Hello, please can someone advise this almost desperate patient with shade choice??

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Lesley

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Hello, I am not a lab tech..I am a 50 year old UK woman who has been scouring the internet for realistic help on making a final decision on colour of my porcelain teeth.

Can I ask away here - or should I post somewhere else...or not at all? :D

Just need some advice from a professional.

many thanks
Lesley
 
amadent

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Lesley _ as the patient who is going to live with the teeth for a long time
you should pick what ever shade you feel is correct for you-

some folks like to go "age appropriate" while others think the whiter the better
 
rkm rdt

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That word desperate makes it sound like the dentist is not listening to you.
Are you looking for a better way to communicate what you want to your dentist?
 
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Lesley

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Thanks so much. I will try to be brief, but appreciate any advice on what you guys think is THE best colour for as natural looking a white shade as possible. I appreciate it is a very personal decision - but I am going round and round in circles here and I just need to stop, and look at the facts.

Two years ago I had a full upper reconstruction. I am ashamed to say I did not take particularly good care of my teeth as a child, I was never taught how to from a young age, and even had a mother who would give me sweets at bedtime. Anyway - at least at the age of 50, I now live in an age where dentures are not the only option. My lower teeth apart from two rear fillings are in perfect condition.

I had a lot of work done. Two onlays, three implants, and four old crowns replaced (all in place since the 80's with metal cores - I must have had them replaced three times in all, but they were still over vital teeth) I also had a bridge which needed replaced; missing upper left lateral attached to a cuspid which was root canalled. I am missing the canine on this side, as this was removed as a teenager due to bad overlap so the main tooth of this bridge was made to look like a canine.

My own teeth have always been quite white, B1 according to my dentist, but I wanted them lighter as my sister (who despite our mother has all her own teeth) had bleached hers and they made her look so youthful. So I chose BL2 for the uppers, and we started lightening my lowers. they never got beyond B1, and I had to stop because of receding gums and zingers.

My temporary was one of those one piece things, and it was (apparently) made in acrylic BL2, but the colour completely matched my lower teeth. I was surprised at this I as I knew my lower teeth were B1 but, hey, the temp teeth looked fabulous, so was looking forward to getting the perms.

So. The Perms turned out to be very very white, and were also much longer than the temps. Also the canines were huge - bulky and pointy. I was so disappointed, and told my dentist so. So, he recontoured the teeth, which was not ideal, as he shaved off all the translucent ridged edges that made them look so real. They also looked so much whiter than my lower teeth that they looked false and unatural.

Can you believe after paying almost 12,000 British pounds for this makeover, I was too embarrassed to smile as I thought my teeth were too white? However, I got used to them, and it was only in bright light or daylight that I saw how toilet bowl white they were.

Fast forward two years, and the bridge has snapped off. The dentist explained it was a because it was two biting teeth attached to a root canalled and brittle bicuspid. If it had been a canine, it would have been fine. Why he did not take this into consideration two years ago I don't know. So, I have another implant, and am wearing a partial flipper instead of the bridge, and ....oh joy of joys, a front central breaks off.

back to the dentist in time to get all the new teeth made at the same time. We have decided that the best thing to do is to go ahead with the bridge as planned, and use the central implant, and the lateral implant, to bridge the now missing central.

Dentist is covering the costs. *whew*

So I think, I now have the perfect opportunity to change the colour. I discuss it with the dentist, who tells me to go 'down' from a BL2 to B1 would make me unhappy in the long run. he thinks I have a beautiful smile and the colour suits me. I figure as I can only get older, toilet bowl teeth are probably not a good idea. I come home, discuss it with my husband - and he says he LOVES the colour of my teeth. I ask for honest opinions from friends and my sister... I tell them they really can tell me the brutal truth without hurting my feelings, as these are coming out whatever happens, and it is 50/50 for and against.

I know I sound like a vain person - I guess I am a little. I just want to get it right this time, and I just cannot make up my mind. Sorry to go on so long for such a short question....

...what colour do YOU think is the most natural, for a 50 year old lady who would like to have a bright smile but not look overwhelmingly white. Is there a shade between, or is it possible to combine shades? Will I miss my bright whites if I go back to ordinary white?

Many many thanks for listening.
 
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paulg100

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"THE best colour for as natural looking a white shade as possible"

sorry i stopped reading right there.

B1. Thats why its top of the natural shade guide ;)
 
amadent

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"THE best colour for as natural looking a white shade as possible"

sorry i stopped reading right there.

B1. Thats why its top of the natural shade guide ;)

:tee:
 
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Lesley

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Ok..thank you. My dentist also said something about making them darker at the neck with two shades or more of porcelain. Can this look natural?

