Your leading source for cosmetic dentistry
information and referrals.

A CEREC crown on a front tooth

Posted on by .

I recently broke a front tooth and had it fixed through the Cerec method. As I was going out of town the next day I agreed to this procedure and was told it would be a permanent crown requiring only the one office visit. The next day when I had reached my destination at the home of a friend I was visiting the crown came off. Needless to say I was frantic to find a dentist who could at least put the crown back on. My friend was able to contact her dentist who was familiar with the Cerec procedure and said he uses it himself. Apparently the bonding was bonded to my tooth and not sufficiently to the crown itself so he rebonded it. Upon returning to my home five days later I went to see my dentist and told him what had happened. He said he would redo the whole thing. After reading the very informative information provided on you website, I realize my dentist is probably not as experiened in this procedure as is necessary. The present crown is a bit longer than my other front tooth and the color is lighter also. I have another appointment with my dentist to discuss this whole situation before any further work is done. My main concern now is since the crown was rebonded by my friend’s dentist and is probably permanent, what risks might I be facing to other teeth if and w! hen the crown is removed and the procedure is repeated. I am now thinking of having the regular procedure of making a mold and temporary crown and going back for the permanent crown. I’m not even sure if I should continue with this dentist as I feel the original work was not done correctly; try to seek a refund and find another dentist or just what. I know these coments are long, but I hope you can find the time to give me your opinion. Thank you very much.
Shirley from Texas

Shirley
I don’t think I can advise you what to do, not being able to see the situation myself and not knowing anything else about your dentist. But I’ll try to be helpful.

Matching a crown to a single front tooth is tough to do. Is this tooth that broke one of your two front teeth? If so, it’s not surprising that the color is off. Usually it takes a lot of back and forth and custom coloration to match a single front tooth. Now a CEREC crown is milled from a single block of ceramic that comes from the factory. To match this factory shade to your front tooth, it would have to be custom stained and would take quite a bit of skill. I know of dentists who have CEREC machines but don’t use them for single crowns on front teeth. Others are artistic enough to pull this off. Is your dentist capable of this? I don’t know. It doesn’t inspire confidence that the crown wasn’t bonded properly in the first place, and that both the shape and color are off. But it is nice that he is offering to redo it for free. Sort of makes me think that he’s honest and a nice guy, but maybe in a little over his head. But I could be wrong in that – I’m just trying to figure things out based on what you’re telling me.

I would be inclined to get a second opinion from one of our expert cosmetic dentists in Texas.
– Dr. Hall

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.

Unhappy with her two crowns.

Posted on by .

Hi Dr.Hall,
When I first decided to get braces, all I wanted was to get my front lateral incisors (on front) straightened. Instead, my orthodontist gave me 2 options: (1) Two porcelain crowns on the incisors or (2) have my dentist remove the incisors and then close the gap thereafter. When these options were presented, I felt that I did not have my original choice to just straighten the incisors, so I ended up choosing the porcelain crowns. Since this cosmetic change in 2004, I remain unhappy with them because I was never given my first choice–just to straighten my teeth without any additions or removals. And because I was in my 20s and didn’t know much about the differences between Empress or metal or no metal bond, now I regret my decision in having these fake things on me. My questions for you are: (1) How long will these crowns last before I have to replace them? (My dentist at the time said I would have to replace them every 10 years.) (2) Should I reconsider removing these crowns in the future (about 2014);get braces again; and follow through with the 2nd option I was given back in 2004 (where I have the lateral incisors removed and have them remove the gap this way? (I heard that if I do it this way, the muscle memory in my teeth would make it more difficult to maintain the straight teeth.) Is this a common procedure? How would this look? Would my bite get worse if I do it this way? What are the pros & cons of making this change? When I first picked this orthodontist, I chose him because he did not want to perform any surgery and he was COST EFFECTIVE. However, having gone to him is costing me more in the long run bc I was told that I would have to replace these crowns over time. Please help. I don’t want to make the wrong decision again. (Every time I mention my concerns to a dentist, they always say, “You worry too much. Your teeth are fine.” It’s obvious they are not cosmetic dentists bc they don’t understand how the patient feels emotionally and financially about it all. This does not help the situation. So, please don’t say that to me either.)

