Replacing Old Veneers or Implants in Beverly HillsDental work that failed, or that looks wrong.

Veneers that are too white, too bulky or too uniform do not look like teeth; they look like dental work. The usual causes are porcelain made too thick over too little preparation, opaque porcelain that blocks the light natural enamel lets through, a shade chosen without regard to the tooth beneath, and a design made to a template rather than to the face. Replacing them well is harder than doing it right the first time, and it starts with working out why the first set failed.

The gum line is often part of the problem. Teeth are framed by the gum, and where the gum sits at different heights, new veneers look uneven however well they are made. In this case and this one, a gum lift came before the new veneers.

Veneers that are too long are often an attempt to hide a gummy smile. Lengthening the teeth at the edge does nothing to the gum showing above them, and the teeth then look too long for the face as well. In this case, six overlong veneers were replaced only after the gum line was raised and the rise of the upper lip lowered, with ten new veneers designed to the new frame.

The old veneers are removed and the teeth beneath them assessed. You wear the new design first as temporary veneers, adjusted in the mouth until you approve it, and the final porcelain is copied from them. In the case from abroad, the veneers had gone in without temporaries or a try-in, so the design was not tested in her mouth before the porcelain was bonded.

A crown is made to the gum line and to the teeth around it as they were on the day it was fitted. When the gum recedes, its edge shows; when the teeth around it change color, the crown does not. Porcelain does not respond to whitening, so where you want your teeth lighter, we whiten them first and match the new crown to them.

In this case, an old crown on a front tooth was replaced together with three new implant crowns, so all four matched her own whitened teeth. In this one, receding gum had exposed the dark edges of old veneers.

An implant that is sound can carry teeth that are not, and for many patients that is why they stopped smiling in photographs. A single implant crown has natural teeth beside it, so any mismatch shows: a crown longer than its neighbors, a shade that sits apart from them, or a gray shadow through thin gum from a metal abutment. In this case, two implants placed in adolescence ended up higher than the natural teeth, and their crowns looked short and wide.

In a full arch there is nothing left to match, and the common failures are failures of design. The teeth are too large or too long for the face, too white for the person's age, or one flat shade with every edge in a straight line. A visible join shows where pink acrylic meets the gum. The bridge is bulky, pushing the lip out or crowding the tongue; bulk on the palate side is a common cause of a lisp, and reducing it returned speech to normal in most patients in one study.

Teeth that are too long usually mean gum was lost and never rebuilt. A bridge that rebuilds only the teeth onto a receded gum line leaves them too long, because every tooth has to stretch to reach the tissue. Pink porcelain, porcelain shaded to match gum, replaces the gum and bone height that was lost, including the small triangles between the teeth, so the teeth keep natural proportions. It is needed where gum and bone have been lost; where little has been lost, the bridge can carry teeth alone.