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Susan, Catherine, Kathy, Pam and Dr. Huefner

When patients comes in to Dr. Huefner’s dental practice to have us create a new smile for them with porcelain veneers or porcelain crowns they are always a little concerned about knowing that they’ll get the kind of smile that they want, that they’ll be happy with the end result.  This is very understandable.  Obviously the patient has certain goals in mind, as does Dr. Huefner, the cosmetic dentist.  And if communication is good between all, then we will most likely all be on the same track.

Experienced cosmetic dentists, like Dr. Huefner, usually have a trick up their sleeve that enables his patients the ability to preview their new smile and actually approve of all the parameters before the final smile makeover is made with porcelain veneers and/or porcelain crowns.  It is called the “trial smile” and the subject of this post.

I’m going to take you through Mark’s cosmetic treatment and explain the process and the “trial smile” preview experience.

Mark’s smile before cosmetic dentistry by Dr. Huefner

Above you’ll see how Mark’s smile appeared when he came in for his first cosmetic dentistry consultation.  The first thing Dr. Huefner asked was “How can I help you Mark?”  Mark replied that he was in a business that required that he do a lot of public speaking and that he had become increasingly more self conscious that his appearance wasn’t keeping up with the rest of his image.  He felt that his unattractive smile might be holding him back and was ready to explore how cosmetic dentistry might be able to improve his smile.

After taking some photos of Mark’s teeth and smile and putting them up on the computer monitor for Mark to see, Dr. Huefner then asked Mark what didn’t he specifically like about his teeth, what would he like to change and what would he like his smile to look like?

Mark indicated that he didn’t like that his teeth were crooked and discolored.  He particularly didn’t care for the way his upper cuspids (canine teeth) stuck out like “fangs”.  His goals were to have straight, masculine looking teeth, whiter, but not “too white”.  He looked at a number of the before and after photos Dr Huefner showed him of other patients he had treated who has similar problems to Mark’s.  After more discussion with Dr. Huefner, Mark expressed to Dr. Huefner that he wanted a smile similar to several of the patients that he had seen.  Dr. Huefner assured him that his goals could be achieved.

Dr. Huefner explained to Mark that he would be very specific about designing his new smile and that the process involved utilizing the “trial smile“.  First, taking into account everything that Mark had mentioned, Dr. Huefner would design a smile and let him preview it first.  The shape, length, color, relative proportion of all the teeth were all things that both Mark and Dr. Huefner would need to approve of before making the final porcelain veneers or porcelain crowns.

Mark had a good question.  “What if I don’t like the trial smile?”, asked Mark.  Dr. Huefner told him that the trial smile could be modified if he didn’t like it, and that was the most important reason for using the trial smile in the design part of treatment.  If Mark wanted his teeth longer or shorter than the teeth in trial smile, Dr. Huefner could make those changes before the final porcelain veneers were made.  Likewise, if he wanted the color lighter or less light, then he could make note of that for the final porcelain veneers as well. Also, if one side was longer than the other, it could be adjusted as well.  When all adjustments were made according to Mark’s  preferences, then Dr. Huefner would take photos of Mark’s “approved trial smile“, along with models and measurements of each tooth.  Then those records would be given to Dr. Huefner’s master ceramist so that he would have a very specific guide as to how to make the final porcelain veneers or porcelain crowns according to the smile that Mark approved of.
Mark’s "trial smile" after approval. The next step was making the final porcelain veneers to match the design of the "trial smile".

Mark’s "trial smile" after approval.

Above is a photo of Mark with his “trial smile“.  Mark approved of the design, length, color and proportion and the design next goes to Dr. Huefner’s master ceramist to fabricate Mark’s porcelain veneers.

Note that Mark will be wearing his “trial smile” for two weeks.  One of the other greatest features of the “trial smile” is that the patient walks out of the office with it after the first treatment visit.  Therefore an almost instant transformation.  When the patient returns two weeks later for the final porcelain veneers or porcelain crowns to be placed, the “trial smile” is gently removed and the porcelain veneers and/or porcelain crowns are placed for the patient to inspect.  Upon approval of the final porcelain veneers and/or porcelain crowns, Dr. Huefner will then permanently bond or cement the restorations in place. 

