The questions patients actually ask

66 answers, all of them straight. If yours is not here, call (212) 593-1212 or email office@laldental.com.

About the practice

What is a prosthodontist, and how is one different from a general dentist? +

A prosthodontist is a dental specialist in the replacement and reconstruction of teeth. The specialty is recognised by the American Dental Association and requires three years of training beyond dental school. General dentists can and do place implants and provide cosmetic work; a prosthodontist is the specialist that complex cases are referred to.

What does board certified actually mean? +

Dr. Lal is a Diplomate of the American Board of Prosthodontics, certified on 1 March 2006. It is a step beyond holding the specialty: a four-part examination, which he completed over four years between 2002 and 2006. Most prosthodontists do not take it.

Does LAL Dental accept insurance? +

Insurance participation is confirmed with the office directly, because the answer depends on your specific plan. Call (212) 593-1212 or email office@laldental.com and the office will tell you exactly what your plan covers before you commit to anything.

What will treatment cost? +

No honest figure can be quoted before an examination, because the cost of reconstructive work depends entirely on what is there to start with. What you can expect is a written plan with the sequence, the stages and the cost set out before treatment begins, rather than a number that changes as it goes.

Will it hurt? +

For most routine fillings the Solea laser allows treatment with no drill and, in many cases, no injection. For surgical treatment such as implant placement, discomfort afterwards is usually mild and managed with ordinary painkillers. Most patients return to work the following day.

I am anxious about the dentist. What are the options? +

Say so at the first appointment, because it changes how treatment is arranged rather than just how it is described. For many patients the laser removes the specific triggers, the sound and vibration of the drill and the injection itself. Appointments can also be staged so that nothing happens on the first visit except talking.

How long does it take to have new teeth? +

It depends on the treatment. A single implant is normally about four visits. A full-arch fixed bridge is typically 8 to 10. In suitable cases, fixed provisional teeth are fitted at the time of surgery, so you are not without teeth during treatment.

Can you fix dental work that was done somewhere else? +

Yes, and it is a routine part of a prosthodontic practice rather than an unusual request. The first step is working out why the previous work failed, because repeating it more carefully rarely produces a different result.

What if I need treatment the practice does not provide? +

You are referred, and the practice coordinates with the specialist providing it. Prosthodontic treatment routinely involves working alongside surgeons, periodontists and physicians, which is normal practice for complex cases rather than a limitation.

What materials and laboratories are used? +

Restorations are made from modern ceramics chosen per tooth, balancing appearance against the load that tooth carries. Dr. Lal has lectured on digital laboratory workflows, including at the Dentsply Sirona Lab Summit, and works with laboratories capable of them.

How often should I come in for a hygiene visit? +

Every 4 to 6 months for most patients. The right interval depends on your gum health, your risk of decay and your history, and it matters more after reconstruction, because crowns, bridges and implants fail through gum disease and decay at their margins.

How often do I need x-rays, and are they harmful? +

Every few years for a routine patient, and more often where there is a specific reason. Dental x-rays are among the smallest radiation-dose studies in modern medicine: a routine examination with four bitewings delivers about 0.005 mSv, comparable to the exposure of a one to two hour flight.

Where is the practice, and how do I get there? +

LAL Dental is at 245 E 50th Street, New York, NY 10022, in Midtown East between Second and Third Avenue, convenient to Midtown, Turtle Bay, Murray Hill, Sutton Place and the Upper East Side.

Full-Arch Implant Reconstruction

How many implants does a full arch need? +

It depends on the bone available and the design of the bridge, and it is decided during planning rather than in advance. What matters more than the count is where they go: implants are positioned to support the finished bite, not simply placed where bone is easiest.

How long does full-arch treatment take? +

The number of appointments depends on your starting position, and 8 to 10 visits is a reasonable expectation for a fixed bridge from beginning to end. Many patients leave the surgical appointment with fixed provisional teeth rather than a removable denture.

Is a fixed implant bridge better than a denture? +

For most patients who can have one, yes. A fixed bridge is anchored to the jaw, so it does not move when you eat or speak, and it transmits force into the bone, which helps preserve it. A conventional denture rests on the gum and does neither.

Will people be able to tell? +

A well-made full-arch restoration is designed around your face, not just your jaw: lip support, tooth proportion, midline and the amount of tooth that shows when you smile are all planned deliberately. That design work is the part a prosthodontist is specifically trained for.

Single-Tooth Dental Implants

Why choose an implant over a bridge for one tooth? +

A conventional bridge is supported by the teeth on either side of the gap, and preparing them means cutting down two healthy teeth to replace one missing one. An implant stands on its own and leaves the neighbours untouched.

How many appointments does it take? +

A single-tooth implant normally involves about four visits. Most patients are able to work the day after the implant is placed.

