Ticked off (&Q re ceramic brackets and porcelain veneers

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#1 Post by **ellebee** » Thu Nov 23, 2006 9:01 am

Please bear with me, this is long.

Before I was braced , I asked my ortho several times whether the brackets would damage my two top front porcelain veneers.

(As a kid, I fell while roller-skating and fractured the tips of my new adult front teeth. In my 30s, I finally had the damage repaired with porcelain crowns aka veneers.)

My otho assured me that the veneers would not be damaged by bonding the brackets to them.

Both top front brackets popped off in the first 24 hours because the assistant used the wrong etchant. The first one came off during my drive home and I turned around and went back and the assistant rebonded it.

My ortho actually met me in his office before regular office hours the next morning to rebond the second one (which came off after I got home) because I was catching a flight out of town later that day.

When I had the first bracket rebonded, the assistant gave me the case the clips come in with an extra clip (in case the bracket came off while I was out of town) along with the "operations guide and directions for use."

This morning I picked it up and read it. It says:

"Contraindications ... GAC Ceramic brackets should not be bonded to dental porcelain."

It also says:

"Bonding to porcelain may cause chipping or breakage of the crown or facing during treatment or debonding."

Great. Just great. I am so steamed.

Anyone have experience with ceramic brackets (or any kind of brackets) and porcelain veneers/crowns?

If I have to have them replaced, is it reasonable to ask the ortho to bear the cost (above whatever my insurance would pay, i.e., 50%)?

I don't know if I should bring this up now or wait and see. I'm afraid the assistant would get in trouble for giving me the instruction booklet.

This ortho came highly recommended and has a thriving practice, which would seem to indicate he is considered good.

Bumming today ...

Elle

#2 Post by **Attagirl2** » Thu Nov 23, 2006 9:35 am

Hi ellebee. Sorry to hear the mess you have been and are in. I would bring the whole senerio up to the orthodontist at a separate meeting. I would also do it soon. If you let it go and don't do anything now, since you became aware early on, they might try and blame you for not bringing it up... if you waited until debanding. I think if you incur any damage to your crowns, the orthodontist should cover the cost of the whole replacement!

As for the assitant getting in trouble. Those brochures are there to pass out. She shouldn't get in trouble. Bottom line - the ortho put them on you.

#3 Post by **Kat** » Thu Nov 23, 2006 3:02 pm

Providing you did ask him and he did tell you it would not be a problem...

I'd scream about it and demand that the ortho calls one of his dentist friends and replaces them for you. (making sure they are correct and accepted by you that they are as close to perfect as you want them)

Now, if they were in bad shape but would have lasted for more years to come I'd make some kind of deal with him, tell him you did not want to even think about replacing those veneers until forever, ...---just make sure you are coming out on top, after all you did ask and he assured you all would be ok.

Not trying to get something for nothing here--Don't let him squeek out of it. Keep it like it pisses you off but you are willing to let him correct it. I mean this is not sesame this is expensive stuff here and you did walk in with a concern.

#4 Post by **joney** » Thu Nov 23, 2006 6:59 pm

Ellebee

This does not sound good. Veneers are expensive so I would try to get this resolved a.s.a.p. Good luck with it, I hope it goes well for you.

Regards
Joney

#5 Post by **ellebee** » Thu Nov 23, 2006 11:04 pm

Thanks for the replies. I've calmed down a bit. Whatever damage is done is already done. I've got a long way to go before the brackets are removed (assuming I see the treatment through) and maybe there will be no damage.

Worst case, I'll have to get the veneers redone, in which case I will ask him to pay. Asking now, when we don't even know for sure that there is going to be damage, might create tension in our doctor-patient relationship.

When I got the veneers about 15 years ago, I remember my dentist at the time saying, "I can't promise you they will last 30 years because this material and technology hasn't been around for 30 years." So I always assumed that sometime in my lifetime I'd be replacing them.

Of course, I'd rather have them another 15 years or more. He did a really good job and you can't tell they aren't my natural teeth. We bleached my teeth before he matched the veneer color and I have to say the color has stayed true.

I guess I will just deal with the problem -- if there is one -- when the time comes.

