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
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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?
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.
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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.
My cosmetic dentist wants to use Zirconia crowns
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
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.
Crowns are wrong color
Dr.Hall,
This might be a stupid question, but I’m going to ask it anyway. Two days ago I got porcelain crowns for my two front teeth. The color of them is noticeably more yellow than the rest of my teeth. I was in a lot of pain from sitting in the chair so I didn’t really get a long look at them before I left. But when I got out into the sun, I looked again and noticed a big difference. Now if I wanted whiter crowns, I would have to pay for them all over again right? (which I’m definitely not about to do, seeing as I already spent a fortune on them!) Or do you know if they can be whitened at all? I’m thinking that since I just got them done, that maybe he can do it over with a whiter shade….for free? Sorry if this is a stupid question, I just don’t know what to do….thanks for your time!
– Jennifer in Massachusetts
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Jennifer,
This is one of the most consistent differences between the expert cosmetic dentists that we recommend on www.mynewsmile.com and others who just call themselves cosmetic dentists. There is that passion that true cosmetic dentists have that they want to make sure the work looks perfect to you before they cement it in or bond it. The other 98% of dentists really love to fix things and don’t have much appreciation for appearance-related issues. They really don’t see the importance of making sure you have a good look at the teeth before putting them in. Part of the reason may be that they think it looks “good enough” and they’re afraid you’ll be too fussy.
You’re kind of stuck with the color, unfortunately. Nothing you can do to porcelain will lighten the color. The only option is to re-do them. Maybe your dentist will do that for free. You can always ask.
Don’t let anyone talk you into putting porcelain veneers on top of the crowns. That has the potential for looking really bad, and if it’s done right, it will cost the same as re-doing the crowns. It doesn’t make any sense at all—don’t do it.
Dr. Hall
Related links:
Tooth bleaching
Ask Dr. Hall a question
Find a cosmetic dentist near you
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.
Do they do smile makeovers with crowns?
Dr. Hall,
I recently had a smile makeover done. I had thought I got porcelain veneers, but it looks like the porcelain goes all the way around my teeth. I assume this is because my teeth as they were previous were not good candidates for veneers? Is it normal to have the entire tooth covered when done only for cosmetic reasons? I’ve gone to other dentists since having them done and they are all impressed, and say that it is normal. What do you think?
– Andrew in Utah
Andrew,
The difference between porcelain veneers and porcelain crowns is only a matter of degree, and there is no hard-and-fast distinction pinning down exactly when a porcelain veneer becomes a crown. And most cosmetic dentists have fees that are either exactly the same or very nearly the same for either procedure, because they take about the same amount of work.
And yes, it is common to have porcelain crowns done across the front teeth for cosmetic reasons. There are several reasons a dentist may include the whole tooth in a smile makeover–if the tooth is weakened for any reason, if there are existing fillings in the teeth, or if it is needed to control the bite.
I would expect the dentist to discuss this with you and if he or she recommends crowns, to explain why. Most cosmetic dentists try to be as conservative as possible, meaning that they try to preserve natural tooth structure as much as possible. Crowns are a more aggressive treatment than porcelain veneers: Veneers require a very light shaving of the front of the tooth; crowns require a substantial reduction of the tooth all the way around. So I would expect to be given a good reason for getting crowns rather than veneers.
– Dr. Hall
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.
Can I use Supersmile toothpaste with porcelain crowns?
Dr. Hall,
I would like to know if I can use supersmile toothpaste with porcelain crowns? I have porcelain crowns.
Linda in Louisiana
Dear Linda,
Yes, Supersmile toothpaste works great with porcelain crowns. Supersmile was designed for use with extensive cosmetic dental work. It keeps stains away, yet it is non-abrasive.
– Dr. Hall
Related links:
Read all about whitening toothpaste
Read Dr. Hall’s opinion about what is the best toothpaste
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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.
Dr. Hall,
About 1 1/2 years ago I had nine front teeth replaced by a “cosmetic” dentist. One front central tooth broke in April and now a second tooth has fallen off. I am awaiting replacement on Monday. The replacement tooth in April my dentist’s assistant ordered was incorrect in color and shape which the dentist tried to reshape.
I have no confidence in this Dentist or assistant. I know Dr. Smith uses a plastic/porcelain mixture as his advertisement states porcelain crowns prone to fracture. And Dr. Jones [not their real names] has good credentials.
I would appreciate your input please on both these dentists & is resin/porcelain effective?
Thank you,
Jeanne from Florida
Jeanne,
Unfortunately, the law allows this term “cosmetic dentist” to be tossed around pretty loosely. I can find no evidence, in my sources, of any significant credentials in cosmetic dentistry for either dentist you mention. But because cosmetic dentistry isn’t a legally separate specialty they can make claims to being cosmetic dentists. That’s why I maintain this web site – to help steer people around this confusion.
And I can only guess at what your dentist means by “plastic/porcelain mixture,” as this is unusual terminology. My guess is that he is referring to composite, and if this is the case, it is a poor substitute for porcelain. It is weaker, not nearly as long-lasting, and much more susceptible to staining. But it is easier to work with and less expensive to fabricate.
