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
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.
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.
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.
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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.