Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

May 7, 2016

The technician can’t get the color right on my two front teeth


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Dr. Hall,
I’m writing you from Germany. I’m a dental patient and getting two front crowns with e.max but my technician just won’t get them in the right colour.
My stumps are not dark and my teeth have a BL3 colour.

The problem with all the crowns I tried in was that they turned out too grey.

The technician has made a couple of sets of crowns already, and has experimented with pastes. When they tried in the first set of crowns they looked too grey. He then tried a bright white fit checker underneath, and they still looked grey.

So for the second set he made them with a bright white ingot and layered over it to cover the white. When we tried them in without any paste they looked grey again. This time he had a regular try-in paste in the colour light +. So he put that underneath the crown. The crown was not grey anymore but completely opaque and lifeless and had a terrible bright white. I did not like the crowns At all. The technician said he can’t do it better. I am so unhappy and don’t want to end up with two opaque front teeth that do not match my other teeth. Do you have any idea what went wrong? Did he use the wrong ingots? Or the wrong try in paste?
I thought maybe we should use a LT Bl3 ingot and a try in paste that is less opaque.
Please, please, if you have any suggestions I would love to hear from you.

Tilo's front teeth crowns

I do have photos of both crowns which I could send to you.

Thank you so much!

Tilo from Germany

I asked for photographs, and here is what Tilo sent me. The top photo is a view from the side that shows the color discrepancy.

And the bottom photo is a view from the front, with lips relaxed, that to me was even more revealing because it shows that the shape is all wrong:

Tilos-front-teeth-crowns-2

And here is what I wrote back to Tilo:

Tilo,
Let’s see if I can help you.

After seeing the photographs, I do think the problem is fundamental, that the dental lab technician isn’t very good with color. And more than that, the technician isn’t very good with aesthetics in general.

But I suspect it is even more than that. Your dentist is the one who selected this technician. Dentists who are accustomed to doing aesthetic work and who do it well will always choose a dental technician who can produce a high level of aesthetics.
Here is how I see your situation. This dentist and the technician I imagine have maybe done many crowns together, including crowns on front teeth. In their mind they have turned out fine. The patients maybe weren’t thrilled with the results, but they were willing to accept them. Now you come along and for you, the work simply isn’t good enough. They have been back and forth trying different colors, and it’s not good enough for you. If I am sizing up this situation correctly, you are becoming annoying to them. They think you should just accept what they have done–it’s good enough and you’re too demanding.

On the other hand, a dentist who does high quality aesthetic work would not put up with this level of work from his or her lab technician. It sounds to me that in this group of three–the dentist, the technician, and the patient–that you’re the lone voice thinking this isn’t good enough.

This Work Isn’t Good Enough

But you’re not completely alone, because I agree with you. The crowns simply aren’t good enough. But you may have to do more than get your dentist to pick another technician. Your dentist may not even know any technicians who are artistic enough for this case. I don’t know how things work in Germany, but I would brace yourself for maybe needing to find another dentist to finish this for you. I wouldn’t switch dentists immediately, but would ask your dentist if he knows how to find a technician with better aesthetic skills.

Having said that, let me get to the crowns. The problem isn’t just the shade and the grayness. The shape is a problem, too. They are too bulky and round-looking near the necks of the teeth. In the middle photograph of the second group where you have your lips relaxed, the crowns look awful! They are very prominent and make you look like a chipmunk!

Then, as you have written, there is a problem with the color. But it isn’t just the shade that is picked–the color is flat. The color of the crowns looks fairly uniform from the gumline to the biting edge. This is not how teeth look naturally. These crowns have kind of a uniform grayish tinge. If you look at your natural lateral incisors, you’ll see that they are kind of a very light creamy color near the gumline, with a very slight reddish-brown tinge. Toward the middle of the tooth they are lighter, with more white. Then, near the biting edge, they are fairly translucent with a more opaque halo at the very edge. So you see, it’s more involved than a simple color selection. Though I suspect that to your dentist and the lab technician, it’s a simple matter of selecting a shade. What I did when I was doing crowns on front teeth is that I would draw a large color map of the tooth and I would diagram the different color areas. I would have a basic background color that I would ask for, one that I would select from the standard shade guide, and then I had different tint tabs that I would use as a reference and explain to the technician where I wanted these color accents and variations. You are getting nothing like this from your team.