To some dentists the extra visits and process of the “trial smile” may seem like a overkill, but not to skilled cosmetic dentists.  It is much more important to spend time in the design and approval process than having a patient not happy with their cosmetic dentistry and then wanting to have the dentistry redone and changed.

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

Paulette’s dark yellow teeth really bothered her.  They weren’t straight like they were when she was younger and they also had chipped and worn down considerably.  Between several of her front teeth she had fillings that had also darkened considerably over the years.  She finally “had it” and decided it was time for her to get the smile she had always wanted!

Paulette had chipped, worn and discolored teeth and wanted a beautiful smile

After consulting with four other dentists Paulette made an appointment with Dr. Huefner to discuss the methods and techniques that he would recommend to recreate a beautiful, youthful new smile for her.  Two dentists had recommended braces (orthodontics), then “capping” (placing full crowns).  One had recommended bleaching and then replacing her discolored fillings with natural, tooth colored fillings.  The third dentist had recommended porcelain veneers, a concept that Paulette liked.  However although she like his approach the best, she felt a little uneasy about his ability. With all the different opinions she was hearing, Paulette was confused and said that she needed one more opinion.

When she came to consult with Dr. Huefner, he confirmed that in his opinion porcelain veneers was the best way to give Paulette the kind of smile she wanted.  Then Dr. Huefner showed Paulette her a number of photos of other patients he had treated over the years and the results he had achieved for them.  This gave Paulette the confidence she was looking for and proceeded with her treatment of eight porcelain veneers by Dr. Huefner.

After Dr. Huefner placed eight porcelain veneers Paulette had the "perfect smile" that she had always wanted

Paulette loved the end results that her porcelain veneers gave her, saying “This is fantastic!”  The color was exactly what she had wanted, whiter, but still natural looking.  All of her teeth were even, no more tooth crowding or tipping.  The shape of the teeth was very youthful and “life like“, giving Paulette all the confidence she needed to smile anytime she wanted.

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

It was four weeks before the Ms. Globe beauty pageant being held at the Westin Mission Hills Resort in Rancho Mirage, CA.  Inessa Guenther, Ms. Germany-globe, came to Dr. Huefner to discuss cosmetic dentistry.  Could he do a new smile for her before the Ms. Globe Pageant?  She didn’t like the yellow color and spaces between the front teeth.  How could those things be corrected?  Also, what she really wanted was a stunning smile, one that would say to the world when she was on stage that she “is beautiful, confidant, mature and feminine.”

Inessa didn’t like the recession and yellow color around her roots.

Inessa front teeth were also chipped and spaced.

Dr. Huefner carefully listened to Inessa’s concerns.  One was time, could she get her treatment done in time for the pageant?  There was also color, she wanted her teeth whiter, but vital and real looking.  She had seen cosmetic dentistry that looked thick and fake, and had high expectations.  After considering everything, Dr. Huefner recommended porcelain veneers. It would give him great control overcoming the numerous problems that Inessa expressed to Dr. Huefner.  Also, the length, shape and color of the teeth could be customized for her facial features and expectations.  Inessa wanted to begin treatment immediately, and her completed smile with porcelain veneers was finished within two weeks right before the first week of the Mrs. Globe beauty pageant.

Inessa’s porcelain veneers by Dr. Huefner

Inessa’s new smile with porcelain veneers by Dr. Huefner

Inessa Guenther at the Ms. Globe Beauty Pageant with her new smile, with Dr. Huefner at the pageant and as one of the runner ups with the new Ms. Globe.

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

Many people get porcelain veneers on their teeth to improve their smile and appearance because their natural teeth became worn, shortened and chipped over the years. So, how does a cosmetic dentist know how long to make the new teeth?
Cosmetic dentistry is an art and there is no absolute rule, but there are many guidelines and generalities that I use in determining the length of the teeth.
One thing is how much of the teeth show when smiling? When the upper lip is at rest and the mouth is slightly opened so that the back teeth are not hitting, we usually like 1-2 millimeters of the upper front teeth to be showing (around 1/8"). That would be consistent with unworn teeth on a person in their 20s or 30s. Even patients in their 40s or 50s usually want to look a little younger, so that is a good guideline.

