Episode 56 - Smile with Lumineers, Veneers, Invasalign And More: Dr. Dan Spills All He Knows..

Transcript

Take care of your oral health by consulting with a San Diego cosmetic dentist.

TERI HAUSMAN: I'm Teri Strucks, host of beauty now.  A weekly podcast that brings you the latest buzz in all things beauty.  We featured many famous experts in their fields.  Lips, lasers, breast augs, butt rejuvenation, skin rejuvenation, hair, lashes, eating for beauty, anti-aging, cellulite and much much more.  Today, we're going to talk about veneers, your teeth, how can we have that pretty pretty smile.  And we have a board certified dentist, Dr. Dan Gustavson:.  Welcome Dan.

DR. DAN GUSTAVSON: Hi Teri, how you doing?

TERI HAUSMAN: First of all, I'm doing great, Dan.  Can you tell our listeners today about what's the best way to get the best looking smile?

DR. DAN GUSTAVSON: Oh, there's a lot of great ways to get a great smile these days.  As a matter of fact, I think probably the best way is to go into your local favorite dentist and say, "Hey, do you, you know, do you do cosmetic dentistry?”  Find out if that's one of the things that they- it's not so much a specialty but it's, it's just something that, in other words, there's no specialty like there is in orthodontics or pediatric dentistry.  Something like that.  So just find out what their level of experience is in doing cosmetic dentistry.  Get to know them.  Get to trust them.  Feel out the office and see if you like what they're doing.  Have them show you some of the before and after cases that they've done.  This is really a powerful tool, these days, because everybody seems to have really great websites and there's a lot of information available to patients, these days.

TERI HAUSMAN: You know, that's a good point.  Before and after pictures on any procedure, I would say that, ask if you can talk to the patients and I think that's a good start.  Now what is, there's those plastic braces that you can have.  I think they're called Invisalign.  What do you think about those?

DR. DAN GUSTAVSON: Oh, I think they're one of the best things to come out in Dentistry in years.  In decades.  Mainly, you know, my wife, Dr. Miley Ramirez does a lot of the Invisalign cases for our patients in the office.  So people who want a little bit more conservative dentistry maybe don't want to have anything placed on their teeth but instead just want to shift or move them around a little bit.  Maybe they're happy with the color of their teeth, and then they wear these Invisalign.  It's like a clear retainer, so to speak.  And, with these retainers, the teeth will shift from, say, crooked to straight or if there are gaps between the teeth, they can close the gaps.  So it really is a lot easier than the traditional braces with the wires and the rubber bands and all the things that I had growing up as a kid.  And I'm sure-

TERI HAUSMAN: And I had, I had a headgear, that's really ugly.

DR. DAN GUSTAVSON: Yes.  Yes I know a lot of people had those and they're not a lot of fun.  And Invisalign really solves a lot of problems like that, yes.

TERI HAUSMAN: So, Invisalign's kind of like a series of different retainers that move your teeth, correct?

DR. DAN GUSTAVSON: That's exactly what they are, yes.  It's usually, I would say, twenty to maybe thirty at the most sets of retainers, so these cases tend to last six to twelve months.  If maybe somebody has a bit more crowding in their teeth, it might be a little bit more than a year, but it's pretty rare that a case goes for more than a year with Invisalign

TERI HAUSMAN: So is this more for adults than children?

DR. DAN GUSTAVSON: Yes, definitely more for adults than children.

TERI HAUSMAN: Adults than children.  So, and what about, we hear so many different things, now.  There's Lumineers, Veneers.  Set us straight.

DR. DAN GUSTAVSON: Okay, like, what's the difference between Lumineers and Veneers?

TERI HAUSMAN: Yeah, what's the difference.  I mean, first of all, wouldn't you say, I mean, I would say, too, that Invisalign is the best route to go, because you don't damage your, your teeth.  You're protecting your teeth so that's more for somebody who actually likes their teeth.

DR. DAN GUSTAVSON: Absolutely.  You know, it's a very conservative procedure.  We'll call it minimally invasive.  As in, we're not really touching the teeth a whole lot.  We do polish a little bit to create room when somebody has crowding with their teeth.  So then the trays have a place to move them to, with the Invisalign.  But, in answering your question with Lumineers vs veneers and I'll throw out the other term which is bonding, that's out there and we'll start with that one and say bonding is plastic veneers.  They're bonded.  It's a white or a tooth color type of material that's bonded directly on the teeth.  So, by bonding, I mean, it's a plastic that's glued to the tooth structure.  Generally, no tooth structure is removed.  The bonding is just added to the tooth structure.  And then-

TERI HAUSMAN: But the bonding, I'm sorry, so the bonding actually, you paint this property onto your teeth.  And it, does it make them look better?

