Dr. Hall,
I recently had all six of my upper front teeth crowned. I researched this thoroughly and asked my dentist many important questions. He told me that he was going to use all porcelain crowns. He said that often these cannot be used on the front teeth because they would hit the bottom teeth and cause them to grind down. He said that I had “25% spacing” (or something like that). I was told that this was adequate to get the all porcelain crowns. Yesterday I went to get my new crowns placed and was very disappointed to see that the teeth in my mouth were silver on the back. I was certain that he or the lab had made an error. He told me that half way through the procedure he realized that there was not enough room to give me the all porcelain and decided to go with the porcelain fused to metal crowns. He assures me that this was his only choice. I am very disappointed and frustrated. What should I do? This was a huge investment for me (both financially and emotionally). My crowns do not look bad from the front, but I am worried about the dark line as my gums recede. I am also self-conscious about the back of my teeth. My current dentist assures me that if I get a second opinion, I will be told the same thing that he is telling me. I called the office to ask what the difference was in price between what I paid for and what I received. I was told that both types of crowns are the same price. After reading the information on your site that does not seem like it would be true. What do you feel that I should do next? Thank you for any advice that you can offer.
– Amanda in Arizona
Amanda,
Porcelain fused to metal is NOT the only choice in this situation. I always placed all porcelain crowns on upper front teeth.
If you went to any dentist on our list of real Arizona cosmetic dentists, they would all agree that your situation of six crowns on front teeth is clearly a situation for all-porcelain crowns. They wouldn’t dream of using metal in a situation like that. But they’re artists, and they’re different.
What you’re dealing with is that you have a technician dentist, like 98% of the dentists, who went into dentistry because they like to fix things, and the beautiful translucence of pure ceramic just doesn’t impress them much, and they don’t know what to do with it besides. They just don’t get it. And he lives in a different world where the dentist knows best and these crowns look “good enough” and it’s not that important what you think of how they look. It will be illuminating to you, I think, to read our web page about the difference in personality between a cosmetic dentist and the other 98% of dentists at www.mynewsmile.com/cosmeticdentist.htm.
But I don’t know what to tell you to do with where you are right now.
I don’t think there’s any point in trying to get this dentist to do all-porcelain crowns. He doesn’t seem to appreciate them.
I think your only recourse is that he did the metal without your consent, and if you wanted to press him legally, you could possibly have a good case, depending on whether or not he gave you a full opportunity to refuse to have him put them in once you found out they were porcelain fused to metal. He could be in an awkward situation legally if he didn’t give you that full opportunity. And handing you a mirror while you’re upside down in the chair and saying “here they are, we’re ready to cement them” I don’t think is giving you a full opportunity. There is a clear difference between pure ceramic and porcelain fused to metal. And it doesn’t matter if 100% of dentists agree with him if he did this without your consent. But you would have to be willing to fight that issue and I’m not sure you’d be willing to do that. You wouldn’t have to sue him, but you have to be ready to threaten to and willing to follow through if you really had to. Then you could get a real cosmetic dentist such as we recommend to re-do them at his expense. You could get a lawyer to write him a threatening letter and see where that goes. There is a key legal principle in medical and dental care called “informed consent,” and if a dentist violates that, the courts consider that a very serious thing. Anything they do to your mouth has to be with your consent.
I hope this is helpful.
On the cost issue, the cost could very well be the same in his office. Some dentists just have a set fee for a crown and it doesn’t matter what kind.
Most porcelains will wear the opposing teeth that they chew against, and this could be an issue in your mouth. But there are materials such as Empress crowns that do not wear the opposing teeth. A real cosmetic dentist would know how to do your case.
I hope this is helpful.
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.