional and thorough and caring, but I guess there's no way of knowing for sure. Unless I knew others who had been treated by him, but, of course, I don't, since it's in Mexico.
I believe Dr Rivas does not do any lab work, so would there be any way of knowing the quality of the lab(s) he uses - other than the question of "high noble metal"?
The purpose of the onlays, as I understand it, is to build up the height of the teeth so the bite meets better. I do not believe that my jaw has ever been out of place, just that the wearing down of the teeth from grinding now prevents the lowers from meeting the uppers properly.
About the preparations, Dr Rivas said he would take impressions, then something about "articulate", then study the bite, then do temporaries, then prepare the teeth, then final impressions, then place temporaries. Somewhere in there was "models to the lab". I don't have this exactly as he said it, as it's from notes and memory, but do these things seem to indicate he's on the right track and doing all that should be considered?
Re: veneers - he carefully pointed out that the veneers should only build up the tooth face so much - that if they were too thick, they would interfere with brushing, and also something about the gums need stimulation from chewing to remain healthy or to not recede or something, and if the veneer is out too far, the gums won't get the stimulation.
He said that my smile will be close to as good as it would be if all teeth were crowned, but that avoiding crowns, when possible, is good because crowns destroy all tooth enamel.
will appreciate your thoughts on these things - I think you are helping me gain some confidence in the procedures, but please don't hesitate to be blunt if you see any red flags here.
I'll go to work on the additional fee or bonus right now. thanks very much
Thanks again. So helpful.
So, the porcelain on zircon is a good thing? Am I understanding that right?
And, if he's proposing porcelain on zircon crowns, is that a bit of an indicatin tht the lab work will be good?
I guess my biggest uncertainty now is the aesthetics, as far as the front teeth are concerned - the 6 upper front teeth would all be crowns, and the lowers would be reshaped or some built up or whatever, so that my smile - every tooth in it - will be new, shaped by someone in some lab. How the heck do I have any idea if the appearance will be great for me and my face/smile, or just maybe technically great but not right for me and my face/smile? It's sort of an artistic / judgement thing. I mean, I'm not George Clooney, but I'm aware that a lot of reconstructed smiles look artificial and/or wrong for the person's face. What do you think?