DR. DAN GUSTAVSON: Yes, absolutely.  So, if somebody came in and they had some chips, broken edges on their teeth, slightly discolored teeth, things like that, a bonding can be placed on the teeth to really make them look better.  Like, a lot better, actually.  The disadvantage of bonding versus say the Lumineers or the porcelain veneers is that, over time, the bonding is plastic as opposed to porcelain so it's a little bit more dull over time.  And I'm not saying it goes from white to yellow or something. It's just they, they fade a little bit over the time, say a five to seven year period.  Whereas porcelain or the Lumineers tend to last a bit longer than that.  They just have a bit more luster and you've probably seen porcelain, certainly in sinks and everything else.  It's got that shine to it, right?

TERI HAUSMAN: Right.

DR. DAN GUSTAVSON: SO that's the advantage that we have with porcelains, that they mimic enamel.  They, they really are more real-life types of colors that come off of the porcelain materials.

TERI HAUSMAN: So, bonding, you don't really damage your tooth, either.  It's like a, an application that you put onto your tooth and that's plastic.  And veneers, you do have to damage the teeth, right?

DR. DAN GUSTAVSON: Well, not necessarily.  And that's where, you brought up the name Lumineers.  It's more of a trade name.  It's by one of the local California companies that they have all the rights and the patents and everything on this particular process.  And it is a form of conservative veneers.  In other words, they talk about this product as being a porcelain that we don't have to prepare the teeth and it's bonded like the plastic is, only it's made out of porcelain and it's bonded directly or glued onto the tooth structure.  So, again not damaging any tooth structure whatsoever.  And then we have the other types of porcelain and to make this pretty straight forward I would say there probably two or three, nowawadays, types of porcelains.  There are some milled porcelains, where they're put in the machine, like a block of porcelain, and it can be milled to fit someone's tooth.  Or there's porcelains that can be added or we call it "Stackable Porcelain".  The technical name is called Feldspathic.  And then there's other types that are pressable and one of these popular names is Empress.  So if I were to talk about Empress and compare that with Lumineers, Empress is a pressable ceramic, whereas Lumineers are the type of porcelain that is like a powder and, and a liquid paste kind of thing that's put in an oven.  And once the veneer is made, it's very very shiny when it comes out of that oven, whether you used the porcelain pressable or the Feldspathic.  So the different types of porcelain depending on the scenario: What the patient wants and what their physical needs are.

TERI HAUSMAN: So, basically, you have to go in for a consultation, because there's so many different options.  What's your preferred option for patients?

DR. DAN GUSTAVSON: I'd say, these days, probably a little bit of both the Lumineer type of restorations, where we're using Feldspathic so I can be very conservative and the other one being Empress and even, lately, we've been doing a lot of cases with this Cadcam tech which is kind of catching on.  There's a product called E max out there that is really pretty amazing so let's say somebody came in.  If you came to me for consultation.  You said Hey Dr. Gustavson, people call me Dr. Dan so you say "Hey Dr. Dan, I've got these really really dark teeth.  I, maybe I took tetracycline as a kid and my teeth have brown or gray colors to them" and you're embarrassed to smile or anything.  And with dark colors like that, I may choose something like the E max material, 'cause it does a great job of blocking out those really dark colors underneath.  So we don't see them, even through the porcelain.

TERI HAUSMAN: So that's, there's so many different things now.  E max is completely different than Lumineers?

DR. DAN GUSTAVSON: Absolutely.  Completely different, yes.

TERI HAUSMAN: And that is actually something that you make up in the office or do you send that out to a lab as well?

DR. DAN GUSTAVSON: Well, the neat the thing about that is yes, I would use a lab but I'm actually very involved in the E max process because what I would do is I take a camera imaging system and you know how they do when they go in and do arthroscopic surgery on a knee or an elbow or something like that and they use those little tiny cameras?  Well, we have those type of cameras, for use in the dental office.  We can take an image of a tooth and it'll come up on a screen.  So now I have this, it's called "CadCam" technology.  So, now I have this tooth or in veneer cases it's often several teeth, up on a computer screen.  I can rotate them around, I can move them sideways, I can flip them upside down.  And the patient is just relaxing, and listening to an iPod in the chair.  They don't even pay attention to this stuff.  So I've got this whole three-dimensional computer image.  That I make sure is perfect.  Then, I send that image to my lab technician.  And, I go ahead and have the veneers made between the two of us.  In other words, I start the process, my lab technician finishes the process and, and puts the perfect colors in and then, then I bond them into the patients teeth usually about a week or two later.