Maybe the best thing I can do for you is to encourage you to stick to your demands. Don’t let them cement these crowns permanently, but insist that they match and look natural in your mouth. There are dentists and technicians who can do this level of work.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 5, 2016

On the appearance of my front teeth, my dentist just says “trust me”


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Dr. Hall,

I had my top 4 front crowns replaced and the new crowns are gray in appearance. They kind of match the rear teeth but in many conversations with the Dr. having the new crowns match the bottom teeth and whiter than the old crowns was very important. When the color was being chosen, I stated that it looked dark. The response I got was “trust me.” At the time the crowns were being installed, I again said they looked dark and the response was “they are perfect, trust me.” In the dentist’s photographs they don’t look terrible although the gray is clearly visible. In natural light I am extremely unhappy with them. So much so that I now consciously try not to smile. We met with the dentist and he again claimed that they looked great but stated that he would discuss with his peers and “make it right.” The next correspondence we received was a certified letter stating that he would not re-do the work and in his opinion they looked great. He claimed that his peers felt the same way, although without looking at anything other than pictures taken with a bright flash I question how that can be determined. What should I do?
– Glen from Massachusetts

Glen,
I love your question and the situation you relate, because it illustrates so well the mentality of much of the dental profession. It’s an authoritarian attitude that is truly foreign to excellent cosmetic dentistry. What your dentist is telling you is that, as far as the appearance of your teeth, “the dentist knows best” and “who are you to tell me how your teeth should look?”

I have interviewed a number of great cosmetic dentists who create beautiful smiles. Some of them do celebrities. I will tell you that any smart celebrity simply wouldn’t trust a dentist with the attitude being displayed by your dentist.

When I do a website for a dentist who wants to promote himself or herself as a cosmetic dentist, I will have a long interview with them. One of the key things I ask them is how they create a smile design and what they do to make sure the patient is happy with any new smile they create. Without exception, these great cosmetic dentists are focused on how the patient perceives the appearance of the work. They view themselves as treating the self-perception of the patient. In the ethics of the cosmetic dentistry world, that is the problem the dentist is treating. If the teeth don’t look great but the patient has no sense of embarrassment over it and smiles broadly with no self-consciousness, then there is no problem. On the other hand, if the patient hesitates to smile or covers his or her mouth because they’re embarrassed over the appearance of the teeth, then that needs treatment. And the measure of whether or not that treatment is successful is that the patient now feels proud to smile. “After” photographs will typically show a relaxed, confident smile. Self-consciousness is gone. If that isn’t achieved, the cosmetic dentist would consider the treatment a failure. This is the universal attitude of these great cosmetic dentists.

However, to many in the dental profession, such concern over what the patient thinks is considered pandering to the patient and unprofessional. That is why this dentist, when you raised objections over how these crowns looked, replied simply, “trust me.” You see, your opinion doesn’t matter to him. And then, rather than making it right, he went to his peers. But any true cosmetic dentist would be appalled to let you out of his or her office with a smile they had created over which you were self-conscious.

You Are in the Wrong Dental Office

What to do? Well, for starters, you are absolutely in the wrong dental office. Any efforts you make in that office to get this right are going to be futile, because, based on what you have told me, this dentist is psychologically incapable of addressing your problem. So look for another dentist. Now there are many dentists who would have enough empathy with you to at least try to get this right for you, but if you really want to get it right, so that your front teeth look completely natural, you should go to an expert cosmetic dentist. If you let me know what city you are in, I could maybe find one for you close to you.

