Frequently Asked Questions

Information about different types of Veneers Systems
by Dr. Bard Levey

As not only a dentist who has placed many porcelain veneers over the years, but also as a patient who has had porcelain veneers in my own mouth since 1985, here is my explanation for the myriad options available for porcelain veneers.

I am currently working with a few different Porcelain Veneer Systems, which in my hands, allows me to meet the varying needs of my patients. Other dentists may use one or all of these systems as well as some other methods including direct bonding using composite resin. The following explanation describes some of the advantages, disadvantages, risks, and options for each system. Whenever treatment is purely cosmetic in nature, it is also important to remember that not performing any treatment is another option as well. I frequently tell my patients that when doing something as a purely esthetic enhancement, either make it a change for the better or don't change it at all. All porcelain is not alike so it is important to choose an option that will give you the result you are hoping to obtain.

1) Full preparation porcelain primarily using MAC Empress Porcelain. These are the most versatile restorations and can be made as true veneers (covering only the front of your teeth), wrap around veneers, full crowns, and 3/4 crowns. The flexibility of uses allows us to use these restorations to solve virtually any cosmetic/ esthetic issue. Due to their inherent thickness, Empress restorations are perhaps the strongest available and the laboratory offers a lifetime warranty against porcelain fracture and breakage (My laboratory guarantees these restorations against breakage, chipping for the life of the patient's tooth while under our care. Replacement due to decay is not covered, so you will still need to brush and floss normally). To place these restorations requires significant removal of both the enamel and dentin of your tooth structure (ie. the top 2 layers), which also allows us to create a porcelain veneer which has normal thickness without any extra bulk. This extra depth of porcelain allows the final result to have the most life like and esthetic result of all porcelain systems. It is important to understand that any time a tooth is reduced in size, it can lead to senstivity to hot / cold, or can cause the nerve of the tooth to die (which will require root canal therapy to treat.) While these issues are possible, they are not common (unless we can see in advance that a tooth has already had extensive work or has deep decay). Because this type of restoration wraps around the top and sides of each tooth and is therefore also the least likely of all types to become dislodged or to pop off. Anesthetic is required for both the preparation and insert appointments for these restorations and follow up visits are often needed to adjust your bite. We will frequently advise the use of a soft mouthguard for night-time use to help protect your teeth against night-time clenching and grinding.

2) Minimal preparation porcelain veneers (like Lumineers®)- Ideally used when the underlying tooth structure is in good-perfect condition, and your main concern is color change or correction of subtle rotations or length issues. These restorations are ultra-thin, and therefore require little reduction of your natural tooth structure. A new technique using a tray to insert the veneers called Glam Smile or soon to be called Lumi Tray is generally only applicable when 8 or more teeth are enhanced; this tray technique is not possible for the enhancment of fewer teeth. A traditional insert technique can be used when placing as few as 1 or 2 veneers. The thin-ness of these veneers is both an advantage and disadvantage. Little, if any, of your natural tooth is removed. The exquisite inherent characterizations which are possible in Empress porcelain (purely because they are thicker porcelain made possible by tooth reduction) are not possible in the thin veneer. These restorations can make an enormous change and enhancement to your smile, but side by side, are not quite as beautiful as Empress porcelain. Because these veneers are so thin, they are generally bonded to the enamel of your teeth (which is the strongest of all bonds). These veneers are covered by a 5 year laboratory warranty against chipping and breakage (again, no laboratory will warranty porcelain if decay is present). Because little of your own tooth stucture is removed, the potential issues of sensitivity is greatly reduced. And the really good news, because of the minimally invasive nature of these restorations, they can generally be placed with little to no anesthetic. Now, for some of the disadvantages of this technique. Because little if any of your own tooth structure is removed, these restorations will add some "bulk" or thickness to your smile. Normally, because the thickness is so minimal, you will adjust to this change very quickly, but this change is something to consider before choosing this technique. Full coverage crowns (or replacement crowns) can be done, but obviously reduction of your own tooth, or removal of the existing crown, would be required). While bonding these veneers over existing crowns is an approved use, this application in my hands has not proven to be a reliable bond and I do not advise or perform this use at this time. (Should you seek other opinions, other dentists can and will bond these veneers over existing crowns). Since these veneers are generally bonded to just the front of your existing teeth, they can pop off or break. Pop-off/breakage is probably the single biggest drawback to this minimum reduction technique. When this pop-off occurs, a new impression will need to be made and a new veneer will need to be fabricated. It is important to realize that all cosmetic procedures require maintenance, and pop off/ chipping is a possible side effect that must be considered before elective porcelain bonding is undertaken, especially when using this minimum reduction technique. While generally not a painful issue, pop-off or breakage is an inconvenience as this process generally requires 2 visits to the office and the possible use of a fragile temporary. We will also frequently advise the use of a soft mouthguard for night-time use to help protect your teeth against night-time clenching and grinding. The Lumineers® laboratory does have over 20 years of data and successes with their porcelain system.