TERI HAUSMAN: So, do they go around with their teeth kind of filed down for a week?  You have to hide and then you come in and-

DR. DAN GUSTAVSON: Yes, you have to live in a cave, for a week.  No, I'm just kidding.

TERI HAUSMAN: Yes, that's what I'd suggest.  No.

DR. DAN GUSTAVSON: Great question.  You know, as a matter of fact, I have never, in the twenty years I've been placing veneers, let someone walk out of my office without a pretty comfortable, happy smile.  They have plastic temporary veneers on their teeth.  They look great.  You know as a matter of fact, if you came to me in that example, if you had dark teeth, when you walked out, even if I was waiting for my lab tech to work with me on this case, you would walk out looking better for sure than you walked in.

TERI HAUSMAN: Dr. Dan, I am liking this.  This sounds really good.  We do have to take a commercial break to thank our sponsors.  One of them being Ice.com.  We'll be right back with Dr. Dan Gustavson:.

COMMERCIAL BREAK

TERI HAUSMAN: Hi.  We're back with Dr. Dan Gustavson:.  This is Beauty Now.  Teri Strucks.  Welcome back, Dan.

DR. DAN GUSTAVSON: Hey.  Thanks for having me.

TERI HAUSMAN: Sorry.  Dr. Dan.  Don't want to be impolite, here.

DR. DAN GUSTAVSON: That's fine.  Dr. Dan it is.

TERI HAUSMAN: So we were just talking about veneers and Lumineers and ecad.  Keep talking and tell us what to do.

DR. DAN GUSTAVSON: Yeah, E max is the one we were talking about.

TERI HAUSMAN: So E Max is different ... so Cad is the computer right?

DR. DAN GUSTAVSON: Yeah, Cadcam is the-

TERI HAUSMAN: Cadcam

DR. DAN GUSTAVSON: Technique or the process.  E Max is, like, the trade name, so

TERI HAUSMAN: Okay

DR. DAN GUSTAVSON: I said, the Lumineers, to clarify that, let's say you came to me and you didn't have really dark teeth and you said "Hey, you know?  I just, I'm not crazy about the shape of my teeth and they're not perfect.  And I want them to look better and a little more uniform all the way across.  Then I might suggest something like Lumineers.  And, this is that Feldspathic porcelain that we talked about earlier and the difference there is it's a very very thin, very conservative type of material that can be bonded onto the teeth, just like the E Max that we talked about earlier.  The difference is, we really have to have case selection, here.  I can't say that Lumineers work for every single patient.  I've replaced them on some patients, where they didn't work correctly.  And I've done the same for the E Max.  We want to make sure that we're choosing the right material for the right patient under the right circumstances.  And that's why I spend so much time finding ouTeri Hausman: what does the patient want?  When you came to me and you said you want to hide your dark teeth, that tells me a lot.  So I really want to ask a lot of questions of the patient.  What do you want?  And how do you want your teeth to look?  I have patients come in and they give me cut-outs and I'll have some gentleman come in and say, "Here, I wanna look like George Clooney" or "I wanna look like this guy" or "Brad Pitt"-

TERI HAUSMAN: We want them to, too.

DR. DAN GUSTAVSON: Exactly.

TERI HAUSMAN: Do your job.

DR. DAN GUSTAVSON: I'm sure you do.  So I love that.  I love it.  Because they give me feedback and they give me guidance and then I can help them get what they want.

TERI HAUSMAN: Except for, you have to make them know that you're not a magician, and they're not going to look like George Clooney but their teeth could look pretty damn good.

DR. DAN GUSTAVSON: That's right.

TERI HAUSMAN: So how long do veneers last and what lasts the longest?  What's your fav?

DR. DAN GUSTAVSON: For longevity I would say E Max is a very very strong material and the Empress is a very very strong material.  I would say an average time for veneers would be ten plus or minus years.  I have been in practice twenty years and I've placed veneers twenty years ago and they're still going strong and I think it really has a lot to do with patient compliance.  Are they brushing and flossing their teeth?  Are they taking of them?  Are they wearing a mouth guard if they grind their teeth at night?  Are they doing things to protect their bite?  I think these are things that can really improve longevity and so I would say ten to fifteen years is a really pretty fair guess on how long these materials are going to last.

TERI HAUSMAN: So, what about Lumineers and, and I keep forgetting this: E Max.  They all last about the same?