Another thing is if a person smiles, do they show the gum line of the upper teeth and the entire length of the four front teeth? If so, then another thing comes into play – the length to width ratio of the front teeth. Studies have shown that both dentists and patients like the appearance of the upper front teeth most often if their length is 1.29 times longer than the tooth width. Or, said another way, if the width of the front teeth is 75-80% of the length of the front teeth.
The lower lip gives us another guide, as when the patient smiles the teeth generally look very good if they follow the curve of the lower lip, which dentists call “the smile line”. Here is a photo of my patient Jill Frick (who was previously Mrs. U.S.Globe). Note how her teeth beautifully follow her lower lip.

Most cosmetic dentists find that the actual length of the front two teeth will look best if they are between 10mm and 12mm long, and the average length of an unworn upper front tooth is 11.5mm.

The above are just some guides, but the ultimate guide is “does the patient like it” and “do they look good with that length of teeth?” And this decision should be made prior to fabricating the final veneers.
How can this be done? A good cosmetic dentist should always verify that the patient likes and approves of the length of the front teeth BEFORE we tell our ceramist how long to make them. This is done by having the patient wear temporary veneers, called “the trial smile”, for several days and then comes back to the cosmetic dentist for verification. This gives the patients an opportunity to actually function with the length of the new teeth before making them. It’s important that they like the length, and also have no speech challenges with the new length. If they are too long, sometimes patients will have challenges with the “f” sounds (like “fire truck” or “fifty-five”) or "v" sounds ("victory", "victor"). Or, if the upper veneers or crowns are too thick on the back or lower veneers or crowns are too thick on the front, challenges with the “s” sounds (like “sixty-six”) can happen.

The “trial smile” is a beautiful way for cosmetic dental patients to preview and sample the length of the new veneers and solves many of the challenges. If the patient says that they are too long, then the trial smile teeth can be shortened to the patient’s liking and then measured for the lab. If they are too short, the trial smile teeth can be lengthened as well.

You can see that cosmetic dentistry really is more of an art than a science. Good cosmetic dentists have many cosmetic concepts and principals to go by, but it is extremely important is that the length of the front teeth be a decision made by both the patient and the cosmetic dentist together, and not made solely by the ceramist (who probably has never seen the patient in the flesh).

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

Stephanie’s didn’t like the way her smile had aged. Her teeth were worn down, discolored and there were spaces between her front two teeth. On the side she had some old bridgework that was yellow, and showed a metal black line around the gums. She wanted her teeth whiter and a younger looking smile.
BEFORE

After evaluating her teeth and smile, and discussing her expectations, Dr. Huefner recommended porcelain veneers on her front teeth and a new porcelain bridge to replace the old bridge.

After four dental appointments and a little over a month, here is Stephanie’s new smile with porcelain veneers and a new porcelain bridge.
AFTER

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

Jeff thought that his two front teeth were too big and his other teeth too small. He didn’t like the color of his teeth either. What could he do to get a younger, more attractive smile that didn’t look "too pretty" and still was masculine?

BEFORE

Porcelain veneers was the treatment of choice to solve Jeff’s problems. Braces weren’t an option, as that wouldn’t change the shape or color of the teeth. Capping the teeth would be too aggressive a treatment considering his situation. Whitening he teeth alone wouldn’t give him the smile that he wanted. But porcelain veneers would allow us to accomplish all the things he wanted.

Here is Jeff’s new smile with porcelain veneers after just three visits! Notice how much more attractive it is and all the teeth are whiter than before and more evenly proportioned with regard to size, shape and position.

AFTER

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

A very successful businesswoman, Kaitlin had a smile with short, chipped, discolored teeth was incongruent with her professional image.
Kaitlin’s short, chipped teeth embarrassed her.

Very unsure on whether or not she was willing to have cosmetic dentistry, she consulted with Dr. Huefner about what her options might be.  She had heard about bonding, porcelain caps, orthodontics, bleaching and porcelain veneers, but wanted to know Dr. Huefner’s opinion on what might be the best course of treatment for her?

