So there is the link, and if you’d like to help her out, check out the site or tell your friends.

1) What are the usual metals contained in the metal shell?

2) Is the metal shell the thing that begins to show at the gumline, causing the black lines? (I have those black lines.)

Thank you for your information.
- Carolyn from New Jersey

Carolyn,
There are two basic types of metals that are used in porcelain-fused-to-metal crowns – precious or noble metals and base metals. Noble metals used are gold, platinum, and palladium. Base metals would be chromium and nickel. Dentists will classify these crowns as porcelain fused to high noble, porcelain fused to noble, or porcelain fused to base metal.

The noble metals have less tendency to corrode, provoke less sensitivity, and are made to a more accurate fit.

The metal can show at the gumline, and this is what causes the dark, sometimes it’s even black, line at the gumline. Dentists may try to hide this under the gum, but after several years, sometimes the gum recedes and this line is visible anyway. The dentist may ask the dental lab to cut back the metal at this front part of the gumline and leave this margin all in porcelain. This is called a porcelain butt margin. The dentist will pay an extra fee for this – about $30 to $40, and they generally pass this on to the patient. While this makes this line more subdued, it will usually still be present. The reason is that there is still a lot of opaquer that has to be used in the crown to mask the metal. The contrast between the opaque crown and the natural tooth structure makes it difficult to blend colors here, and creates the effect of the dark line.

Patients generally prefer the all-porcelain crowns, which will eliminate any dark line. And the general natural translucency of the crown without any metal is much more natural-looking. But be careful. I would never ask a dentist who is more comfortable doing a porcelain-fused-to metal crown to do an all-porcelain crown. Dentists who are good at all-porcelain crowns will far prefer them for front teeth. If your dentist suggests a porcelain fused to metal crown for a front tooth and you are concerned about the esthetics so that you want all-porcelain, take that as a signal that you are in the wrong practice. This dentist places a low priority on esthetics and if you try to nudge them out of their comfort zone, the results could be disastrous.
Dr. Hall

1.How natural veneer can be? I don’t want that veneer looks unnatural, is it possible that veneer have the exact shape like my natural tooth? 2. Color of the veneer can be perfectly like my other teeth? I don’t want and I don’t need any smile makeover I just wanna close that fracture. At the end, do i really need veneer for that small gap? (your opinion) I hope you wiil respond to this mail, Thank you in advance!
- Luka from Croatia

Luka,
A porcelain veneer, if done by an expert cosmetic dentist, looks very natural. But if done by your average family dentist it can look very fake. In your case, where your chip isn’t too noticeable, you could end up looking worse than if you had done nothing.

If you have a small chip in a front tooth, the best way to repair that is with composite bonding. The dentist just roughens the surface near where you tooth chipped, and applies a composite material that is bonded to the tooth. It can last a long time–years. If the repair is small, it doesn’t take a lot of artistic talent to get it to look good. Larger repairs require some artistic ability to get them to blend in with the tooth and look natural.

I hope this is helpful.

Dr. Hall

Was it necessary to pull the tooth in the first place because of the root resorption, or was the endodontist forced to pull it because he had already started the root canal and couldn’t finish it?
- Erin from California

Erin,
When root resorption is at the end of the root, it may be caused from the infection that started inside the tooth, and it may be possible to still save the tooth. But it sounds like your root resorption was on the side of the root. There is no way we know of to treat that type of root resorption, so yes, I believe the tooth was not saveable and needed to be extracted.

I had been saying that the before-and-after photographs on the home page were of different patients – that the “before” photograph was a different person than the “after” photograph. I was quite surprised when Rebecca told me that the pictures were of her, but that she had had other dental work in between the photographs. Either way, this is a misrepresentation. The work must be porcelain veneers or porcelain crowns, which would be one appropriate choice for fixing this tooth gap. The “after” photo does not represent the results of using these Teeth Perfect bands.

Here is the comment from her e-mail: “It is the same individual but they had additional work done to their teeth. How do I know? Because they are my teeth!”

Several yars ago when you were in Cedar Rapids, you fashioned a beautiful upper denture for me. That was shortly before you moved to Colorado. Well, needless to say, a number of years have passed and I was in need of a new denture and despite paying an arm and a leg for a new denture that my regular dentist assured me would be done to my specifications and satisfaction, my mouth is extremely uncomfortable and I am unhappy. The appearance is much less attractive and even though I kept insisting on “more tooth” I feel like I have old person dentures. I have considered implants but the cost is more than I can absorb. In my search, I ran across your website and blog. How I wish you were practicing in the area again because I know I would be happy with the end result.

