The Cosmetic Dentistry Blog

Dear Dr. Hall,
I have an old crown in a front tooth. I visited a cosmetic dentist who works as an associate of a very famous cosmetic dentist in my area. He said he won’t know if he can do an all porcelain crown or a porcelain fused to metal crown until he removes my current crown. He also mentioned that even if he has to use a porcelain fused to metal crown, he will be able to add several layers of porcelain to make sure the metal won’t be shown or leave a shadow thorugh my gum.

Can I, as a patient, request that my crown be all porcelain or all ceramic? or should I let my cosmetic dentist pick the most appropriate for me?. I was initially going to have my general dentist have the crown done, but decided to go to a cosmetic dentist after exhaustively reading your website. Thank you for taking the time and effort to reply to our e-mails. Your website is so helpful! Margarita

Margarita,

First, no I think it’s a big mistake for you to try to push a dentist into any type of crown that he or she doesn’t recommend. Dentists that are comfortable doing all-porcelain crowns will by far prefer them on front teeth, provided they have a strong esthetic sense.

Please forgive me if am missing something, but I can’t imagine any reason this dentist would need to take your existing crown off before being able to tell you if he can do an all-porcelain crown on your front tooth. I haven’t met a front tooth that I couldn’t do an all-porcelain crown on. And no matter how much porcelain he layers over the metal, he can’t make the metal translucent – it’s still porcelain fused to metal. Is this guy trying to pull the wool over your eyes? What makes you think he is a cosmetic dentist? And being “famous” isn’t a credential for cosmetic dentistry.

I recommend you get a second opinion from someone better – someone who loves doing all porcelain crowns.  Is there anyone on our recommended list who is close enough to you that you could go see them for this crown?

Especially if it is ONE front tooth – you need a real artist to get it matched right, and it needs to be all porcelain.
- Dr. Hall

Read more about porcelain crowns for front teeth.
Click here to find a cosmetic dentist.

Dr.Hall,
This might be a stupid question, but I’m going to ask it anyway. Two days ago I got porcelain crowns for my two front teeth. The color of them is noticeably more yellow than the rest of my teeth. I was in a lot of pain from sitting in the chair so I didn’t really get a long look at them before I left. But when I got out into the sun, I looked again and noticed a big difference. Now if I wanted whiter crowns, I would have to pay for them all over again right? (which I’m definitely not about to do, seeing as I already spent a fortune on them!) Or do you know if they can be whitened at all? I’m thinking that since I just got them done, that maybe he can do it over with a whiter shade….for free? Sorry if this is a stupid question, I just don’t know what to do….thanks for your time!
- Jennifer in Massachusetts

Jennifer,
This is one of the most consistent differences between the expert cosmetic dentists that we recommend on www.mynewsmile.com and others who just call themselves cosmetic dentists. There is that passion that true cosmetic dentists have that they want to make sure the work looks perfect to you before they cement it in or bond it. The other 98% of dentists really love to fix things and don’t have much appreciation for appearance-related issues. They really don’t see the importance of making sure you have a good look at the teeth before putting them in. Part of the reason may be that they think it looks “good enough” and they’re afraid you’ll be too fussy.

You’re kind of stuck with the color, unfortunately. Nothing you can do to porcelain will lighten the color. The only option is to re-do them. Maybe your dentist will do that for free. You can always ask.

Don’t let anyone talk you into putting porcelain veneers on top of the crowns. That has the potential for looking really bad, and if it’s done right, it will cost the same as re-doing the crowns. It doesn’t make any sense at all—don’t do it.
Dr. Hall

Related links:
Tooth bleaching
Ask Dr. Hall a question
Find a cosmetic dentist near you

Dr. Hall,
I just spent thousands of dollars on dental work. We finally got to the end with 4 Porcelain/zirconuim crowns on my top front teeth. They are bulky, they are thick front to back and they stick out a little further than my adjacent teeth. My dentist said that they restored my teeth to what they would have been prior to decay. My teeth were NEVER this big. What can I do as far as my dentist if I am not happy. I thought I would be smiling all the time but now I can’t even stand to look at them.
- Debbie from Texas

Debbie,
You’re another example of what I hear so much. I think the best you can do is help tell your friends to go to an artist/expert cosmetic dentist for their beautiful smile, not to their wonderful, kind, family dentist, so they don’t end up with this same problem.