In my opinion, you should be able to get compensation from this first dentist to pay for re-doing the crowns, but I believe you are going to need to brace yourself to get tough with him. The first step is to find the dentist who will go to bat for you–you’re not going to get anywhere without a dentist who agrees with you. Then you would ask this new dentist to try to work with the first dentist to talk him into refunding your money. If that doesn’t work, you could go to a lawyer.

Informed Consent

Your dentist isn’t innocent here, in my opinion, and it seems that he senses that–hence the certified letter. However, he is bracing to defend himself on the wrong principle. The first principle of medical or dental malpractice is informed consent. If I have your story right, your dentist put these crowns in your mouth over your objections. That isn’t informed consent–it isn’t consent at all. That principle of informed consent is your leverage here and your case is analogous to the very first informed consent case that I was taught about in dental school.
informed consentMany years ago, there was a patient in Great Britain who had broken his leg and it had healed improperly. He went to a doctor for help. The doctor studied his case and consulted with his colleagues. They all agreed that the leg needed to be re-broken to heal properly, so they went to the patient and whacked his leg and re-broke it. The patient sued, because he wasn’t told what they were going to do and hadn’t consented. The doctors argued that it was their unanimous professional opinion that this was the treatment he needed. The court, however, ruled in favor of the patient, saying that regardless of how right they felt the treatment was, they needed to obtain the patient’s consent before proceeding.

This dentist of yours may argue that you nodded or gave him some signal that you would let him put these crowns in. But in my opinion, a strong-armed consent isn’t consent, and I think the dentist should be held liable, even if you did allow him to proceed.

This is the point you and your new dentist need to make to the first dentist, and hopefully he will be persuaded that what he did needs to be remedied, without your having to go to court.

And don’t get the idea that an expert cosmetic dentist is going to be way expensive. Interestingly, most good cosmetic dentists charge about the same for crowns that good general dentists charge.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 4, 2016

Fixing a broken front tooth on a 7-year-old

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Dr. Hall,
When I was about 7, I slipped on a monkey bar and it cracked and chipped my right upper front tooth. I didn’t get it fixed right away, but a couple of years later the dentist did a root canal and I also had it filled to kind of match my other front tooth. But now it looks horrible because it’s smaller than my other tooth and it’s discoloring. Would there be a way for my smaller discolored tooth to match my bigger front tooth? And to get rid of the discoloration?
– Vance in Arizona

Vance,
This could be a real problem, if you ask your family dentist to do this. But if you go to an expert cosmetic dentist, such as the ones I recommend on this website, it’s a fairly straightforward case that should require a single all-porcelain crown.

Many cosmetic dentists, me included, won’t recommend doing a porcelain crown on a patient in their teens or younger because often the tooth hasn’t fully erupted. If the tooth continues to erupt after the crown has been placed, the margin ends up very visible, which is not good. So they will repair the tooth with composite, if that is an option, and then do the crown in the patient’s late teens or maybe a little later. And since a composite filling isn’t as strong as a crown, making it a little smaller can keep the composite from breaking.

One problem, though, with composite on the front tooth is that it can be susceptible to staining. An expert cosmetic dentist will have a selection of highly stain-resistant composites to use, but most dentists will just stock all-purpose composites. And then, the tooth itself is subject to discoloration once it has had a root canal treatment.

Here is a photo. discolored front toothThis isn’t Vance, but is a photo of another patient who has had a root canal treatment on a front tooth and a composite repair, similar to what Vance would have had. The composite covers about 1/3 of the tooth, consisting of the lower left corner as we are looking at it. You can see that the composite, while it is lighter than the rest of the tooth, is darker than the adjacent tooth. So the composite has discolored some, and the tooth has discolored more.