Elle

#6 Post by **dee76** » Fri Nov 24, 2006 6:01 am

Hi Ellebee,

I've got 2 porcelein veneers on my top teeth and ceramic brackets on them. I was assured as well that it wouldn't damage my veneers and I haven't had any problems so far.

Good luck with your treatment

#7 Post by **Delag** » Fri Nov 24, 2006 10:02 am

Dont forget that the company who makes the brackets is probably just trying to cover themselves - imagine if they had to pay for every damaged crown etc.. for every patient who used their brackets. It makes me laugh sometimes when I read the packages of US products......don't let kids play with your ipod earbuds as they may strangle....don't eat the battery....don't let kids play with the Twinkie wrapper as they might choke..... Ask your OD, but I wouldnÂ´t worry till then.

#8 Post by **rsprouse** » Fri Nov 24, 2006 10:15 am

First question is do you have a Veneer or a crown? A crown is a full coverage restoration (around the entire tooth) where as a veneer is strictly on the facial and incisal surfaces. It will wrap around slightly near the incisal angle but you preserve a lot more tooth. Whether it is a veneer or a crown it is likely ceramic and not porcelain. Porcelain is typically used in the posterior for crown work while ceramic in the anterior because it is so much more aesthetic (but less durable to function). Brackets can be bonded to veneers or composite bonding in most cases, it just requires the correct etchant and bond.

Good Luck,
Rory

#9 Post by **ellebee** » Fri Nov 24, 2006 4:26 pm

As far as I know, I have porcelain veneers. They were fairly new technology when I got them. Porcelain is much more durable than ceramic (in veneers as well as in floor tiles).

I have heard them described as crowns, but this may help clarify what they are -- the original fractures were "chips" that did not get into the tooth roots.

When I finally got the veneers, the dentist etched my teeth but I did not have root canals, so perhaps that makes them veneers. The backs of the teeth are my own.

From Wikipedia:

"In dentistry, a veneer is a thin layer of restorative material placed over a tooth surface, either to improve the aesthetics of a tooth, or to protect a damaged tooth surface. There are two types of material used in a veneer, composite and porcelain.

"Veneers were invented in the 1930s ... Today, with improved cements and bonding agents, they typically last 10-15 years.... This can be very expensive since porcelain veneers cost around $1,000 each in 2006 prices. They are said to be somewhat more durable and less likely to stain than veneers made of composite."

Sounds like it might be near the time to replace mine anyway. Although they still look good and feel good (pre-brackets).

We'll see.

Thanks again for the replies.

Elle

#10 Post by **lionfish** » Fri Nov 24, 2006 8:10 pm

Uh, Rory's in the industry, ellebee, I think he probably knows that already.

For what it's worth, my OH had one of his porcelain crowns crack after around 8 years. It was nothing he did, it just happened. He was offered another porcelain crown or a gold one; the gold one - the dentist said - would outlive him so he went with that seeing as it was a second molar (gold was also cheaper). Not that I'm suggesting this as an option for a front tooth......although I'm sure there are some people who would be quite happy to choose it!

#11 Post by **lionfish** » Sat Nov 25, 2006 12:57 am

Meryaten wrote:Just one point of information (sorry it's not entirely relevant) but having a crown does not ipso facto mean you will have had a root canal. I have had no root canals ever, but do sport more than one crown. Just wanted to clarify that in case anyone else might read the above and be confused.

OK, thanks for that.

I had a root canal done, I think because the tooth was cracked. In the olden days, they would have just pulled the tooth. I count myself lucky that I live in an age where dentists aim to conserve, rather than pull teeth.

#12 Post by **rsprouse** » Sat Nov 25, 2006 11:07 am

Porcelain is used in some veneer technology. Ceramic can be so much more aesthetic in most situations which makes is popular for anterior restorations. You do not need the durability of porcelain in anterior teeth unless you have a horrendous bite with no posterior occlusion. If the back portion of the tooth is your own then it is likely a veneer (although it could be a 3/4 crown). And regarding no RCT, there are plenty of crowns done on non RCT'd teeth. RCT is typically done for infected teeth or if there is decay too close to the nerve of the tooth where removing the decay will expose the chamber. Good luck in your treatment.

Best,
Rory