I’m reading a little in between the lines and making some assumptions here, but it sounds like your dentist is the typical technician-minded dentist who was trained that he or she knows what is best for the patient and thinks that you’re making too big a deal of this appearance issue. The dentist did what he or she thought was best for you, and in their mind, this is their job, and you’re just supposed to accept that.

A true cosmetic dentist understands all the ingredients of a beautiful smile and gives a lot more attention to these appearance issues. He or she will work with you in designing exactly how your teeth will look BEFORE ever doing the case, and then will give you ample opportunity to try the crowns in before they’re cemented to make sure they look the way you want them to. Most general dentists will hand you a mirror while you’re upside-down in the chair and let you have one quick look before they’re permanently cemented. What you really need is the chance to sit up, let your lips assume their natural position, and get a good long time to check them out. Then you know they’re right. Dentists like we list on our web site who are passionate about appearance-related dentistry will make sure you like them before they’re cemented.

At this point, they’re cemented in. Porcelain/zirconia crowns can’t really be trimmed in size much because the dentist would grind through the surface porcelain to the zirconia core, which would give an unacceptable result. If you’re sweet and insistent and communicate how much you hate these crowns, you may be able to talk your dentist into re-doing them and this time making sure you have ample opportunity to see that they’re what you want before they’re permanently cemented. But he or she wouldn’t be legally required to do that because the way most dentists think, it’s the dentist’s job to decide how they should look and whether or not you like them isn’t an important issue.

Dr. Hall

Read more about:
porcelain crowns
porcelain crowns for front teeth
the difference between an expert cosmetic dentist and a general dentist
other types of all-porcelain crowns including zirconia crowns
smile design

Dr. Hall,
In December last year I had 24 teeth fitted with either Procera crowns or porcelain veneers. I have severe tetracycling staining that goes right through my teeth. I met a friend who had similar work done – and was astonished at the difference in appearance of the work. Her teeth looked totally natural and were very translucent. Mine on the other hand looked totally opaque and quite false in comparison. I am so upset. I have been reading on your web-site about the Procera crowns – and I now realise why my teeth look opaque. It is the opaque white core. I had no idea there were different types of porcelain crown! My dentist led me to believe that my teeth would look like natural teeth. And they don’t. Obviously my friend has a different type of porcelain crown. My question is – to cover the dark tetracycling staining – would Procera be my only option? Could I have a more translucent Feldspathic crown/veneer?
- Joanne from London

Joanne,

You’re making the mistake of blaming the material, but what happened is that you went to the wrong dentist. It’s the DENTIST who is supposed to know these things. But most dentists went into dentistry because they like to fix things, and 98 to 99%% of them aren’t artists. Your dentist did Procera because to him or her, this was good enough. Think about it–your dentist is the professional and attends courses and reads journals. Why did he or she choose to do Procera crowns? Don’t you think your dentist, if he or she cared enough, could find out that Procera is opaque, and that being opaque isn’t as beautiful as being translucent? My guess is that your dentist KNEW that Procera is opaque. But your friend went to a dentist who had a better sense of beauty and was more artistic.

To your dentist, I’m sure your teeth look fine. They’re white, and look like natural teeth. That’s why we are trying to set up this network of cosmetic dentists/artists who know how to do beautiful work. Dentists typically are technicians and not artists.