When a front tooth has a root canal treatment, it also tends to become more brittle over time and more prone to breaking. Doing a crown on such a tooth will actually weaken it more against lateral stresses, which are the types of stresses to which front teeth are most susceptible. So it is wise to put a post in the tooth to strengthen it. A metal post can show through slightly. An expert cosmetic dentist would use a white or translucent fiberglass post. A general family dentist also would probably jump right in and do the crown, but an expert cosmetic dentist would probably want to bleach the tooth first because the darker tooth structure would have to be blocked out making it more opaque than the adjacent tooth, when you want these two front teeth to look exactly the same.

Done correctly, the dentist should get a perfect match with the adjacent natural tooth. It will likely take several try-in appointments to get the color match perfect, and it will require teamwork between the dentist and the ceramist to do this. The tendency of family dentists is to get the color “close enough” and be satisfied with that. But here is a photograph of a case done by one of our mynewsmile network dentists. One of these front four teeth is a porcelain crown, but it is impossible to tell, from the front, which one.

porcelain crown on a front tooth

My recommendation—go to one of our recommended cosmetic dentists and get this done right.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

November 17, 2015

What is the best crown for a front tooth?

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Dr. Hall,
What is the best crown for a front tooth?
– Asra from India

Asra,
The best crown for a front tooth is the one your expert cosmetic dentist is most comfortable with.
Creating a crown for a front tooth, if you want it to look perfectly natural, is a work of art, and you need to let your artist work with a medium that he or she is comfortable with, and also a laboratory technician that he or she is comfortable with. If I were doing it, I would do it with feldspathic porcelain, but other cosmetic dentists might select a different material.
But please note—the dentist needs to be an expert cosmetic dentist, an artist. In saying that I have cut out 98 to 99% of dentists. And actually, in India, you may only have a handful of dentists in the entire country who would qualify as expert cosmetic dentists. That’s an important qualification.
A dentist who is an artist, for example, would never select porcelain fused to metal for a front tooth.
Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 7, 2015

These crowns are not the color they appeared to be when they were tried in

 

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Dr. Hall,

I have just had two all porcelain crowns made for my two front teeth, #s 8 & 9. The crowns were a wonderful color match to adjacent teeth and I unreservedly authorized them to be cemented in. After the cementing procedure, I looked in the mirror and IMMEDIATELY noticed a slight grayish hue to the teeth. I inquired about this, and the dentist stated that the cementing product he used was transparent in color. I have looked at the teeth in different light conditions over the past several days and STILL see this. Is there something in the cement or its curing that could have caused this?
– Sara from Florida

Sara,
Did the dentist try in the crowns dry? Or was there some type of try-in paste used between the crown and the tooth under it?

That is one possibility that could account for a difference in perceived color between the crowns when they were tried in and when they were cemented. If the crowns are dry, they don’t transmit the underlying color of the tooth as well as they would with a bonding medium between the tooth and the crown. Darkness, stain, or metal posts in the teeth underneath could cause a gray tinge to the crowns. What I did in my practice when my bonding cement was going to be transparent was use a clear glycerin to accurately mimic what the resulting color would look like when it was bonded.

If that’s not the case, then the only other explanation I can think of for a discrepancy in the color like this would be color metamerism, which is the property certain materials have to appear one color under one light and another color under another. Some porcelains may match the teeth under a cool fluorescent light but then won’t match in, say, daylight or under incandescent light. But a clear bonding cement made by a reputable manufacturer will not change colors upon curing and won’t impact the color of the final result beyond helping transmit the underlying color.

If the grayness is only very slight, maybe it isn’t really noticeable, and since both very front teeth are the same, it shouldn’t be distracting. However, if the grayness is significant and noticeable to others, I think your dentist should fix this. At his expense. It could be a great learning experience for him.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 30, 2015

How do you whiten porcelain crowns?

Filed under: Crowns for front teeth — Tags: , , — mesasmiles @ 5:09 am

 

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Dr. Hall,
I have several front teeth that have caps on them. I’ve had them for approximately 30 years. They are not white like I would like them. What would you recommend for whitening my “fake” teeth. I’m assuming they are porcelain, but not 100% sure on the material they’re made up of. They were put in with posts and each one is individual.
—Missy from Pennsylvania

Missy,
If you have caps (crowns) on your front teeth and they are white and they’ve been there for 30 years, I’m pretty sure they have to be porcelain. Nothing else would last that long.

Unfortunately, the only way to whiten crowns is to replace them.

There is a company that is promoting the use of porcelain veneers to cover over old crowns, but that procedure makes no sense for several reasons, one of the biggest of which is cost. With most dentists, the cost of a porcelain veneer is pretty much the same as a new porcelain crown, so why wouldn’t you just replace the crown? Even if the veneer is cheaper, it isn’t cheaper enough to make it worth it.

First of all, if these crowns are 30 years old, there is a decent chance there could be some leakage or even decay under them.

Second, pasting porcelain veneers over old crowns creates some problems. This is a tricky bonding situation, and the bonding between the old porcelain and new porcelain is hard to get very strong, and it tends to be susceptible to stain. And it’s not going to last all that long. If these first crowns have lasted 30 years, why not get new ones and try to get another 30 years out of them? That makes way more sense than bonding some veneers over them that might last another five years.

No, just replace the crowns. It’s time a dentist looked under them to see what is going on there. It’s bound to be at least stained. Have the dentist clean it all up and put on some beautiful all porcelain crowns that can be as white as you want them. Bleach the rest of your teeth first, and then get the new crowns.

But go to an excellent cosmetic dentist. This is a new smile you’re talking about, and you need a dentist/artist to do this right.

—Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 20, 2015

I want CEREC crowns on my two front teeth

Filed under: Crowns for front teeth — Tags: , , , — mesasmiles @ 3:26 pm

Dr. Hall,
I broke my two front teeth in an accident, and they both need crowns. I really want the same day crowns, and my dentist doesn’t do them. Should I ask him for a referral?
– Nolan from Florida

Nolan,
You THINK you want same day crowns, but I’m not sure you really do.
Your answer to this question will tell me whether or not you want CEREC (same day) crowns for these two teeth. Which is more important to you–that they look natural, or that you take care of this in one appointment without having to wear temporary crowns?
Your front two teeth are the most important teeth in your smile, and most people would be willing spend a little more or go through a little more inconvenience to get them looking just right. CEREC crowns simply aren’t that esthetic.

Let me illustrateshould you do a CEREC crown on a front tooth? with a close-up photo of a front tooth.

Look closely at the coloration in this tooth. Notice that there is a tannish color present at the base of the tooth that fades out as you get to the halfway point. Notice also some subtle white splotches in various places. There are a couple near the base of the tooth and some more subtle ones near the center. There is also some gray that you see near the biting edge and wrapping around the sides of the tooth a little. And the very biting edge has a whiteish halo.

A porcelain crown for a front tooth is stacked in layers, and a good ceramist operating from good instructions from a skilled cosmetic dentist and maybe from a photograph will build all of these different colors into your crown, so that it looks lifelike. A CEREC crown, on the other hand, is milled out of a single block of ceramic and so will be missing all of this characterization.

Now there are some highly skilled cosmetic dentists who can paint on these characterizations and make a CEREC crown look more lifelike, but you’re talking about fewer than 1 in 100 dentists who can do this and have the equipment to be able to bake these colors on. And even with them, it is still not as good, in my opinion, as having the color embedded in the crown the way it is in a natural tooth.

I should mention also that this is really a job for a skilled cosmetic dentist. The vast majority of general dentists would not be this attuned to the appearance of these front teeth.

Now if you don’t mind having two front teeth that have a flat color and are fake-looking, then go with the convenience. The temporary crown that you have to wear for a couple of weeks is annoying. But I think most people would put up with that for the result of attractive front teeth.