Thank you.
Sincerely, Alma
PS: At this time, all I know is that I have porcelain crowns and I am not sure if they have metal or not. This may be Empress…these cost me $1450 in 2004. I would have to contact my previous dentist or lab technician who did this and get back to you if this will help. I currently do not have any gray lines showing where the crowns are at this time.
– Alma from California

Alma,
I don’t know, not having seen your case, but I’m guessing that you had what we call “peg laterals” – where the lateral incisors are malformed. In such a case, crowning or veneering those laterals is by far the best choice. I’m glad you didn’t have them take out the laterals. Some orthodontists recommend that but the results almost always look very unnatural.

The comment you’re getting from your dentist telling you not to worry about how your teeth look shows that he or she is definitely not a cosmetic dentist. This is what most dentists believe – that patients’ appearance concerns are trivial. And I believe that this is the problem with your two crowns. Had you had them done by an excellent cosmetic dentist, you would have been thrilled with how they look.

Your initial choice was reasonable – do the crowns. Where the procedure broke down was in the artistry of your dentist. But once you have crowns on any teeth, you’re committed to having crowns on them forever, so you need to make the best of the situation.

You do not need to wait until 2014 to fix these. Most dental insurance plans provide replacement benefits for crowns that are over five years old, which would have been 2009 for you. And once you have them replaced, they could last 10, 20, or even 30 years – there is no fixed lifespan for crowns.

My recommendation is to go to our list of California cosmetic dentists at www.mynewsmile.com and find a dentist who is truly passionate about doing beautiful work, and get these crowns replaced. I’m confident you’ll absolutely love the result if you go to an expert cosmetic dentist such as we recommend.

Good luck,
Dr. Hall

Click here for referral to an expert cosmetic dentist.

Followup: Alma sends her thank-you for our response.

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 seriously botched $25,000 smile makeover

Posted on by .

Dr. Hall,
Recently I had $25,000 worth of porcelain crowns on both my top and bottom teeth-paid up front. I went for my consultation, picked my smile style, and told the consultant that I wanted a white bright smile that looked natural. I was given something to lighten my bottom teeth. I also had a metal bridge replaced so that it would match my upper teeth. All top teeth were crowned. After extensive xrays and mouth impressions, I was fitted with a temporary set of teeth. I was told that by wearing the temps, I would be able to see how my teeth would look, the shape and size, and color, in case I wanted to make any changes in my porcelain crowns. I was also told that I was the one who had to be happy. Two weeks later, when my crowns came in, the first thing I noticed as they were on the table was that they looked dark. I commented on this, but the girl who was to put them on said that they would look different in my mouth. When she put them in (not cemented) she told me to be careful when I sat up to look in the mirror because they were not in yet. From the moment I looked at them, I said “They are too dull!” I continued to say this, even as they were falling out and I could see I had no teeth left on top. By the way, I went in because my front teeth had been bonded years ago and had been chipped away by my bottom teeth. Other than that, I had strong, white teeth. As I continued to say I did not like them, she said suggested we go outside in the natural light with a mirror. Even on the outside, I kept saying I did not like them and that they looked dull. She told me that my eyes were playing tricks on me because I was used to the white temporaries and that once on, I would see a difference. We went back in and I looked in the big mirror above the sink in her lab. One of my front teeth feel on the floor and she picked it up and watched it off…. I was about to cry. Then the girl who cleans the teeth stepped in and said how I would love them once they were in and polished up. Never once did the doctor I paid the money to come in to see what was going on…Never once was I offered an option like, “Do you want them whiter?”

I was so frustrated and upset. I felt pushed against the wall about the matter, having no teeth in my mouth and being convinced that I was seeing things. Needless to say, she cemented them in. After they were in, the doctor came in and started trying to level my top and bottom teeth. Once he found out I was unhappy, I had to tell him, he told me to wear them a week and come back and he would finish … He said we want you to be happy.