After carefully listening to Kaitlin’s concerns and then examining Kaitlin’s teeth, Dr. Huefner recommended porcelain veneers.  That would be the most conservative mode of treatment, but allow Dr. Huefner full control over achieving the best color, length and shape of Kaitlin’s new teeth.  Kaitlin still had reservations until Dr. Huefner described the “trial smile” process, whereby Dr. Huefner would first create temporary veneers in the color, shape and length that he though would be best suited for Kaitlin.  Then Kaitlin could wear them for several days and return to Dr. Huefner to make any modifications that she wanted before the actual porcelain veneers where made.  In essence, the “trial smile” veneers approved by Kaitlin would serve as a template for the actual porcelain veneers.
Kaitlin in her "trial smile" veneers by Dr. Huefner.

In Kaitlin’s case there were very little changes she wanted made, except she wanted her teeth to be a little “whiter”, which Dr. Huefner did for her.  Kaitlin continued to wear the “trial smile” veneers for ten more days while the permanent porcelain veneers were being fabricated by Dr. Huefner’s master ceramist.  Then she returned to Dr. Huefner, he gently removed the “trial smile”, placed the final veneers on her teeth for her final approval, and then bonded the new porcelain veneers onto her underlying teeth with his Argon dental laser.  The resulting smile achieved for Kaitlin was amazing!  It took ten years off of her face and gave her the classy, professional look that she had always wanted!
Kaitlin’s beautiful new smile with porcelain veneers by Dr. Huefner.

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

Nicole had completed her orthodontics (braces) and her teeth were straight, but unfortunately the size and shape of her front teeth weren’t normal.  Thus, although the orthodontist did a great job with what he had to work with, she still ended up with an unattractive smile because she had peg lateral incisors.  Nicole and her mom came to Dr. Huefner to discuss cosmetic dentistry options that could give her the great smile that she had always wanted.

   Nicole had malformed peg lateral incisors which gave her a deformed smile

When Dr. Huefner evaluated her smile he recommended placing four porcelain veneers on her front teeth.  This would enable him to do several things with the shape and length of the front teeth, and then her could create a sensational smile for her.  First, the veneering would correct the “peg” lateral incisors.  Second, he could make the teeth slightly longer, which would make her smile look more attractive.  Cosmetic dentists call this “following the smile line”, which means that the edges of the upper front teeth follow the curve of the lower lip when the patient smiles.  He also suggested that Nicole bleach her teeth first, whitening and brightening them, then when he did Nicole’s porcelain veneers he could use a whiter color to match her other bleached teeth.

    Nicole’s beautiful new smile with four porcelain veneers and without any “peg” teeth

Nicole and her mother were anxious to start treatment, so teeth bleaching was done immediately.  Then, in just two dental appointments, Nicole had her sensational new smile with porcelain veneers by Dr. Huefner.

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA

Sandy, a professional lady in her early 40s, had a “tooth grinding” problem.  She would grind her teeth and night and clench them together during the day, and over the years these habits had a toll on her teeth, they were getting progressively shorter and worn out.  As a result she increasingly didn’t like her teeth and smile, almost to the point that she wouldn’t smile in photographs.

     Sandy had worn down her teeth to almost short little stubs

Interested in what cosmetic dentistry might be able to offer her, Sandy consulted with Dr. Huefner.  She had no reservations about telling him the kind of smile she wanted.  They had to be whiter and straight, with no gaps, and she wanted her gums even (the gums on one of her front teeth were longer than the adjacent tooth).

After evaluating her smile and bite Dr. Huefner recommended porcelain veneers to correct her tooth wear and unattractive teeth.  But, he was very clear that because she had a grinding and clenching habit, that she would be best served to also wear a bruxism appliance at night to protect her teeth from more wear and protect her veneers from possible breakage.

Sandy decided that she wanted her whole smile redone and had ten porcelain veneers and two porcelain crowns done by Dr. Huefner.  She also had Dr. Huefner do some minor laser gum recontouring with his dental gum laser to make the gums on her two front teeth even.  Her entire treatment, beginning to end was completed in three weeks and she absolutely loved the results.  Her comment was, “Boy, this really makes my smile look so much younger!”

     After porcelain veneers and some very minor laser gum reshaping, Sandy had a much more attractive and youthful smile!

Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA