The Cosmetic Dentistry Blog

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