I think the thing that most blew me away about this case was the management of the cervical 1/3:

Here is the mid body:

Here is the incisal edge

Can you tell which teeth are veneers?

Hint: I think I’m going to custom scratch #8 a little bit more next time I see her. It’s just a little too perfect.

Stump shade gives it away:

Photography and Ceramics by Josh Polansky, Niche Labs, Cherry Hill, NJ
So of my good friend Barry Polansky, Author of “The Art of the Exam”, and proud father to have exposed his son to apprenticeship under some of the leading ceramists in the world
Steve Markus
The Centre for Dentistry at Haddon
209 White Horse Pike
Haddon Heights, NJ 08035
www.SmileSouthJersey.com
856 SMILE S J

The wheels of bureaucracy grind slowly. Fourteen years after public health dentists recommended that fluoride levels be reduced to 0.7 ppm (Heller et al.), the Department of Health & Human Services has officially recommended doing so.

Fluoride Action Network is concerned that this new level of fluoride in drinking water has been set too high. It neither protects teeth from dental fluorosis, the stated reason for the lowering, nor does it protect the baby’s developing brain, an issue not even mentioned by either the CDC or the EPA.

It goes on to say: “• According to Kathleen Thiessen, PhD, one of the authors of the NRC 2006 report:
“[W]hile the proposed recommendation for a lower national fluoride level in drinking water is a step in the right direction, and a quiet admission that some people are ingesting too much fluoride, a number of concerns are not yet addressed. Infants fed reconstituted formula, people with high water consumption (e.g., athletes, laborers, persons with medical conditions such as diabetes insipidus), persons with impaired kidney function (and consequent reduced excretion of fluoride), and persons with a hypersensitivity to fluoride will continue to have fluoride intakes in excess of a safe level, even when the new recommendation is implemented. These people also deserve to be protected.” (Thiessen, 2011)
• No mention has been made by the HHS or EPA that the chemicals used to fluoridate drinking water in the US are hazardous waste byproducts of the phosphate fertilizer industry. This is the first time in the history of mankind that highly hazardous waste has been shown to have health benefits, yet no toxicological studies have been performed on them.”
For further information visit the Fluorosis page of our website.
And for the full article: click here

Comments from colleagues: This issue is trivial compared to other real life factors. Ask your adolescent patients what they have for breakfast everyday. For far too many it is pop and candy or Monster, Red Bull, Rockstar etc. Not only does this diet wreak havoc on teeth, but 30 yrs from now we won’t being hearing a word about health issues from Fl in water, as the more serious health complications heart disease, diabetes, stroke etc will dominate our concerns.

Controlling tooth decay should be simple: we know the cause and how to
eradicate it, but due to the issues of diet & oral hygiene (not Fl in
water) I continue to see adolescents with 20+ decayed teeth and
adults, who if you gave a tooth brush, wouldn’t know which end to use.

Maybe it’s just my area?

It boggles my mind that they waste so much time & $ with the Fl in
water issue and completely neglect the real killer!
Misleading information. We need to put together a press release. It’s not fluorosis, but what it’s doing to every other organ system that the fluoride has an affinity for that is the intrinsic difficulty. Add to that Homer Simpson is on the control valve, and so the concentration city to city and day to day can vary if not properly monitored. This is a page about human error with Fluoride.

Take a look at all the Extreme Makeovers we have performed in

our

office.

My first reaction to the reflection in the mirror handed to me after Dr. Stephen Markus completed the restoration of my smile was to exclaim to the good doctor, “You are more than a dentist, you are an artist!” I have never in my seventy plus years been so confident and comfortable speaking and smiling in the company of others. Illness and the ravages of time had taken their toll on my mouth’s health and appearance, but Dr Markus has given me one more blessing to add to my list on many. My heartfelt appreciation to Dr. Markus and his talented and caring staff.

For more, visit the testimonials page of our website.

Rochelle Friedman

So, I’m getting closer to funding the sign with flashing lights for my front lawn:
WE REPAIR $500 VENEERS Call our office – 856 546 0665
Fortunately for her, I only have to do the six anteriors to make her smile better. Unfortunately for her, those 6 are gonna cost her a bit more than she paid for 10. The wax-up is in Juan Olivier’s hands now.

She looks like Bogart when she tries to smile, her obicularis oris (muscle that controls the lips) is being stretched like a rubber band. The smile line and mid lines are both canted (he missed the fact that her interpupillary line is not parallel to the horizon, she’s got one eye about 1/2 inch lower than the other.

The lower antherior plane isn’t parallel either. He was given ample opportunity to make things right, so now, for the cost of 10 veneers, perhaps he’ll take some training. Yes, that’s a nice little glob of cement distal to 12, that in all the time he spent trying to make her happy, he obviously never saw. And how about the natural appearance of 3/8″ thick porcleain! Look at the edge detail! The incisal bevel is in the wrong direction, so as to make those suckers look even thicker.