If you opt for the CEREC crowns, you don’t need a referral from your dentist. It’s easy to find a dentist who does CEREC crowns–just search for CEREC crowns with the name of your locality also in the search box.

By the way, there are other brands of same-day crowns. CEREC is the most popular. There is also PlanScan and E4D, which use the same on-site milling technology.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 11, 2013

Finding a cosmetic dentist in the Cayman Islands

Hi there Dr Hall,
Many thanks for such helpful information on your website. Your support is greatly appreciated! I currently reside in the Cayman Islands, my front right tooth slightly overlaps my front left tooth. Is there anyone you could recommend in Grand Cayman, so many cosmetic dentists I don’t know where to start. I have visited one, whom suggested getting all my teeth whitened, then 2 zirconia crowns on both front teeth as sister teeth. Are there any other options to compare, or does that sound wise. I am 34 with 2 young kids and finally want not to be too embarrassed to smile.

Many thanks
– Denise

Denise,
What you’re telling me about what this dentist wants to do makes me nervous. The idea that he or she wants to do zirconia crowns on these front teeth rather than bonded porcelain makes me think that he or she is not comfortable with bonded porcelain. Bonded porcelain would be preferable to zirconia. Zirconia is great for back teeth or bridgework, but I wouldn’t recommend it for an esthetically critical situation on your two front teeth. And I would think the ideal treatment would be porcelain veneers anyway, not crowns at all. Doing two or more crowns on front teeth can put you at risk of breaking them off from lateral stresses.

I don’t understand all these cosmetic dentists you are talking about. I just googled cosmetic dentists in the Cayman Islands and looked at several websites and couldn’t find anyone I would trust with even the simplest cosmetic procedures, much less something as involved as what you are telling me. Even in the United States, fewer than one dentist out of fifty could do a beautiful job on your case. I would be surprised if you could find a dentist in the entire Caribbean area who could do a nice job on this. Quite frankly, I would fly in to Miami and have someone there do this. Dr. Sam Sadati near West Palm Beach is one I know personally who would do beautiful work for you. You could have your teeth whitened there locally and then get the two veneers or whatever your case requires done in Florida.

Why spend money to give you a mediocre cosmetic result and then possibly end up with damaged front teeth besides? Spend a little extra for a couple of trips to Florida and get it done right.
Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 2, 2013

Do you need a crown on a front tooth with a root canal treatment?

Just had a root canal on the tooth right next to the front tooth. Is it necessary for a crown to be put on ? Can a post only be put in and if so, repair the discoloration with a porcelain veneer ?
– Ann from New York

Ann,
There’s a simple answer to your question and a more thoughtful answer, and I’ll give you both.

The simple answer is that dentists were taught in dental school that if a tooth has a root canal treatment, it is weakened, and thus it needs a crown to strengthen it and prevent tooth fracture. Plus, after a root canal treatment, a tooth will turn dark, so a front tooth should have a crown to preserve its appearance.

The more thoughtful answer differs from this approach in two ways. First, on the “likelihood to break” issue:
– Yes, a tooth is weaker after it has had a root canal treatment. But there is a difference between back teeth and front teeth. Back teeth, because they have a flat chewing surface and cusps are prone to splitting – the chewing force comes down between the cusps and this pressure tends to force the cusps apart. A crown will prevent splitting of the tooth. A front tooth, however, doesn’t have these forces. The risk with a front tooth is that chewing creates a horizontal force that may break off the tooth. A crown, since it requires removing 1-2 millimeters all around the circumference of the tooth, will actually weaken it against these horizontal shear forces and make it MORE likely to fracture.

On the discoloration issue, yes, teeth with root canal treatments will discolor. However, if the root canal cement and the root canal filling material are carefully cleaned out of the inside of the crown of the treated tooth, that discoloration will take years to occur and will be mild.