After a week, I went back. In the light I had also discovered that the bridge I had replaced did not even match the other teeth. The girl said, You have a metal bridge (4 teeth @ $1700) so it’s going to be different. I explained to the doctor that I had tried to tell the girl before she put them in I was unhappy with the color… He said ” Well we have to be fair to everyone, the lab, the workers ,,, no way can we redo what we have done.” He then said maybe he could remove the stain on my porcelain crowns to match the white bridge. I am suppose to go back in a week. He said if the lab used a certain stain, this might be possible. I am so upset. I trusted these people. I don’t know what to do. My husband is going to go with me this next visit. I have to go back. I can’t eat with the crowns because they have not been level and are very painful. Any suggestions? Thanks for any help!
– Sandi from Texas

Sandi,
If I am sizing up correctly what was done to you, based on the story you have told, you are the victim of seriously unethical cosmetic dentistry. You were told that they would be sure you were happy with your smile makeover, but it sounds like they had no intention of actually honoring that promise.

Again, if I am sizing up this situation correctly, and if it happened the way you told me, you are dealing with very pushy people, and you are going to have to take a different tack if you are going to get anywhere. You have to be willing to get a lot more serious with your complaints and maybe get some legal help. Are you up to standing up for your own rights?

If these teeth were put in over your objections, then this is classic malpractice. A fundamental principle of health care is that all treatment is rendered with informed consent. When you didn’t consent to the treatment, and they put in the teeth anyway, legally, that amounts to assault. But if you are going to get anywhere, you have to have some steel in your spine and be willing to stand up to these people. And just having your husband go in with you to the appointment isn’t good enough.

My judgment would be that you will need to help this dentist see that he is legally on thin ice in order to get him to fix this. I would suggest getting a lawyer to write a letter that suggests that you may sue them unless they totally redo this for you and honor the promise they originally made that you had to be happy with how they look before they would put them in. Or, if you don’t want to do that, you could take this e-mail and that might help open their eyes. Then, if they don’t agree, you could go to a lawyer.

For additional help, I could line you up with a great cosmetic dentist not too far from you. If it were me, I wouldn’t settle for this dentist re-doing the work. I wouldn’t ever let him touch my teeth again. Instead, I would demand that he pay me to have the work re-done by someone more compassionate and skillful. At this point, do you trust him? I wouldn’t.

Good luck,
Dr. Hall

Other links:
Click here to find an expert cosmetic dentist
Click here to ask Dr. Hall a question.

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 case of serious overtreatment?

Posted on by .

Dr. Hall,
I had bonding placed on my 6 front top teeth for whitening purposes. Since then it has chipped off. I relocated to South Carolina and went to a dentist here. He told me that my teeth are stained inside and that I either needed internal bleaching or porcelain crowns. What options do I have?
– Deanna from South Carolina

Deanna,
I get so aggravated hearing of situations like yours. This sounds to me like a dentist who doesn’t know what he or she is talking about, and I strongly suggest getting a second opinion from an expert cosmetic dentist. I’m on a plane answering this question, so I don’t have access to any maps, but hopefully Summerville is near one of the cosmetic dentists we recommend in South Carolina. Even if it isn’t, it would be worth several hours’ drive to get this done right.

Maybe I don’t fully understand your situation. Do you have root canal treatments on your front teeth? From what you’re telling me, the only problem is the color. If that is true, crowns are overkill, and internal bleaching isn’t possible. I don’t understand where this dentist gets this idea. For crowns, your front teeth have to be ground down to stubs. And if this dentist knows as little about cosmetic dentistry as your e-mail makes it sound, I have grave concerns about how these crowns would look when he or she is done with you. Don’t let him or her grind your teeth down.

And six teeth aren’t a smile. Don’t be surprised if a real cosmetic dentist suggests doing eight or ten teeth. When the teeth are dark and the front six teeth are made considerably lighter, the result looks really weird.

Depending on what your teeth look like, the amount of discoloration, and their general health, you either need simple teeth bleaching or conservative porcelain veneers bonded onto the fronts of your front eight or ten teeth. Anything more is overtreatment.

Good luck.

Dr. Hall

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.

How to get rid of the black line on porcelain fused to metal crowns.

Posted on by .