DR. DAN GUSTAVSON: Umm, yes, though I would say the Feldspathic porcelain ones are not quite as strong and so, if you ask about my favorites, my favorites are probably more the E Max and the Empress these days and I've done a lot of these cases in the last decade or so.  Simply because they are a bit stronger than the Feldspathic porcelains.  They just have, we call it edge strength.  They have better edge strength so they can bite more comfortably into apples and crackers and things that are a bit harder and not have to worry that the edge is going to chip off.

TERI HAUSMAN: So I would say, listeners, get your pencils out and write all this down because it is confusing.  And you do have to know kind of what you want.  Unless you have a really great doctor, like Dr. Dan who will kind of guide you into the best thing for you.  What about when veneers go wrong?  Lumineers or whatever?  How do you take them off and repair?

DR. DAN GUSTAVSON: They're all pretty much the same.  Whether it's bonding or or Lumineers or any kind of veneers, we would take the, an instrument and basically polish them off.  Because they're bonded pretty tightly, I mean, you can eat comfortably and confidently with these things on.  Therefore, we have to remove that bond.  And, we basically remove all the way from side to side and top to bottom and basically get back to the original tooth structure underneath.  It probably takes ten or fifteen minutes or so to do that.

TERI HAUSMAN: Oh, it only takes that amount of, is there something special that you use to not damage the tooth, and get rid of it?

DR. DAN GUSTAVSON: Yes, basically there are some pink colored dyes and stains and things that we can use to see if there's a transition, you know, where's that cement line because, of course, we have a white tooth and white cement and a white veneer so we want to make sure that we've got through that porcelain material and through the plastic and again, there are some scientific aids that we have to help us find out where the original tooth structure is.

TERI HAUSMAN: Now, is there any types of guarantees that ... let's just say a patient comes in and they get Lumineers and then one year later, they're cracked, so ...

DR. DAN GUSTAVSON: Yeah, that's a great question.  I know Lumineers have a five year warranty.  And, they will allow for one remake of a tooth.  But, again-

TERI HAUSMAN: You mean, just one tooth.  What if four are cracked.

DR. DAN GUSTAVSON: No, no I'm sorry, I mean one remake per, so let's say if you broke your front tooth several times, they're not going to pay for it over and over again.  This is why case selection is so important, so if somebody came in with a really deep overbite, I wouldn't necessarily recommend that they have something like Lumineers because I don't want to have to keep remaking and I don't want the patient to get frustrated with that.  So that's where that case selection comes in very very critically at the very beginning, to make sure that somebody with a deep overbite is not going to have to keep going through this warranty stuff all the time.  We just want to pick the right material for them from the very very beginning, so they're very happy and they don't have to deal with this warranty stuff.

TERI HAUSMAN: Now, what about if you chose a doctor and you got, let's say, and you got some Lumineers and then you didn't want to go back to that doctor to repair them.  Would the other doctor, the new doctor be able to repair them or would that not work.

DR. DAN GUSTAVSON: I have done that before, yes, and I've called the company and they'll generally stand behind their product as long as it's within that five year span and that seems to work out fine.  You know, I think they're pretty flexible about these things.  And you know, one thing I really love to do as well is, I like to try to give people, if they're willing to do it, a kind of a look-see, before we do anything.  In other words, what I do is, I take a model of their teeth.  You know, those stone models that you get when you were a kid with the braces and all.

TERI HAUSMAN: Right.

DR. DAN GUSTAVSON: So what we do is, I take that and I wax up, just simply, I put wax on them and then I make a, what we call a matrix.  With the Matrix, I just flow in some tooth-colored plastic material in there, put it on the patient, peel away the excess material and without doing anything, without touching any teeth, I can give them a temporary version of what we think they could look like.  In other words, they get to wear that around for, let's say, a day.  At home or at work or wherever and get some feedback from some family or friends and make sure their bite is going to be okay.  That they're going to like the look and like the way they speak and the color.  And they can give them a trail run.  And I do these all the time, it's just a really nice, preview trial run with the veneers, before touching anything.

TERI HAUSMAN: And so, you can do that with almost all of these things, like veneers and-

DR. DAN GUSTAVSON: Veneers, bonding, Lumineers, you, I do it all the time.

TERI HAUSMAN: And what's the other two called?  E Max and-

DR. DAN GUSTAVSON: E Max.  The Empress.  Absolutely.

TERI HAUSMAN: Empress.  And then, well, of course, Invisalign would be your first choice if you have good- what about dental implants?  I hear so much about people, now, as they get older they have dental implants.  What-tell us about that.