Will the crown match my other teeth? +

That is the point of using all-ceramic rather than metal. Shade, translucency and surface texture are matched to the teeth beside it, which matters most at the front of the mouth where a single crown has to disappear next to a natural tooth.

What happens if I just leave the gap? +

The bone that held the root begins to resorb, and the teeth on either side tend to drift or tip into the space over time. Neither is quickly reversible, so the decision is worth making sooner rather than later.

Multiple-Tooth Implant Bridges

Do I need one implant per missing tooth? +

Usually not. A bridge spanning several teeth can be supported on fewer implants than there are teeth, provided they are positioned to carry the load. How many, and where, is decided at planning.

How long does it take? +

After the initial examination, expect roughly 4 to 5 further visits before the fixed bridge is permanently attached.

Is there much discomfort afterwards? +

Some minor bruising and swelling of the gum and soft tissue is normal, and is usually managed with ordinary painkillers. Most patients are back at work the following day.

Why not a removable partial denture? +

A partial denture is cheaper and faster, and it clips to your remaining teeth, which puts stress on them and traps plaque against them. It also has to be taken out. A fixed bridge on implants stays in, and it preserves the bone underneath.

Computer-Guided Implant Surgery

What does 'guided' actually mean? +

Your jaw is scanned in three dimensions and the implants are positioned in software, planned against the teeth you are going to end up with. A custom surgical guide is then made that reproduces that plan in the mouth, so the placement is executed rather than judged.

What is flapless surgery? +

Conventional implant placement involves lifting the gum to see the bone directly. When the plan is accurate enough to be trusted, the implant can be placed through a small opening in the gum instead. Less surgical trauma generally means less swelling and a more comfortable recovery.

What is immediate loading? +

Fitting provisional teeth to the implants at the time of surgery rather than waiting months. It is not appropriate for every case, and it depends on how firmly the implants sit at placement. When it is appropriate, it means you do not go through treatment without teeth.

Is this available everywhere? +

The technology is widely sold. The planning judgement is what varies. Dr. Lal has published on computer-generated surgical templates for implant planning and lectures nationally on guided surgery with immediate loading protocols.

Full-Mouth Reconstruction

How is this different from just having several crowns done? +

Separate repairs treat teeth. A reconstruction treats the bite. When teeth are worn or have been rebuilt repeatedly, the way the jaw closes has usually changed, and restoring individual teeth into a collapsed bite tends to produce work that keeps breaking.

Can you fix dental work done somewhere else? +

Yes, and it is a routine part of a prosthodontic practice. Patients often arrive after treatment that has not held up, or that never looked right. The first step is working out why it failed, because repeating it more carefully is rarely the answer.

How long does a full reconstruction take? +

It varies widely with the starting point and cannot be quoted honestly without an examination. What can be promised is that the whole plan is designed before treatment starts, so you know the sequence, the stages and the destination in advance.

Will I be without teeth at any point? +

No. Reconstruction is carried out in provisional restorations, which let you and Dr. Lal test the new bite and the new appearance before anything permanent is made.

Dental Crowns

How long does a crown last? +

A well-made crown on a sound tooth commonly lasts a decade and often considerably longer. Lifespan depends much more on the health of the tooth underneath and how you bite than on the crown itself.

Porcelain, metal, or both? +

All-ceramic crowns look best and are the default at the front of the mouth. Where a tooth carries heavy load, material choice is a judgement between strength and appearance, and it is made per tooth rather than per patient.

Why did my last crown fail? +

Usually not the crown. Decay at the margin, a fracture in the tooth beneath, or a bite that overloads it are the common causes. Replacing the crown without addressing the reason tends to produce the same result again.

Porcelain Veneers

Do veneers ruin your teeth? +

They involve permanently removing a thin layer of enamel, so it is a commitment. How much is removed depends on the case, and conservative preparation is the aim. Anyone who tells you veneers are reversible is not being straight with you.

Will they look fake? +

That comes down to design, and it is a decision, not an accident. Tooth proportion, edge shape, surface texture and how much tooth shows when you smile are all planned. A uniform, extremely white, perfectly straight set is a choice some patients want and others specifically do not.

Are veneers always the right answer? +

No. Crowding is often better treated by moving the teeth than by covering them. Discolouration alone may only need whitening. Veneers are the answer when shape, colour and position all need correcting at once.

Dental Bridges

Bridge or implant? +

If the teeth either side of the gap are already crowned or heavily filled, a bridge uses them without further loss. If they are healthy and untouched, an implant is usually better, because a bridge requires cutting them down.

How long do bridges last? +

A conventional bridge commonly lasts many years. It usually fails at a supporting tooth rather than in the bridge itself, which is why the condition of those teeth matters so much at the planning stage.

How do I clean under a bridge? +

With floss threaders or interdental brushes designed for the purpose. A bridge is joined, so it cannot be flossed normally, and the area underneath is exactly where problems start.