How do you get rid of the black line on the gum caused by metal-infused porcelain crowns? What are the choices from cheap – to expensive?
– Susan from Great Britain

Susan,
There really isn’t a cheap way to fix this.

The problem is the whole structure of the porcelain fused to metal crown. Not only is there that black line right at the gumline, but the laboratory technician has to use powerful opaquers in the part of the crown that is near the gum. If a dentist tries to just drill away the black line and cover it over, there is still a serious color match issue between the base of the crown and the root of the tooth, and it can get really messy trying to blend that in, and will probably look ugly.

So you’re down to two basic choices: live with the black line, or get a new crown. And do it right this time, which means getting all-porcelain or all-ceramic for upper front teeth.
In the United States, the cost will vary from around $1000 to about $2000 per tooth, depending on what part of the country.
Dr. Hall

Read more about porcelain crowns on front teeth.

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.

My dentist recommended

Posted on by .

Hi Dr. Hall,
My dentist had recommended porcelain fused to metal crowns for my front top anterior teeth to fix wear and a gap. After reading all the different kinds of crowns available I asked if he could do an all ceramic set maybe Zirconia. His reply and his partner’s reply is that they will only do porcelain fused to metal crowns. Their credentials (at least the partner who overlooked my case) are quite impressive as are their prices, and they say that since I tend to grind my teeth and I do not want to wear a night guard that if I get Zirconia they feel that they won’t hold up. Is it true that occasional grinding without a night guard eliminates Zirconia or an all ceramic crown. I have been waiting for years to have this fixed and they are ready to start the process. They also charge more for anterior crowns vs posterior, not sure if that is the norm. I need to get my smile back. Thank you for any response you could provide!
– Bob in Los Angeles

Dear Bob,
I recommend a second opinion. Yes, Zirconia crowns are very strong and will work on the front, even under great stress. And something great about them is that they can be made thinner than porcelain fused to metal, meaning that less of the tooth is ground away, which will leave your front teeth stronger. I used all-ceramic crowns on front teeth with people with severe grinding problems, and they didn’t break. And zirconia is much stronger than the materials I used then.

Not knowing your mouth, I can’t prescribe with certainty, and the issue may be more that they feel they need metal as an opposing chewing surface for your lower teeth, which doesn’t wear down the lower natural teeth as much. Although there are soft porcelains that can be used on the surface of zirconia, too.

I suspect that, in spite of your dentist’s credentials, he may not have that passion for appearance-related dentistry. His passion may be for things that work well – it’s kind of an engineering approach. Many dentists that have a great deal of education are very academic types and consider it beneath them to worry too much about appearance issues.

And don’t ever try to push a dentist outside his or her comfort zone. For others that may read this post, if your dentist recommends porcelain fused to metal crowns for front teeth, don’t try to get them to do all porcelain. If they really care about the artistic quality of their work, they will have a strong aversion toward placing porcelain fused to metal single crowns on front teeth. If you don’t like the preferences of your dentist, then find a dentist who is more in harmony with those preferences rather than push your dentist outside their comfort zone and risk disaster. You’re fortunate that your dentist had the integrity to resist your request. Some will say, “fine, we can do that,” and they really aren’t good at the technique that you want, at all.

But I would strongly encourage you to give in on the night guard issue. There is a risk beyond just wearing your teeth down. As you get older, you can break off your teeth at the gumline from the grinding. That can happen whether you have crowns or not, and may even happen more readily if you have crowns.

Yes, some dentists charge more for anterior crowns.

You’re in the Los Angeles area. We recommend a number of excellent Los Angeles cosmetic dentists there. Go to one of them for a second opinion. See what an expert cosmetic dentist says before you go ahead with this.
– Dr. Hall

Click here to read more about porcelain crowns on front teeth.

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.

Crown is turning dark. Should I have a Lava crown?

Posted on by .

Dr. Hall,
In 2005 I chipped my front tooth (#9) and had to have a root canal done with a tooth-colored post. I then had an all-porcelain crown placed on the tooth and it looked perfect. Over the past 3 years, my tooth has slowly turned gray. I’ve been told it is the original, underlying tooth that is slowly decaying and shining through the all-porcelain crown. I wanted to have the root canal redone to completely eliminate the gray, but my dentist said that it’s not a good idea since I have a post in that tooth. She said the only alternative is to go with a Lava crown, which would mask the gray somewhat but not perfectly. I desperately want the gray completely gone – is there any alternative besides a dental implant?
– Danielle in Florida


We thank our advertisers who help fund this site.