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Yes! Not only can we use dental imaging to help our patients visualize the end results of cosmetic and restorative work, but we also routinely use a unique process that we call our SMILE DESIGN COSMETIC PREVIEW. To be brief, this preview is an actual 3 dimensional of your own proposed new smile. By simply asking the right questions, taking various photos of your current smile, and figuring out exactly what you would like your new smile to look like (we really try to "get into your head" to figure out exactly what you like or don't like about your current smile) we are then able to close gaps, straighten, lengthen, and/or change contours of any areas that might require enhancement.

All of these changes are done on a precise model of your teeth BEFORE any changes are actually made to your own smile. The benefits of using this process is a predictable, gorgeous result.

Of course! We are always happy to accept referrals from other dental offices as well as from recommendations by our patients to their family and friends. Your referrals are our best compliments! And remember when you refer someone to us, second opinions and consultations are always done at no charge.

That's a great question. Our office works with nearly all insurance plans as a non-participating provider. This means we work very hard to help you get the maximum reimbursement from your insurance company while still having the freedom to offer you the full range of treatment options that modern dentisty has to offer. See the next section "Are you an HMO provider...." for the risks that you, the patient, often face unknowingly when you go to a "participating" provider. As a non-participating dentist, we will treat you as real person with real needs and wants. We are not constrained by insurance contracts that indirectly limit your treatment options. (Sadly, if a dentist will not get reimbursed for a procedure by an insurance company, they will probably not offer that type of treatment). We will submit x-rays, digital photos, and when necessary narratives to be sure that you receive your full allowable reimbursement from your insurance company. Our sophisticated computer system will also store all of your insurance information for you so you never need to remember to bring insurance forms to your visit. Just bring your card to your first visit and we will take care of the rest-we will print, document, and mail your insurance forms for you after each visit. In short, we will make the often difficult insurance process easy, maximize your allowable benefits (as determined by the plan that your employer has purchased for you), and do all of the paperwork for you.

We will also be sure to fully discuss with you-our patient - all fees and financial options BEFORE any treatment is started. We will then come up with a comfortable financial plan to allow you to complete your treatment. Once we have a financial plan in place, you will be able to pay us either directly or from one of the many payment options that we are able to offer to you.

This is a question we are often asked by our patients when their company switches to an HMO/PPO dental plan, and we hope to clear up much confusion by answering it now.

Every dentist is solicited 3-4 times a month by insurance companies to join their "family" of HMO dentists. Contrary to popular public belief, there is no quality control or screening process to select top dentists in the area. In fact, the insurance companies make no evaluation or assessment of a dentist's clinical skills whatsoever. Basically, the only two prerequisites I've ever seen to sign up as a HMO provider are: 1) do you have a license to be a dentist and 2) do you have a heartbeat (and I'm not sure about the latter.)

SEE ATTACHED CREDENTIALING QUESTIONNAIRE. This is an actual questionnaire that I received asking me to join a certain HMO; Please note the only questions that they ask are whether the dentist has ever been convicted of a crime or had their license taken away. There are no questions whatsoever regarding the dentists level of training, education, areas of focus, etc."

The promotional material provided to you the patient by this multi-billion dollar insurance company is very appealing. It makes it sound like you have just won the lottery , and there really is a free lunch, or so it seems. It appears that everyone wins in this deal: you, the patient, now get FREE (or greatly reduced) cleanings, x rays, exams, and perhaps even fillings. Even the major treatment is cheaper-you are ecstatic! The upper management of your employer has a much cheaper premium to pay each and every month-they are ecstatic! On a recent train trip from New York to Kentucky (don't ask, but I really did it) I couldn't help but to notice that through every city, small and large the largest building in every city had the name of a major insurance company proudly engraved on the top. The insurance company executives are among the most highly paid in the business world-they are more than ecstatic.

So who is the loser here? Everyone seems to be getting more for less, this must be the mystical free lunch at last! Unfortunately, it isn't. There has to be someone absorbing the costs of al this free or cheaper treatment. You may have guessed it already, it's the HMO dentist primarily, and then ultimately you the patient.

Now you might ask "why would anyone want to work harder for less money?"

This is a really great question that we in the profession have asked ourselves. Let's look at why anyone would do this?

The insurance company attempts to dazzle the prospective dentists with the promises of wealth, endless patients, busy practices, happy patients, and then they add,

"Oh, did we forget to mention that you will have to give away many services for FREE and cut the rest of your fees by 30-50%? But don't worry about that," they quickly point out, "because you will have two to four times as many patients to try to see in order to make up for the lost revenue. You'll just have to work a little faster."

To some dentists, the temptation is too great and they sign up only to quickly realize that their soul now belongs to the insurance company. I believe that a automobiles, and bottles of Windex can be made more quickly with no loss in quality (see Toyota, Honda, Nissan , etc. for details). I do not feel that dentistry can be performed the same way.