Dentures and Partial Dentures

Why do dentures move? +

A complete denture is held by suction, the shape of the ridge and the muscles around it. As the jawbone resorbs over the years, the shape it was made to fit changes, and the fit loosens. That is the bone changing, not the denture failing.

Can a denture be made stable? +

Yes. Even two implants can hold a lower denture firmly enough to change what a patient can eat. It is often the single most effective improvement available to a long-term denture wearer.

Do dentures have to look like dentures? +

No, and it is worth saying that a denture is a set of teeth designed from scratch, so tooth shape, colour, arrangement and the amount showing are all chosen. Slight irregularity is usually what makes them convincing.

What is a partial denture? +

A removable replacement for several missing teeth that clips to the remaining ones. It is a reasonable option, though it does load those teeth and traps plaque against them, which is why fixed alternatives are discussed first when they exist.

Professional Teeth Whitening

How long does it take? +

An in-office whitening appointment usually takes between 45 minutes and an hour.

Will it whiten my crowns and fillings? +

No. Whitening works on natural tooth structure only. Existing crowns, veneers and white fillings keep their current shade, which is why any that show are usually replaced after whitening, not before.

Does whitening damage enamel? +

Professionally supervised whitening at appropriate concentrations does not damage enamel. Temporary sensitivity is common and settles. The risk in whitening is usually poor technique and unsupervised overuse rather than the chemistry.

How long do the results last? +

It depends almost entirely on what you drink and whether you smoke. Coffee, tea and red wine restain teeth steadily, and most patients top up periodically rather than whitening once.

Solea Laser Dentistry

Really no injection? +

For most routine fillings, yes. The laser cuts without the vibration and pressure that make drilling uncomfortable, so many procedures can be done without anaesthetic. Some cases still need it, and it is available whenever you want it.

Is it quieter? +

Yes, and for a lot of patients that is the bigger deal. The sound and vibration of a drill are what most dental anxiety is actually attached to.

Does it work for everything? +

No. It is well suited to routine fillings and various soft-tissue procedures. Crowns, implants and reconstruction still need conventional instruments.

Why does no injection matter so much? +

Beyond the injection itself, it means leaving without a numb face. You can eat, speak and return to work straight away, and more than one filling can often be done in a single appointment because there is no need to numb separate quadrants.

Sleep Apnea Oral Appliance

Can a dentist diagnose sleep apnea? +

No, and you should be cautious of anyone who says otherwise. Sleep apnea is diagnosed by a sleep physician, usually with a sleep study. We work with your physician: they diagnose, and if an oral appliance is appropriate, we make and fit it.

How does an appliance help? +

Obstructive sleep apnea happens when the airway is blocked during sleep, often by the tongue falling back or airway tissues collapsing. The appliance holds the jaw forward overnight to keep the airway open.

Is it an alternative to CPAP? +

For some patients, and that is a medical decision made with your physician. Appliances are often considered where CPAP has not been tolerated. The best treatment is the one actually used every night.

What are the warning signs? +

Heavy snoring, extreme daytime drowsiness, difficulty staying asleep, waking with a very dry or sore throat, and frequent morning headaches. If those are familiar, ask your physician about a sleep study.

Invisalign Clear Aligners

How visible are they? +

Close to invisible in normal conversation. They are clear, custom-made and removable, which is the reason most adults choose them over fixed braces.

How long does treatment take? +

It depends entirely on how far the teeth have to move, so it is quoted after an assessment rather than in advance. Minor corrections are considerably quicker than comprehensive cases.

Do I have to wear them all the time? +

Close to it. Aligners only move teeth while they are in, so results track how consistently they are worn. This is the one treatment where the outcome is genuinely in the patient's hands.

Can aligners fix everything? +

No. They handle a wide range of cases well, and some bites need fixed appliances or a different approach. An honest assessment up front is worth more than an optimistic one.

Hygiene Visits and Examinations

How often should I come in? +

Every 4 to 6 months for most patients. The interval should reflect your gum health, your risk of decay and your history, not a single default applied to everybody.

How often do I need x-rays? +

Every few years for a routine patient, and more often where there is a specific reason. X-rays show what an examination cannot: decay between teeth, bone levels, and the condition of existing work below the surface.

Are dental x-rays harmful? +

Dental x-rays are among the smallest radiation-dose studies in modern medicine. A routine examination with four bitewings delivers about 0.005 mSv, comparable to the exposure of a one to two hour flight.

Why does a specialist practice do routine hygiene? +

Because reconstruction only lasts if what surrounds it stays healthy. Implants and crowns fail through gum disease and decay at the margins, so maintenance is part of the treatment rather than an afterthought.

Still deciding?

A consultation is a conversation about what is going on and what the options are. It does not commit you to treatment.