DR. DAN GUSTAVSON: Oh, they're just amazing.  A guy named P.I. Branemark out in Sweden came up with this idea.  He's, like an orthopedic surgeon fifty years ago and they said "Well, wait a minute, if it works in hip bones and this that and the other, why don't we try it in the jaw?"  And, so we've got one of these companies out forty-years of clinical studies and they're just amazing.  I had a young lady, for example, she came in and she had fallen down.  I mean, she was nineteen years old and had fallen down and she lost her front tooth.  I mean, it just fell out.  It came out in this accident.  And I mean, pretty gal.  We put an implant in and it looks like a screw, basically.  A little piece of titanium that is put in just with local anesthetic.  It's not as big a deal as you might think.  And it's probably simpler, easier than getting a filling placed.  The implant goes in and then I wait a little time, make sure it's locked into the jawbone.  And we gave her a temporary tooth, so she could wear that around for a while.  And what we did was we made her a crown that matched all the rest of her teeth and cemented that to that implant post and voila, within a few months, she had a perfect smile once again.

TERI HAUSMAN: And does that take one or two visits?

DR. DAN GUSTAVSON: It's definitely several visits.

TERI HAUSMAN: Several as in-

DR. DAN GUSTAVSON: Probably at least-

TERI HAUSMAN: But that's not a root canal, right?

DR. DAN GUSTAVSON: It's not a root-canal, no.  If somebody has-

TERI HAUSMAN: My sister, we had an argument about that the other day.  She told me it was a root canal and I'm like: I don't think so.  So a root canal is what?  When-

DR. DAN GUSTAVSON: If a tooth is dying and it has infectious material in it, then that needs to be taken out.  It's a very dangerous situation so either the tooth needs to be extracted or a root canal needs to be done.  And, all that is, is cleaning out the tooth making it a nice sterile safe environment and then placing some rubber material in there called Guttaperch and sealing it back up.  That's all.  Just sealing the tooth.  That's all a root canal is.

TERI HAUSMAN: So what if you haven't had an injury and then you need one of these posts, what does that mean?

DR. DAN GUSTAVSON: You mean, like, the implant?

TERI HAUSMAN: Right.

DR. DAN GUSTAVSON: Well, let's say, I've had a couple of patients where they were born without some teeth.  They were just genetically missing some teeth and they just never came in to begin with.  And other teeth were moving and shifting around and so we placed implants to, to add some teeth back to where, so they never lost anything to begin with, but now they have a full set of teeth and now they can bite correctly.

TERI HAUSMAN: And, I heard it's harder for the front teeth, right?  Because that's where you bite into stuff.

DR. DAN GUSTAVSON: It's not necessarily- I actually prefer working on the front teeth.

TERI HAUSMAN: Really.

DR. DAN GUSTAVSON: They're actually a lot more fun.  They're a bit more of a challenge aesthetically and I think I like that challenge, but I think from a technical standpoint it's actually harder to get back in the molar area with those little tiny screw-drivers and parts and things that we need to get them done, so, you know, the front is really not that bad.

TERI HAUSMAN: Well, we have covered a lot of teeth stuff, today.  We're gonna have you back, Dr. Dan.

DR. DAN GUSTAVSON: Any time.

TERI HAUSMAN: We're going to have you back and if you would like to get a hold of Dr. Dan, you're going to go to personallifemedia.com.  We're going to have Dr. Dan Gustavson:.  He's got a practice in San Francisco for those California listeners.  And, if not, what's your best advice to find a really good dentist.

DR. DAN GUSTAVSON: You know, there's the age old asking friends and family.  I think that's a great way to do it.  Or to call your local dental society.  Because the local dental society often has referral service and they know what's going on.  A lot of these other 1800 dentist and things like that ... yeah, it's kind of a paid advertising type of situation, so you never know who you're going to get.  But, you know, you call the dental society and say, you know: Who's got the good reputation out there?  And then, of course the web, the internet is an amazing source, if you go right to the websites and check out, you know what is their practice philosophy and who is their doctors are.  I think there's some good resources out there.

TERI HAUSMAN: And where they're trained, I think.

DR. DAN GUSTAVSON: Yes.  Where they're trained and how many cases do they have like this and do they have some really neat cases to show you?

TERI HAUSMAN: And check out those before and after pictures.  Thank you so much.

DR. DAN GUSTAVSON: You're very welcome.

TERI HAUSMAN: You may now, listeners, if you'd like to get a hold of Dr. Dan again, call personallifemedia.com and if you have any questions, [email protected] and we will get back to you with all your questions and thank you once again Dr. Dan.

DR. DAN GUSTAVSON: No problem Teri.

TERI HAUSMAN: Look forward to talking to you again.

DR. DAN GUSTAVSON: Okay, sounds good.

(Song) “You Had A Little Work Done” by Mark Winter