My preference for a front tooth would depend on the amount of healthy tooth structure remaining in the tooth. If, say, 70-80% of the tooth is healthy tooth structure, I would recommend restoring the tooth simply with a translucent or white fiberglass post and composite. Then, when the tooth begins to discolor, that could be corrected with a porcelain veneer or a crown at that point. If substantial amounts of tooth structure are missing, I would use the same white or translucent post with an all-ceramic crown.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

June 9, 2012

Why can’t my dentist get this color right on my implant crown?

Dear Dr Hall,
I was not happy with the color of the crown attached to my implant, so I returned to my dentist who said he thought it was fine and sent me away to “think about it.” I returned and he very reluctantly agreed to re-do the color. I recently had the revised crown attached again, but the color is worse – it is now quite noticeably darker. Both times I visited the lab for color assessment. And both times the dentist did not bother to check the color before attaching the crown. I am very disappointed, but do not want to return to this dentist as he obviously is not able to improve. He also had considerable difficulty with attaching the crown which resulted in considerable discomfort and left me wondering whether the attachment to the implant has been damaged. Post-procedure, I cannot eat on that side of the mouth at all. This implant has cost me a considerable sum. I would like to know what my options would be for correcting the color of this crown, and if the attachment has been damaged, would I need to get a whole new crown and implant, and who should pay for this? Is it possible to place a veneer over the crown? Thank you for your help.
– Mary from Australia

Mary,
Your case is a great illustration of the great difference between dentists when it comes to aesthetics. Only about 2% of dentists, from my experience, are very good at aesthetic dentistry, and I have people all of the time having a hard time believing that and wanting to know why. (And that 2% is in the US – probably less in Australia). But dentists become dentists because they like to fix things – they’re just not into works of beauty.

Your dentist clearly has a low degree of interest in the aesthetics of his work, and that is the reason this isn’t working. And you have given clear indication here in your e-mail of his indifference. Any dentist who is seriously trying to do beautiful cosmetic dentistry will be very attentive to your opinion and if you thought the color didn’t match well would not try to tell you that it was fine. Such a dentist would actually make sure the color was right in your eyes before cementing the porcelain crown and would not hesitate to send it back to the lab. But your dentist did not have enough confidence in his own color-matching skills to match the color himself but instead sent you to the laboratory. And then, after being burned once and having to re-do the crown, rather than trying it on and making sure you liked the color this time before permanently cementing it, he just puts it on.

You have figured out that you cannot rely on this dentist to get this right. If you want this done right, you have to find a dentist who actually wants to be good at aesthetic dentistry. I wish you had told me where in Australia you are and I could give you some guidance on that, because good cosmetic dentists are few and far between in Australia.

When a dentist sends you to the laboratory technician for the “color check”, that is a pretty good sign that the dentist knows he or she isn’t very good at tooth color, and those cases often end up looking very poor. All the technician can do is look at the tooth that needs to be matched and take notes about the color. Then he or she dismisses you, goes into the laboratory, and tries to follow the notes that were made. The dentist is supposed to have a higher level of skill than the technician, and should know how to make those notes and instruct the technician. And nowadays, with digital photography, it is very easy for a dentist to hold up a shade guide tooth to your tooth and snap a color-correct photograph and e-mail it to the technician, with notes. The technician can then use that photograph and the notes during the fabrication of your crown, and this is often the best way to get an accurate match.

Do not – absolutely do not try to get a veneer placed over the crown. The crown is difficult enough by itself. Get the crown re-done. If that is done correctly, it will not damage the implant at all. Trying to do a veneer over it and get the color right makes it all the more complicated. Besides which very few dentists know how to properly bond a veneer onto a porcelain crown. That could turn this from a simple bad dream into a true nightmare.

If you need any more help with this, please write back.
– Dr. Hall

P.S. – I see you found our website by searching on “dental catastrophe.” I had not thought of that search term before, but it is appropriate!

Click here to read my blog posting about how to ask for a refund from your dentist.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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