Danielle,
This is kind of a tough question, but there is an answer.

First, I want to comment on the tooth turning gray underneath your crown. A lot of dentists don’t realize that root canal filling materials, when left in the visible part of the tooth, are strong contributors to this graying of your tooth. I’m not absolutely sure of this, but my guess would be that your tooth wasn’t cleaned out thoroughly when the tooth-colored post was placed.

Yes, one solution could be to mask the darkening color. But it doesn’t need to be a Lava crown. Even regular feldspathic porcelain can be made opaque. But it is a less-than-ideal result.

My response to a problem like yours would be to take a little extra time and care and get this done right. Yes, a post is difficult to remove. But if it is tooth-colored, it is probably fiberglass or some similar material and they can be removed safely. Get it out, clean out the tooth thoroughly, bleach it if necessary, and put on a new crown that is naturally translucent, giving you your beautiful smile back.

If this dentist is the same one that first put the post in, then as I see it, she gets a grade of about “C” for her cosmetic dentistry skills. Yes, she did a lovely crown, but she missed cleaning out the tooth and her understanding of esthetic dental materials and opacity is a little lacking. You need an excellent cosmetic dentist with “A” skills for this job. Check our list for someone in your part of the country. Then go back to your regular dentist for the rest of your care, because it does sound like she has some good skills. Not great on the cosmetic dentistry, but very few dentists excel at that.
– Dr. Hall

Links:
See our page on all-porcelain crowns for some comments about Lava crowns.

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.

Does my front root canal tooth need a crown?

Posted on by .

I need a root canal on my tooth #7. I expressed my concern about having a crown in the front (fear that the dark line would show after time, etc.) a while back. So this past visit he said that he does not need to crown it after the root canal. He will fill it because it is deep but narrow.

I hear that teeth become brittle and can break off after a root canal, so is it wise to not crown it? I just dont’ know which way is the smarter way to go. is it just a matter of time before the tooth discolors and break, or is there a good chance it will be fine?
– Rachel from New Jersey

Rachel,
Let me explain about root canal treatments on front teeth and crowns. There aren’t a lot of dentists who fully understand this, but I’m hoping that your dentist does.

Yes, teeth do become more brittle after a root canal treatment. Besides, teeth that need root canals usually have extensive fillings or decay. When that tooth is a back tooth, the danger is that the chewing force will split the tooth, which can make the tooth unsavable. So, it’s fairly routine to just put a crown on the tooth and protect it.

However, on front teeth, there are no strong forces that tend to split a tooth vertically. That is because there is only one cusp or a biting edge. But there is a possibility for a front tooth, especially an incisor, to shear off horizontally – that does happen.

So then, what is the best thing to do if you have a root canal treatment on your upper lateral incisor as you are going to have? If there is not extensive loss of tooth structure, a crown could actually weaken the tooth in the critical neck area – that’s where an incisor would be most susceptible to horizontal fracture. If a crown IS placed, it is probably best to reinforce the inside of the tooth with a flexible fiber post.

So this means that yes, you can get along without a crown on this tooth, and as long as the filling isn’t extensive, that will leave your tooth less likely to fracture, not more. But then you have the discoloration problem. Root canal teeth tend to turn quite dark.

But here is what your dentist can do, and maybe he doesn’t understand this. It turns out that almost all of the darkening, at least in the first couple of years, comes from root canal filling material and sealer cement that is left inside the tooth. If your dentist will clean all of these root canal materials out of the crown of your tooth – the part that shows – you may have no discoloration at all for a good ten years. He can instead fill the tooth with a composite or a core material and bond it to the inside of the tooth. After ten or twenty years, the tooth may become noticeably darker, and you can deal with that problem at that time.

Dr. Hall

Other links:
Read about root canal treatment on a front tooth.
Read about porcelain fused to metal crowns and the dark line at the gumline that they tend to develop.

