About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Better to do nothing than cheap cosmetic dentistry


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Dear Dr. Hall,
I reside in Henderson, NV. I have four porcelain fused to metal crowns on my front teeth since I was 24 yrs old. In 2015, I wanted to update dental work, I ‘Kör whitened‘ my teeth, which made those crowns look bad. I visited a cosmetic dentist, Dr. Featherstone who you have listed on your website. At that time, my paltry insurance would not co-operate, so I didn’t stay with Featherstone. His billing assistant actually had a credit application there to apply for a loan. Plus, she said, we had to pay in advance, and if there were money left over at the end, they’d refund it. My husband & I slunk out of there, glad to be free of that.

Next, I visited Dr. Michael Wilson, the only other one on your Nevada list. He would not do four, only eight, saying about four, “You won’t like it.” At first I agreed to do it, right then and there, he measured for a laboratory wax-up version, $800. I backed out the next morning, and a week later went and picked up the model. He was decent about it, and we left the door open.

Well, from there, I went to my general dentist, Dr. F. Those original crowns from when I was young were big and long and gave me a big smile, in every picture all my life. Now, Dr. F’s version are short, greenish (I picked the wrong shade). His words were, “I’ll make sure you get the teeth that you want.” But, he couldn’t please me, and ended up giving it to his assistant. I mean, it was excruciating, going over it again and again. You finally just settle. These teeth are too short, when I wake up in the morning with mouth agape, you can’t even see any teeth (thus, it makes you look like an old person). She remarked, “Oh, you probably are looking on the internet, and expect these perfect teeth.” Yes, exactly. I had your examples and pictures in hand.

Anyway, here I am, three years later, still not sure where to turn. Thank you for letting me vent. I live with this. My husband raises his voice at just the very mention of it.

Thank you very much.
– LaRae from Nevada

LaRae,
Quite the story you have.

I’m confident that either Dr. Featherstone or Dr. Wilson would have done a beautiful job for you. I’ve seen work from both of them and have interviewed them both. It’s too bad that they were too expensive for you. Your case illustrates a point I often make—if you can’t afford quality cosmetic dentistry, it’s better to do nothing and save up to have it done right than to go cheap. If the first dentist who did the Kör bleaching knew what he was doing and was honest with you, he would have told you that the crowns wouldn’t bleach and the results would commit you to re-doing the crowns. It would have been good to have had a complete plan from an expert cosmetic dentist from the start.

About Dr. Wilson wanting to do 8 crowns instead of 4—we see this where good cosmetic dentists will disagree on how to proceed with a case and in some cases will turn down a case unless they can do it the way they think will turn out the best. When I was practicing, I was more like Dr. Featherstone where I might compromise on a case because a patient didn’t want to spend more to get the “perfect” result.

– Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

A crown or a veneer on a front root canal tooth?


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Hello Doctor Hall. About 2 years ago I had a root canal on a front tooth. I had a general dentist do the root canal. It wasn’t painful and I was very happy. He wanted to put a veneer on the tooth for a very low price. But, I decided not to do the restoration at that time.

I didn’t realize that lack of blood flow to the tooth would make it change color and about a year ago it started to change. I eventually had a porcelain crown put on by another general dentist. She filed down the tooth to a small fang and it really bothered me at the time. So far, the crown is stable. But I know these things don’t last forever. I just want to know if I was duped by the second dentist who did the crown rather than a veneer? Thank you for your time.
Gary from Florida

Gary,
I have a couple of points in response to your question.

First, about the choice of a crown versus a veneer. The simple answer that is taught in dental school to the question, “How do we restore a tooth after a root canal treatment?” is, “Do a crown.” Dental schools really don’t get into doing veneers much. So I wouldn’t say that the second dentist “duped” you—she just did what she was probably taught. But yes, it can be unsettling to have your front tooth ground down to a stub in preparation for a crown.

Here’s the explanation for that. Most teeth, when they need a root canal treatment, have an extensive amount of tooth structure missing and they really need a crown. I take it, from your initial decision to not do a restoration, that your tooth did not have extensive decay or a large break. Maybe it was just bumped in an accident. Also, after a root canal, a tooth tends to become more brittle and subject to fracture. A crown helps protect against fracture of the tooth.