Porcelain or ceramic crowns, done right, are NOT prone to fracture and are the most beautiful restorations in dentistry today. Done right and maintained properly, they are practically impervious to staining and they don’t break.
Dr. Hall
Helpful links:
Porcelain crowns
Care of porcelain veneers
GlamSmile veneers are cheap, but are they good?
Click here to find a 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.
Porcelain crowns are now rough/dentist on our insurance list
Dr. Hall,
My wife recently had porcelain crowns on front upper teeth. At a follow-up appointment, the dentist attempted to “buff” the crowns to make the color match color of surrounding teeth. Now her color is still off and the crowns have no shiny appearance. The dental assistant who says she was present during buffing says the color is as close a match as possible with what was available and that porcelain won’t be shiny like natural teeth. Unfortunately, the dentist is not a cosmetic dentist. We are seeing him because he’s on our insurance approved list.
Any advice will be greatly appreciated-
– Charlie from Indiana
Charlie,
A couple of points.
First, yes, you are right, the porcelain should be shiny. But it’s worse than you think. Besides looking dull, when the dentist buffed off the glaze on the porcelain, he or she made them so that now they will stain, so they will look even worse as time goes on. But a cosmetic dentist can bring the shine back with a diamond polish.
Second, you have to decide if you just want your teeth “fixed” so they are functional, or if you want them to look nice, because if you want them to look nice, you will have to pay for it. You will not get a beautiful result from a dentist that is on any insurance company approved list. Dental insurance companies make these approved lists by finding dentists who are willing to cut corners and thus cut costs. That approach is simply incompatible with good cosmetic dentistry.
My advice would be to find a cosmetic dentist near you from our list, and have that dentist bring back the shine and make these look as good as possible. The dentist you are going to may be a good “fixer,” but does not appear to even understand the esthetic problem he or she has created.
– Dr. Hall
Related links:
Read about Cerec 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.
The porcelain crown looks funny.
Dr. Hall,
I just had 4 veneers placed on my top teeth. One is a crown. After having them permanently placed, I noticed (on the crown tooth) an outline, sort of like a patch, underneath the tooth. The doctor said it was my original tooth. It seems there’s more cement concentrated on that tooth which shows through. The doctor said no one would notice it but I do and am unhappy about it. She said if she were to replace it, the new veneer would look different from the other 3 because it wasn’t made at the same time. I don’t know what to do. I signed a form stating I consented to the way they look however had I seen this prior to her placing them on permanently, I would have brought it up. Is there any truth to what she’s saying? Am I taking a chance getting a new one put in and having it not blend in with the others? Should she charge me?
– Janet in New York
Dear Janet,
This is typical of what happens when you go to a general dentist who isn’t expert in cosmetic dentistry, and I’ll see if I can help you.
General dentists are taught in dental school that they know what is best for you, and your job is to just accept that. True cosmetic dentists are different — they are very tuned in to what you think, and if you don’t like how the work looks, then they consider the treatment a failure, and they will stay with you until you love it, as long as you’re reasonable.
My opinion is that this dentist should fix this until you like it. The reason being, and I’m guessing somewhat at this, that you agreed to the porcelain veneers simply for the sake of the appearance. Thus, this dentist was representing to you that she was going to make your smile look great. And it doesn’t. Her response to you is typical of general dentists — she knows how it is supposed to look, and it doesn’t matter that you don’t like it.
And I’m a little confused in what you’re telling me. You said you signed a consent form that you liked how they look. But then you say you didn’t see this prior to her placing them on the teeth permanently. That’s confusing. And then you say this is the crown tooth, but then you’re going to replace the veneer, which is confusing, too. But I’ll guess at what you’re meaning and give you some general direction. True cosmetic dentists will let you get a long, hard look at what things look like before putting them on and will be sure you have examined every detail. General dentists generally give you a quick look in the mirror while you’re upside-down in the chair, and that’s it.
A good cosmetic dentist teamed with a good dental laboratory will be able to duplicate the shade and shape of the crown and match it to the other veneers. That may be beyond the ability of this dentist, but it is routine for a good cosmetic dentist. If it were me, I would ask that she do this, and in my opinion, it should be for no charge. And the way to make sure it looks the same is to insist on getting a complete look when it’s tried in and pin her down — does this look exactly like it’s going to look once it’s on? It isn’t acceptable to have it put on permanently before you see how it looks, to make sure it matches. There are ways to check this, and she should know these. But it shouldn’t be that hard this soon from when the case was first done. She should have a copy of her instructions to the lab on the shade to make this crown. The same instructions to the same lab should produce the same result.
And then, please tell your friends that when they want things done to beautify their smile, to go to a real cosmetic dentist. Only a couple percent of dentists are artistic enough and really care that much about beautiful smiles to do a good job at that. Check our list of recommended cosmetic dentists for help with this.
I hope this is helpful.
– Dr. Hall
Related information:
Porcelain crowns for front teeth.
Porcelain veneers
The difference between a cosmetic dentist and a general dentist
Read about one-visit Cerec crowns
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.
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