What I’m worried about is that you think that you can just go into a regular general dentist and this time tell them to use feldspathic porcelain instead of Procera and everything will be fine. No, that won’t work. You need to find a dentist who has a passion for beautiful cosmetic dentistry and he or she will take care of all those decisions and will choose a material that will look wonderful. So, as to your question about being able to have feldspathic porcelain, I hesitate to answer, because it is much more complicated than that. My technique with tetracycline stains was to do porcelain veneers, and I would do a deep preparation, and then use a composite opaquer directly on the dentin until the dark color was fully blocked out. Then I would take an impression and send it to the lab, and have them do beautiful, translucent feldspathic porcelain veneers. But there are other techniques that work well and newer porcelains that diffuse the light in such a way as to block color while still maintaining the appearance of translucency. But don’t try to figure this out for yourself and then tell the dentist how to do it. That just doesn’t work.

But you are actually better off than most of those who have written to me after having tetracycline stains masked. Most of them end up with gray teeth because the dentist erred in the other direction and made them too translucent. Tetracycline stains are difficult to cover. The darker color has to be masked. And there are very few dentists who know how to do that well. There are very few dentists who care enough to strive for that level of beauty.
- Dr. Hall

Dr. Hall,
Recently, I have had 6 front teeth crowned. I asked my dentist after some of my own research, to use only “bonded all porcelain” crowns as I wanted the most natural look possible. It is my understanding that it takes a true cosmetic dentist with extensive training to do this type of crown and so, when the dentist agreed with me, that this was the best thing for front teeth, I went ahead. I do not like the results as they look like false teeth and also do not feel comfortable. Naturally this has been an upsetting experience.

He told me that he would re-do the work. He suggested that I visit the lab person and tell him what I want. I do not have any relationship with this lab person at all but have been going to this dentist for 17 years.

What can I do? I truly appreciate your help.
- Leslie in North Carolina

Leslie,
You unknowingly put your dentist in an awkward position. It’s not just that were you asking for a specific type of crown, which generally isn’t a good idea, but you were expecting your dentist to become an artist and do a beautiful smile for you. Yes, it does take specialized extra training to place a bonded all-porcelain crown. But it sounds like the crowns are WORKING ok. It’s just that you don’t like how they look. So it’s the artistry, mostly, that you have a problem with. You want these to look beautiful and natural, and your dentist is not an artist, it seems to me, and doesn’t know how to create that “look.” People who are attracted to the dental profession become dentists, almost always, because they like to fix things, and they have a strong tendency toward a technician mindset and aren’t very artistic at all.

So it looks to me like he doesn’t know what to do. And it sounds like he’s hoping that the laboratory technician will be able to translate your desires into a beautiful smile, but I think that’s just because he’s at a loss as to how to create a beautiful smile. I don’t think it will help for you to go directly to the lab technician.

And your dentist is being really nice to you–to offer to re-do them. He doesn’t have to do that, but he wants you to be happy, so you must have a good relationship. This will be expensive for him.

Here’s what I’d suggest. I’d get some help from a real North Carolina cosmetic dentist by getting a second opinion. I know Dr. Jan Kraska in Greensboro, NC, really well, and besides being a very artistic cosmetic dentist, he is a really nice guy, too. Now that will be a bit of a drive for you, but if you really want a beautiful smile, I think you’re going to have to do this. I’d call and talk to Shelley, his wife, who usually answers the phone, and explain that Dr. Dave Hall suggested this, and that you’d like to get your dentist some help with re-doing these crowns so that you like how they look. And offer to pay for a consultation fee, for whatever time it takes for Dr. Kraska. Then ask Dr. Kraska to help direct the lab to making a beautiful set of crowns for you, or even see if your dentist needs to go to a different lab, or see if he would suggest something else.

I’d let your dentist know that you want to do this. I think if you explain it nicely he will cooperate as much as he can. He sounds like a very honest man who wants what is best for you, so I’d hang on to him for all your long-term care. But I think that he was put in an uncomfortable position since he isn’t an artist, and that’s how you could explain it to him, or however you want to put it.

I hope this is helpful.
- Dr. Hall