PS. I realise I am a boring idiot to you guys who work with this stuff every day. I didn't realise B1 was the 'top' of the natural shade guide, but thanks for the info.
 
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paulg100

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yes thats correct. the B1 shade tab has transition from neck to insical.

i work onsite at a "cosmetic" practice.

We do are best to talk anyone out of going brighter than B1.

unless the patient has bleeched adjacent natural teeth brighter, the bleech shades just look fake generally.
 
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paulg100

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yes 040 is the old bleech guid from ivoclar. Its the equivilent of BL4 now, which is the lowest shade on the bleech shade guide...

Now your doing it arnt you :)

Youve looked at the bleech guide and now you think B1 looks dark. If you had never seen the bleech guide you would be quite happy with B1.

"but appreciate any advice on what you guys think is THE best colour for as natural looking a white shade as possible"

The shades on the bleech guide are NOT natural looking.

Think what its like when you paint a wall. You do a test in a small area and the colour dosent look bright enough. So you paint the whole wall in a brighter colour and then you think oops!, now that looks to bright.

Its the same with your smile. On a small shade tab brighter looks ok, but the whole smile....

If your not convinced. Ask for a BL4. If the worst comes to the worst then the lab can shift that to a B1 easy, with a bit of external staining.

You cant go up from a B1 to a BL4. that would mean redoing at least part of the ceramic work, and if the ceramist has put a look of time and effort in to the first result, you most likely wont get all the love back on the second time around, even if they charge for the adjustment.
 
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rkm rdt

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Listen to Paul's advice...and your dentist's.
 
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Lesley

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Thank you Paul. I appreciate your time.

In certain lights I l kinda like my smile, and I guess at the back of my mind I think, now that I have had it, will I miss it. It sort of lights up my dull old face. If I look at my mouth showing only my lower teeth, it is like someone turned the lights out! However, it is also true that in broad daylight they are stupidly white, they look totally unatural. I just kind of wish I could get somewhere between B1 and the lowest bleach shade.

So, I am convinced, and I have decided to go with the B1. No more faffing around asking everyone to make up my mind for me.

One last question. Because of the problems I described earlier, I am getting five front teeth redone in B1. This will leave a crowned canine in BL2. Will this really stick out? Would you advise that I get this done at the same time. (I will have to cover the cost myself for this one, but if it gives me the final smile I want, I will happily do that.) Is there anything that can be done to take that tooth down to a B1, or is this impossible with a fixed crown. Forgive me, but I don't know what work has to be done in the lab and what the dentist can do in the chair. You mentioned the teeth going back to the ceramist for adjustments, and I don't understand how this is possible if the crown is already cemented in. I guess maybe you were talking about adjustments to perms before they are cemented in.
 
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paulg100

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"Will this really stick out? Would you advise that I get this done at the same time."

Yes in nature the canines are darker than the front 4.

No it cannot be altered by the dentist.

If the dentist can remove it without breaking it then the lab MAY be able to stain it down, MAYBE.

I would get it done with the rest for the best result.

"You mentioned the teeth going back to the ceramist for adjustments, and I don't understand how this is possible if the crown is already cemented in"

Evaluate the case at try-in without cementing, or put in with temporary cement so that they can be removed with damaging them (hopefully!. ceramic soaks up moisture once its been in the mouth which can cause problems when re-firing in the lab).

Esthetics are subjective at the end of the day, and only you can deside whats right for you.

I can honestly say we have never had a patient go away unhappy with a B1 and we do alot of cosmetic smile make over work.

and to be fair, im sure your a lovely looking 50 year old lady, going on 40, and im sure B1 will look great for you, but again, only you can decide.
 
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Lesley

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Thank you Paul, for all the advice. It has been a very long few years to be honest, a long journey. Living with awful teeth for years, saving up for the dental work, going through all the treatment as a slightly nervous patient who does not numb up too well (root canals expecially) - and then thinking I was finally all done and finished, then to feel so flat at the end of it all...unsure and unconfident about my colour choice...then to have three teeth break and start all over again. I just want to get it right this time.

Here's a pic of how I look at the moment. This was a montage I made up for an online dental journal. You can see the difference between the uppers and lowers. (Actually that was just after bleaching the lowers two years ago and they are slightly darker now. I find it so painful I probably wont do it again.) I think B1 will be more age appropriate as the years go on. I just needed someone to tell me that. I wish my dentist would.

Thanks for your nice comments and your great help. I wish I was one of your patients.

Lesley
teeth journey.jpg
 
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