Can you tell me what you think about the all on 4 one hour implants? They are very costly but are they a good option? Can you recommend an implant or cosmetic dentist in the Chicago area? I’d love to hear from you and get your advice and opinion.

Thanks.
- Mira from Chicago

Dear Mira,
Yes, I remember you. I hope everything is going well for you otherwise.

When I was in Iowa, I used to drive to Chicago for my own dental work and see Dr. William Cohen, who practices in the northern suburb of Glenview. He is very nice, a terrific cosmetic dentist, and can work with you for dental implants. His fees are reasonable, and he does a lot of work with dentures and dental implants.

I wouldn’t recommend the all-on-four technique. It’s kind of risky. I would check with Dr. Cohen. He would be straight with you and would be willing to discuss all of the available options to help make this affordable.

- Dr. Hall

Susan,
I can’t tell from what you’re telling me if something is wrong with this tooth or not. It’s typical for a tooth to be at least a little sensitive to pressure after a root canal treatment. Five weeks is a little long for this to be going on. But if it’s still getting better, it should be okay. If the root canal treatment caused a little swelling, which would cause this tooth to swell up a little in its socket so that you hit it first, it could take a while for that to heal itself.

If it is getting better from week to week, I wouldn’t do anything now. But when you go to your dentist for your next regular checkup, I’d ask them to x-ray this tooth and check it out, just to make sure it’s okay.
Dr. Hall

You may want to read more about pain after a root canal treatment.

- Ken from Arkansas

Ken,
It’s not common, but it’s not rare, either, to have a condition called “referred pain” in your teeth. You can have a problem in your upper teeth and it feels like the lower teeth hurt, too, or sometimes even just the lower teeth hurt when the problem is an upper one. Or to feel pain in your upper teeth from a sinus infection, or to have that pain referred to lower teeth.

One of your sinuses is very close to the roots of the upper back teeth, so it is fairly common for a sinus infection to cause a toothache. This pain might be aggravated by pressure, and wouldn’t usually involve sensitivity to cold.

One quirk of pain in the teeth is that one possible symptom of a heart attack can be pain in the lower jaw or pain in the left arm. So it’s a good idea, whenever you have pain that you don’t understand, to see a doctor.

I hope this is helpful,
Dr. Hall

Debra,
A flipper is a simple tooth replacement, usually for one or two missing teeth, that merely affixes a false tooth on a plastic plate that snaps into your mouth. It usually has a couple of simple wire clasps on it. It’s most often used for upper teeth, because they are the most visible and cause the most embarrassment if they’re missing. But yes, depending on the room the dentist has between your lower teeth and where your tongue attaches, a flipper can probably be made to replace a bottom tooth.

Just remember that a dental flipper is not very sturdy and is usually made to be temporary.
- Dr. Hall

Sally,
Lumineers is just a particular brand of porcelain veneers, so I will answer your question by talking about porcelain veneers in general.

I am getting the feeling from what you’re telling me that your dentist is uncomfortable with these cosmetic procedures. Porcelain veneers are usually not taught in dental school, and, while they work great for dentists who know how to do them, they can be intimidating for dentists who don’t. I think this is where your dentist is coming from.

One firm rule I always tell people is to not ever push your dentist out of his or her comfort zone. I have received so many e-mails from people who have really gotten burned trying to do this. Dentists are trained not to let you know when they are uncomfortable because it makes patients nervous. You’re lucky that your dentist is giving you these clues. He feels you would be unhappy with the result, and in his hands, you may well be unhappy. But porcelain veneers are a very beautiful restoration when done right.

So my advice is to stay with your regular dentist for your cleanings, checkups, and general dental work, but to find an expert cosmetic dentist to solve this particular problem.

If you otherwise love your smile and the only problem is this one dark tooth, then if it were me doing it, I would just do either direct bonding or one porcelain veneer over this tooth. If there are other things you don’t like about other teeth, then a full set of porcelain veneers may be in order. But find a true dentist/artist for this. Go to our list of recommended Northern California cosmetic dentists. If you’re not convinced you need an expert, please, for your own sake, take the time to read through some of the cosmetic dentistry horror stories that people have told me, and then you’ll be convinced that the average dentist on the corner is no place to go for this appearance-related work.
- Dr. Hall