We thank our advertisers who help fund this site.

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.

My cosmetic dentist wants to use Zirconia crowns

Posted on by .

Dear Dr. Hall
To find an accredited cosmetic dentist I used your website. The dentist was not aware of using bonded all porcelain crowns for front teeth, the accredited cosmetic dentist relied on the advice of the lab tech. The lab tech refused to use bonded all porcelain on front crowns (upper)and insisted the dentist use Zirconia. Who is more knowledgeable or experienced in accredited cosmetic dentistry, the lab tech or the dentist? Thanking you in advance for your prompt reply.
Gina from Connecticut

Gina,
I’m not sure I understand what you’re saying.

Are you saying that you went to a dentist that we recommended on mynewsmile.com, and that this dentist had not heard of bonded, all–porcelain crowns for front teeth?

If so, I’d like to know, and I’d like to know which dentist that was.
And how was it that the lab tech was asked?

l want to try to figure out what happened with your case and then see if I can help you.

Thanks,
Dr. Hall

Dr. Hall
When I mentioned to Dr. N. Summer Lerch of New Haven,CT that I was looking for an accredited cosmetic dentist that would be skilled in bonded all– porcelain crowns for front teeth. Dr. Lerch did not confirm or acknowledge your findings that bonded all-porcelain crowns for front teeth would have the strength that Zirconia would have. Dr. Lerch relied on the lab tech’s recommendations for the crowns. Actually the lab tech refused to make the crowns in stackable porcelain. Unable to find another dentist at that time because I was charged in full for payment of my crowns on the day the lab tech refused to use stackable porcelain on front crowns.
If all this is confusing I will include my home phone if you have questions.
Thanks
Gina

Gina,
Zirconia crowns ARE stronger than bonded all porcelain. They have no metal, and while they are not all-porcelain, I would call them all-ceramic, and their appearance is excellent. They can be made beautifully translucent. A conventional porcelain is usually baked over the zirconia framework, and the end result can be made to look so natural that you could not tell them from natural teeth.

I don’t believe that your dentist was unaware of bonded all-porcelain, but rather than for your situation she felt that zirconia would work better. I’m not in a position to second guess that recommendation, not being able to examine you.

Which particular crowns should be used in a given situation is a matter that depends on a number of factors. I don’t recommend that patients try to push their dentist into using a particular type of crown, because often part of the decision is based on what works well in the hands of a particular dentist, and this will vary from dentist to dentist. Rather, I recommend that each patient find a dentist whom they trust and has the skills necessary to produce a beautiful result, and then give that dentist free rein to choose the material that works best for them in each particular situation.

Dr. Lerch was carefully considered before I recommended her on this website, and I am absolutely confident that she could produce a beautiful result for you. She has been on the accreditation examining board, which means that her esthetic talent and technical ability are highly regarded among her peers.

As far as relying on information from the lab tech, when a dentist has a trusting relationship with a skilled laboratory technician, yes, we often use them as a source of information on new materials. Zirconia is an up-and-coming material that many top cosmetic dentists are turning to, because it is so strong and can be made highly esthetic. And when it comes to the technical information about the strength of the material and its suitability for various situations, then yes, we will turn to the technician. I have criticized on this blog dentists who use the laboratory technician for a shade-matching appointment, because an excellent cosmetic dentist needs to have a great eye for color and an ability to communicate color. But the dentist and the technician are a team and each brings expertise and talent to every project.

I’m skeptical that the laboratory technician made the final decision in your case. If you were giving me trouble over my choice of material, I might use the lab tech’s opinion to help avoid arguing with you. When we as dentists are faced with a difficult patient who wants to push us into a treatment we know will be sub-standard, it’s easy for us to say things that may seem to that patient to be unreasonable. I’m inclined to believe that Dr. Lerch was showing integrity in your case, but I can see how it wouldn’t appear that way to you.
Dr. Hall

Related information:
Read more about porcelain crowns.
Click here to find an expert cosmetic dentist.

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.

All porcelain crown vs. porcelain fused to metal

Posted on by .

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.

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.

Categories

Follow this blog

Get every new post delivered right to your inbox.