So when Cindy McKane asked what we thought about Lumineers on Sunday, on the CC board, this is what I see on a weekly basis for second opinions, and this, is what I read: “We got our first case back (free offer for an office member for 6 lumineers) and we totally rejected it. The shade and contours were very nice, but the gingival margins sucked so bad that is was a precursor to periodontal disease. They were jagged, fractured, uneven, overhung and short of the gingiva.

When we called, they refused to give me the name of the tech, stating that is not allowed. We were not even permitted to personally speak to the tech. We are to send them back and they will hopefully redo them but there is no guarantee which tech we will get.

I am very disappointed, especially since there is so much hype. The examples you see at the courses show nice smooth margins. These were a disaster. No way a patient, even a dental professional, could keep these hygienic.

Suzanne ”

I can’t be positive that these pictures are Lumineers, since I didn’t write the check to the lab, however, the patient told me that Lumineers are what she was told she was getting, by a dentist who touted his cosmetic expertise.

What makes this case even simpler is the anterior open bite.- I have launched a new website that talks about these and other issues at: www.theedgesmiles.com . Let me know what you think about what I’ve posted there.

I was notified this morning by other members of the Academy of Contemporary Esthetics, of which I am a Fellow, about the story you did last night that made national attention this morning. While I think you attempted to be very even-handed in this report, presenting both sides of the story, I think that the public needed to understand the fact that Lumineers are not widely accepted by those of us practice cosmetic dentistry full-time.

I know you and I have done several stories together in the past, and have offered my services as a consultant when I have dealt with your assistant Dawn Heefner.

Think about this situation for a second. Let’s say you wanted to place an artificial foot on someone, but rather than amputating the foot so you could put the person back at the same height, you just built the new foot over the old one. That would leave the patient with quite a limp, and their shoes wouldn’t fit any longer, because the new foot would be wider, longer and taller than the old one.

Form must follow function. In the mouth, if veneers are done before the bite has been equilibrated to perfection; you are only magnifying the unevenness in the bite by changing the smile without correcting the bite. Add to that the fact that most Lumineers, especially on lower teeth, can substantially modify the bite, and you’ve got a problem.

What the public needs to be aware of is that Lumineers are generally done by dentists who haven’t had the training in cosmetic dentistry that cosmetic dentists have. Lumineers have limited application: To make teeth longer, or to close gaps between teeth.

In the case you showed on TV today, you made several assertions which I would like to expand upon:

1. Lumineers can be done without the discomfort of injections – this is true, in the right applications, but most cosmetic cases we treat require more than correcting already perfectly aligned teeth, and to do that, teeth have to be shortened, narrowed, recontoured and made to fit back in the curvature of the arch. To do so requires some drilling, and therefore anesthesia. Most dentists I know pride themselves on their ability to minimize the discomfort of injections by adhering to a specific order and type of anesthetic. We also have many other anxietolytic remedies including nitrous oxide, headphones, sedation.

2. Ultrathin – How do you develop natural translucency in a thin layer when you have a dark underlying tooth, without the veneer appearing opaque? Most Lumineer cases I have seen are monochromatic without characterization of incisal edges which makes them look more natural.

3. Your ADA representative stated something about wanting to take a wait and see attitude. This made me laugh. These lumineers have been around for 20 years. How long does he have to wait? The ADA gets a lot of advertising dollars from DenMat, so what is a representative of the ADA going to say? Just this week I got a letter from the attorney for DenMat asking me to take down negative references to Lumineers on my website. My colleagues felt I had done nothing wrong, and should have kept the information up, but I don’t have the time for legal battles. The purpose of that information on the site was to dissuade individuals who were contemplating laminates by untrained dentists, to re-think the process. I am currently involved as an expert witness in a case that was one of the worst examples of what happens when untrained dentists are led to believe they can be cosmetic dentists by manufacturers of these products. This is not to say that these restorations are improper. Case selection (and dentist selection) are of the essence. Those pages will be back up on the site soon, after we have modified the terminology.

4. You state that Lumineers have a record of strength and durability. In our experience (and I have asked my colleagues for affirmation in this realm), this is not exactly the truth.

5. Where do you come up with a $1000 per veneer fee? You know, you can buy wigs in a wig store for $29.95, or pay a wigmaker ten or more times as much to get something custom made for you. There should have been a range presented. We used to think about putting a sign out in front of our office saying “We repair $600 Lunineers”.

6. Finally, you have the patient stating that she thinks her smile looks fabulous. This is certainly true from a layman’s standpoint. While the after pictures are not close-up enough for me on my computer screen to assess thoroughly (and I would be happy to critique them further for you if you can send me the jpeg files) the veneers look extremely over-contoured and fat to me and the gums look really puffy. This is typical of the result you get when you don’t adequately prepare the teeth. They also look very monochromatic and opaque, although that may be my prejudice against Lumineers coming through.

Sincerely,
Steve Markus, D.M.D., F.A.C.E
The Centre for Dentistry at Haddon
www.cent4dent.com
Symphonic Smiles – hands-on training in cosmetic dentistry and library of dental office letters
www.symphonicsmiles.com
1 800 520 3440

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