Which is bettter, bonding or Porcelain Veneers?

They are both good, but each has it's advantages and disadvantages. Bonding can enhance the appearance of teeth , requires no particular preparation. It can be used to restore cavities, and add to the contours of teeth. It is can be very natural in appearance and blends quite well with natural teeth colors due to its optical properties.
Bonding does have a problem that it doesn't hold surface detail as well as porcelain and can pick up stain especially when a patient doesn't have ideal dental hygiene. Plaque left on bonded surfaces can create porosity that can allow stain to attach to the composite material and also porosity can make the bonding appear 'water logged'. 'Water logged bonding appears to expand and stand slightly away from the tooth surfaces.

Porcelain Veneers are less able to blend in with natural teeth but still can create an extremely pleasing appearance. They are especially good for lightening and lengthening teeth. If made properly they can mask minor discolorations in the underlying tooth structure because a skilled technician can opaque the porcelain. They hold their surface glaze better than composite and are stain resistant. They do not require the dentist to be the"artist". Instead a dentist can specify an extremely talented ceramicist to create a new look for their patient. Free hand bonding requires the dentist to be the artist and although many dentists are extremely skillful, not all are capable of carving creating extremely natural bonded restorations. For them Porcelain Veneers can provide a more predictable esthetic result.

Porcelain veneers do often require more tooth reduction in order to not look bulky and are more expensive than bonding. Porcelain veneers usually take two or more visits, while a bonded composite restoration can be done in a single sitting.

In terms of cost, in my practice a free hand bonded restoration is about a third of the cost of a porcelain veneer. This is the biggest drawback of porcelain veneers. Many patients who might benefit from porcelain veneers opt for bonding for primarily financial reasons since 10 porcelain veneers can require a patient to spend in excess of $10,000. For many patients ,simple bonded enhancements can improve a smile while not 'breaking the bank'.

How long does a crown take to make?

In my New York City dental practice it takes a week or two for my dental laboratory to return a completed crown. I allow them this time to allowt them not to be rushed and give them a chance to do their best work. The porcelain for these crowns is 'hand stacked' by a ceramicist and is highly esthetic.

Recently a new technology is becoming more popular involving cad cam technology that allows dentist to fabricate same day crowns. Examples of this are Cerec and E4D cad cam machines and where indicated these machines can impression and mill restorations in a single day. These one day crowns are not optimal for all situations since they can not utilize a bevel preparation and probably the esthetics can be better on more customized traditional 'hand stacked' porcelain crowns.

Several of the dental practices in my building have invested in this technology and they seem happy with it. My good friend and collegue Dr Jay Schuster has recently installed one of these systems in his dental practice in Morristown New Jersey and he has invited me to observe the system in action and I look forward the opportunity to learning more about this process.

If a crown comes out can it be recemented?

The answer to this question is it depends. When a patient comes to my office with a crown that has come loose, I inspect the tooth and the inside of the crown. I check for tooth decay and to see if the tooth holding the crown has fractured.

Often crowns that come off should not be reused, since the fit of the crown may have been lacking or the tooth structure holding it has decayed. In that case I will recommend fabricating a new crown for a patient.

If it looks it is a possibility that a crown may be reused, I place it in a ultrasonic cleaner to clean it . After it is cleaned I might try an place it back on the patients tooth and take a bitewing and periapical radiograph in order to check how well the crown covers the tooth.

If the radiographs do not show any problems with the fit or coverage, then If the crown looks like it may still be serviceable I sometimes will recemnent it with a permanent cement.

Should I see a dentist in August?

Yesterday was our first day back in the office after two weeks of vacation. Every year we close for a couple of weeks for some R&R. Although things are a little hectic we are are back in action and seeing patients. Emergencies are being handled as well as regularly scheduled appointments. If you have been putting off your dental care August can be a great time to take care of it. It usually is easy to get an appointment with a dentist since the schedule often is less busy. Keep in mind that most offices take off some vacation time during August so that may have to be taken into account.

What did you do for your vacation?

This summer my son and I spent five days in Paris. We stayed in a tiny room in a hotel in Saint-Germaine-des-Pres and toured the Louvre, saw Notre dame, around on the open buses and took a side trip to Versailles. Paris is a beautiful city and just possibly my son didn't mind being separated from his friends for the week. We ate a lot of crepes and ham sandwiches and probably it’s time for me to go on a diet!

Of course my son is already wondering about where our next adventure will be. I think he has the travel bug, for sure!

How long after an extraction should you wait to have an implant placed?

There is no definitive answer to this question. If adequate bone is present on all 4 walls of a socket,then often an implant can be placed at the same visit as the extraction(or not-its up to the judgement of the implant surgeon). If bone grafting is needed because a socket is missing one of its walls, than most surgeons choose to wait 3-4 months before placing an implant. Many patients, partly due to financial reasons, want to know whether they can wait longer to place an implant and usually its fine to wait upto a year after an extraction to have an implant placed.

Waiting additional time may allow the bone at a proposed implant site to shrink and also allow adjacent teeth to shift. This may make it more difficult to have an appropriately sized implant to be placed. It's best to meet with an implant surgeon prior to an extraction, in order to plan both your extraction and time of implant placement.

Do your office have an "Official Facebook page"?

Until recently we did not. I had a personal page that functioned as a professional page as well. It seemed that it was time to separate my personal from professional on Facebook. Now I have established a professional page "Lawrence Spindel DDS". Please excuse the fact that it's light on content for now, but we will be adding more content soon.