The 2 teeth that have deep decay and treatment planned for extractions... are they your wisdom teeth
? If not, do you know whether you'll miss having them for functioning (chewing/biting)? Ideally, if the teeth are restorable (especially if they are molars
), and the surrounding gums/bone support is there, you should go through with the root canal treatment and then place crowns on them. Aside from providing cosmetic/aesthetic results, as dentists, we should also focus on trying to maintain your existing teeth as best as we can and extraction shouldn't be so quickly performed. (However, if the teeth were in terrible shape and you had preferred to extract and place dental implants
, then that's a different and often viable strategy.)
The veneers on #4, 5, 12 & 13 (the "premolars
/bicuspids")... I would advise you to be weary. They can certainly be performed as I have personally seen many done. I've also had the opportunity to replace a number of them performed by previous dentists. The veneers are held on simply by some composite luting agent. Lack of a better word, it's some form of strong super glue. But if you were to bite down on something hard enough, at the wrong angle, you're liable to chip/fracture the veneers and/or completely displace them. So in short, you can have the procedure performed and it will look great. But expect a certain level of fragility and that they may need to be replaced somewhat frequently.
I'm not keen on the "reobturation of old silver fillings on upper posterior teeth." If your current silver fillings are in good shape (granted they may be oxidized and dark in color), but if the margins are intact, then the fillings can remain serviceable for many years. I've seen silver fillings last over 50 years and still going strong. The point here is, unless the fillings are already failing, it is often better to leave well enough alone. Because as we go in to remove the filling, we have to make the preparation wider and deeper. And considering we're replacing a metallic filling (which has been fine, or I'm assuming never bothered you) with a composite/plastic filling... one would wonder how durable the replacement filling would be, especially if the size of the filling is fairly large.
I'm also curious as to why you need "onlays" on the lower posterior teeth. Would this be for all lower posterior teeth? Likely 8 teeth: numbers 18, 19, 20, 21 & 28, 29, 30, 31. If not, then the dentist would not have "repositioned" your occlusion. The final bite needs to be equilibrated, balanced. Unless your bite has collapsed significantly and that you want to open up your bite (perhaps to make room for your proposed upper anterior
crowns), else one should not mess with the existing bite. Because if not done correctly, this can actually lead to the development of severe TMJ dysfunction/pain and although you may cosmetically fix one aspect of your mouth, you could essentially create a significantly greater problem when the TMJ do not respond well to the sudden change in bite height.
That say, an onlay is a legitimate way to restore teeth assuming the conditions/requirements are met to ensure its durability and longevity.
I cannot comment on the quality of the materials that will be used. Even here in the States, if a dentist chooses a cheap and lousy lab for their work, then the workmanship as well as the quality of the material would be suspect. But at least here in the States, there is potential for legal recourse, so that hopefully the dentist and the lab won't be as daring as to compromising the quality of their work.
Outside of the US, I cannot comment. Personally, I would think that some of these medical and dental providers have positioned themselves as "vacation services," and they realize that some of their clients fly great distances to come and see them. They may or may not care whether their work falls apart once the patients get home because chances are, they won't fly back and confront them. On the same token, these dentists may want additional referrals so you would think it'd be in their best interest to provide the best materials they can to generate future referral income.
Most dentist will be able to provide a portfolio of the work they've done, especially dentists who thrive on performing full-mouth reconstruction cases (such as ones that you're considering). This can give a sense of what it would look like, but again, it does nothing to show whether the new restorations are balanced and/or will function well. And ultimately, every mouth is different so what looks great for the guy/gal in the photo, may not look the same for someone else.
As for paying me again, it is solely up to your discretion. You get to decide if my response is worth the additional payment. And if it is, whether it's worth any bonuses.
Jul***** *****, DDS