Hi Dr. Hall,
Firstly, I’d like to tell how you relieved I am to have come across your website, which addresses many of the questions I have regarding a top-front crown I recently had placed.
Long story short, I fell as a kid and had a root canal done then that left the tooth discolored. I’ve since spent the last few years trying to improve it’s appearance with my general dentist at increasing levels of invasiveness, ending up where I am now, with a discolored, crown and aggravated gum line.
I’m exhausted from the experience and would like to understand all options, before moving any forward, to get this tooth to a place where it looks and feels acceptable or ideally “good”.
I work in Manhattan and have been talking to Dr. – – – – (name withheld), I’d like to know if you’ve heard of his practice? He says he’s a cosmetic dentist. My feelings are that an all-porcelain or porcelain-layered crown with zirconia core would produce the best result, but as you’ve said in your articles, I shouldn’t encourage any doctor/lab to use a material they’re not comfortable with.
Any insight would be greatly appreciated!
Thank you,
Terrence from New York
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Terrence,
No, I haven’t heard of Dr. – – – -. But I looked at his website and I’m very unimpressed. So brace yourself for another disappointing result. Cosmetic dentistry is art, and the vast majority of dentists aren’t artists – they are just engineers. Those who are artists, who produce natural-looking crowns, will proudly display their work on their website. My advice to you is to look for a better dentist who has an online smile gallery. Then look over that gallery to confirm that their work truly looks beautiful.
Also, the focus of Dr. – – – -‘s website is on providing affordable dentistry. He displays on his home page a list of 14 different insurance companies with whom he is in-network. Good cosmetic dentists find it hard to accept the discount payment schedules of these insurance companies because they use the best materials and the best labs and take the time to produce quality results. None of that is possible when trying to be a preferred provider of the insurance company. With all the true cosmetic dentists I’ve interviewed, they will at most be involved with one or two insurance plans, agreeing to their discounted fees. Many of the very best won’t participate with any.
And about the materials, an excellent cosmetic dentist paired with a great ceramist can produce a beautiful result with any of several materials – layered zirconia, e.Max, feldspathic porcelain, etc. When hiring an artist painter, would you try to assess their skill by asking about the brand of paint they are using? I don’t think so. You’d look at their work. That’s what you need to do.
– 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.
I really appreciate your evaluation and insight. Adding one note, off the record – by using your directory to locate a suitable cosmetic dentist in my area, I had initially visited Dr. – – -‘s office (one of our recommended cosmetic dentists) to discuss my situation. In addition to replacing the crown I have at the tooth in question, he also strongly encouraged using a veneer at the neighboring front tooth. Given my experience up until now, I am very hesitant to put any more teeth at risk, especially if I happen to like the color/shape of the other tooth. Would you say it’s a bad idea to proceed with Dr. – – – if I am only willing to replace the discolored crown and not modify any other original teeth at this time?
– Terrence
Response by Dr. Hall,
Terrence,
A porcelain veneer, done correctly, is a very conservative restoration and I wouldn’t be opposed to that, though, if I were doing it, I would just do the one crown. A veneer isn’t putting your tooth at risk. A crown, yes, but not a veneer.
It is possible to perfectly match one front tooth with a crown on the other, but it takes extra work, and I imagine that Dr. – – – and his ceramist have that level of skill. So, if that’s what you want to do, you’re in good hands.
What I did in my practice was give patients a choice. If they needed a crown on one central incisor, I told them I could get a perfect match if I did both front teeth. Or, I could do the one front tooth and go through all the extra try-ins to get a perfect match, but my fee was 50% higher and insurance wouldn’t cover the difference. Everyone chose to pay the extra money and have me do one crown.
Yours,
Dr. Hall
Dr. Hall,
This assurance narrows it down for me, I will reach out to Dr. – – -‘s office tomorrow to discuss next steps. Again, I’d like to express the peace of mind finding your page has brought me, and I appreciate your time.
Best,
Terrence