Understand that as an HMO provider dentist, you are paid $2-8 per month per family or patient whether or not that patient ever shows up in your office! Now if the patient does want to show up and get their teeth cleaned or a filling done (which the dentist is, by contract, often required to do for FREE), do you think that dentist actually wants that patient to come in?

This is the game the HMO provider has to play with you, the patient, in order to stay in business. Now you see why it might be difficult for you to be seen for a routine visit or in an emergency. The biggest complaints from patients in and HMO practice is that they cannot get an appointment or they never see the same dentist twice. Is it any mystery now why that is the case?

In my opinion, and in my case (see "What makes you different from any other dental practice I can visit" below) to be an HMO provider, I would be forced to sacrifice quality, service, and the personal attention we give to our patients. In short, we would be forced to compromise the standards I have set for my office. I could not nor would ever do that; as I stated earlier, my dad instilled in me a sense of pride about being a dentist. This upbringing is something that I will never compromise upon. As an HMO dental provider we would have to use cheap labs, cheaper materials, work faster, and cut corners. Many corners would have to be cut that you would not be aware of, but would likely compromise the type of treatment offered (or not offered), and/or the expected longevity of treatment.

Several years ago one of my friends was in an HMO medical plan and had lower back spasms. She went to her designated orthopedist and after a brief examination, was given some muscle relaxants. After several days, her condition was no better and she tried to get another appointment. She was told that she must have no pain tolerance and would have to get used to it (emphasis mine). I told her "you just don't understand the HMO insurance game." This same scenario was reported on 60 minutes a few years ago in a story involving HMO psychiatric medicine.

The medical profession has all but lost the war to the insurance industry. The story has been well documented, including making the cover of Time Magazine. The dental profession still has, by and large, the freedom of choice. As long as that continues, I will endeavor to provide my patients with the best that dentistry has to offer.

We are very proud of the variety of payment options that we offer ranging from interest free to regular choices that allow you to spread payments over several years. One of our most popular payment choices are our 3,6 and even 12- month interest free periods; payments can then be spread out comfortably to fit into your monthly budget. These options require no down payment at all, have no application nor annual fees, and allow you the option to pre-pay at any time without penalty. Best of all, the entire application process requires just a simple phone call.

Simply call our office phone number 914-271-6224 then press option #2. Our advanced messaging service will connect you with Dr. Levey directly.

When you become a patient of our practice, we think of you as a person, not just another set of teeth to fix and clean. My father, who was a dentist from 1957-1993 would always tell me "never forget that attached to each tooth is a person, a whole person, and often an anxious person." That message became ingrained within me as a boy growing up, and I feel that I have never lost touch with that basic, seemingly intuitive fact. But for some reason, however, I believe that most of the medical world has lost the human element in patient care. Most medical facilities are now large, impersonal clinics; with large waiting rooms loaded with patients, large overburdened staffs, and doctors racing between treatment rooms.

I have made a concerted effort to be sure that my practice will never loose sight of who is most important to us; YOU. You will always be the most important person to us whenever you visit our office or when we speak with you on the phone. Our goal is to blend old world levels of customer service with the newest technology available. The result is a completely unique health care experience.

We can do just about everything you could ever imagine to make you more comfortable in our Design Studio. From our calm, soothing office demeanor and colors, to offering you personal headphones equipped with satellite radio (listen to any type of music that you like, at whatever level you like, with no commercials!), to personal virtual reality glasses that allows you to actually watch a DVD movie, to oral sedation, to nitrous oxide (laughing gas) we can work with you to help you achieve your dental dreams and goals.

We are also able to offer complete sedation services in our office for those people who might benefit from this service. We understand many people have qualms about having their teeth worked on (an ADA survey suggests that up to half of the population does not regularly visit the dentist), so we will do everything possible to make your experience comfortable.

Your face is not like anyone else's-your smile shouldn't be either. That's why we take into account the unique features of your face, including its symmetry and lip line. Working with you, we'll develop a unique "perfect" smile, one that is proportional and flattering to your face. Smile design will allow us to show you what that perfect smile can look like (See FAQ above "Can you show me what my smile will look like ahead of time?").

Smile Design involves our listening to - and understanding - your dreams for your smile. We then apply several artistic principles (such as Michelangelo's GOLDEN PROPORTIONS ) and technical principles (such as how your teeth fit together) to come up with an esthetic smile which is as unique as you are!

While no dentist is allowed to guarantee their work in any way for any length of time due to the many variables that teeth can be exposed to ( including issues such as trauma, cavities, and gum disease) , I am proud to work with Microdental Laboratories who have created the MAC Veneer. The MAC Veneer is unusual, not just for the exquisite beauty inherent in the porcelain itself, but also for its warranty.

The MAC Veneer (which can be used for veneers, crowns, caps, and overlays) is warranted against fracture for life. That's right, if the porcelain breaks, or chips, there is no charge to replace the porcelain for life. So you can add this to the list of things you can count on... taxes, and the MAC warranty! Remember, you still must brush and floss your teeth as always, because even the MAC veneer cannot protect you from gum disease or cavities.

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