But there is a difference here in the needs between a front tooth and a back tooth. Back teeth have chewing surfaces and cusps, and when you bite down, the pressure on the cusps tends to push them apart. Thus, when a back tooth breaks, it will likely split between the cusps. A crown will prevent that type of break.

Front teeth are subject to different stresses. There is no chewing surface, and the stress on a front tooth is almost all lateral. When you bite together, the lower front teeth push forward on the uppers, and the upper front teeth push backward on the lowers. Also, if you get hit in the face, the impact on the upper front teeth will be a lateral impact. Thus the most likely break of a front root canal tooth is snapping off at the gumline. A crown preparation, which will involve taking off about a millimeter of tooth structure all the way around, will actually weaken a tooth against this type of stress.

Here is a photograph of a crown preparation for a front tooth. This is a very conservative preparation. Most dentists will be more aggressive than this in removing tooth structure. But even with this conservative preparation, you can see that the natural tooth is going to be much stronger in resisting breaking off because of the thicker neck of the tooth.

photograph of a smile, showing the patient's left front tooth ground down and prepared for a crown

A veneer would leave the tooth much stronger. To prepare a tooth for a porcelain veneer, a dentist has to only remove about half a millimeter of enamel, and from the front of the tooth only. Below is a photograph of two front teeth prepared for porcelain veneers.
two front teeth, prepared for porcelain veneers, showing about half a millimeter of enamel removed

So why don’t most general dentists do veneers on front root canal teeth? With a much thinner layer of porcelain, it requires more skill on the part of both the dentist and the laboratory technician to block out the darker color of the underlying tooth. Most general dentists really don’t know how to do that.

Moving on from that point, I also wanted to make a comment about the discoloration of the tooth. It isn’t widely known that the source of the vast majority of the discoloration of a front root canal tooth is not the tooth drying out, but it comes from the root canal filling materials that are used inside the tooth. When I did a root canal treatment on a front tooth, I would clean out all the root canal filling materials from the inside of the crown of the tooth, place a white fiberglass post down into the root to strengthen the tooth, and then seal the opening I had made into the tooth using composite filling material. With that type of treatment, it could be five or ten years before any discoloration would set in and the tooth would need a veneer.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Gap between my crown and my bridge


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I have a space between my 2 front teeth, however one of my front teeth is a crown and the other front tooth is part of a bridge. Can the gap between my front teeth be closed with Lumineers or any other procedure or would I have to get a new bridge and crown, possibly all in one structure to close the gap?
– Laura from Nevada

Laura,
Your question prompts me to ask a question of my own: Why did the dentist who made the crown and/or the bridge leave a gap between your front teeth? The easy way to fix this would have been to make them correctly in the first place.

At this point, yes, you pretty much need to have probably both of them re-made—depending on how big the gap is. Both front teeth need to be the same size—you don’t want to close the gap from just one side by making one side larger.

this microetcher has a long nozzle with a button on it, and at one end a small clear plastic bottle as a reservoir

A Micro-Etcher

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But there is a procedure you might want to try before doing that. There are ways to bond composite to porcelain, and you could start with trying that—treating this as a dental bonding case. If the dentist has what is called a micro-etcher, which is a small sand-blasting handpiece, he or she could micro-etch the porcelain surfaces next to the gap. This would be followed by etching with a hydrofluoric acid gel and then priming the surface with a silane coupling agent. A bonding resin would then be applied followed by composite bonding material to match the shade of the crown and the bridge. The composite would be shaped and polished. In theory, this should work. However, my experience with bonding to porcelain was that after a few months, we would see staining along the margin between the composite and the porcelain. But it could be worth a try to try to avoid the expense of a complete re-do of your front teeth.
I would think it goes without saying that you need an expert cosmetic dentist to do this, such as we recommend on this website.

The company that makes Lumineers, a few years ago, tried to promote the idea of bonding Lumineers over the top of porcelain crowns, but I strongly discourage that. You would get the same risk of staining at the margins, and would spend the same amount of money as you would spend just re-doing the case completely. Click the link to read more about the problems with that approach.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

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