My daughter fell and broke her two front teeth when she was 14. One tooth needed a root canal treatment. Both teeth needed crowns. She’s now 20 and the tooth with the root canal has been getting more gray, so we went to a new dentist to have the one crown replaced.
Besides doing the new crown, the dentist contoured her gum tissue to make the teeth longer. But we’re still not happy with a few things.
The problem is that this tooth still has a gray tinge to it. It is also bulky and sticks out further than the other front tooth. The dentist said that he can fix the gray and he points out that it looks much better than when we started, which is true. But we’ve spent about $2000 and we had higher expectations. Are we being reasonable? I don’t want my daughter to be self-conscious about her smile.
I have before-and-after photos that I can send, if you think that would help.
Thanks for your time,
– Melanie from Oregon
(See Dr. Hall’s answer below.)
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To answer your basic question, no, it is not unreasonable to expect these two teeth to match. It just requires a little more knowledge about color manipulation, and, unfortunately, that isn’t part of the curriculum of a lot of dental schools. So you need to find a dentist who has enough passion about appearance-related dentistry to have taken some post-graduate education where he or she would learn these things. I can clearly see from the photos you have sent that you are in the wrong dental office.
Here’s the before photo you sent of the damaged teeth. This was a nasty accident.
And here is the after photo.
And here is a view of the two crowns from above, showing how much the one crown sticks out from the other.
The bottom line is that these crowns are in no way near acceptable. They are so far off that I have no hope that your dentist could get this right.
One solution (which I don’t recommend) would be to re-do both crowns. But I don’t think that your dentist would even get that right, seeing that he thinks that the answer to crowning a grayer tooth is to make the crown thicker.
There are several ways that expert cosmetic dentists address a situation like this, where you are crowning a severely discolored tooth. One is to communicate, with photographs or an excellent description, the amount of discoloration in the tooth and leave it entirely up to the ceramist to mask it. The ceramist should have at his or her disposal a selection of more opaque ceramics that can cover up the gray. An opaque layer would be in the most interior part of the crown, and then more translucent porcelain placed over that. The problem some dentists have in working with a ceramist is that they aren’t that fussy about their cosmetic dentistry and so haven’t sought out a good ceramist who produces highly aesthetic work.
When I had a case like this, though, my approach was to cover up the discoloration myself and send to the ceramist a case that was much easier to match. If all root canal materials were cleaned off this one tooth and then the tooth were bleached, that would get the color matching much closer. Then the dentist could cover over what remained with a white opaquer. But your dentist might not even have a bleaching agent that could bleach a root canal tooth or any white opaquers because he’s not really that into cosmetic dentistry.
And then making the two teeth the same size. That’s pretty fundamental, that your two front teeth should be the same size. Apparently, your dentist and his ceramist, struggling with covering up the gray underlying color and not having appropriate opaquers at their disposal, have decided to make the one crown thicker in order to cover that up and they actually think that will look okay.
In my opinion, this dentist should give you a complete refund so that you can go to someone who can get this right. I can recommend a dentist in your area, if you’d like. If you get any resistance to giving you a refund, go to the dentist I recommend and see if they will help you with that. Or check back with me and there are another couple of things you could do. You should demand perfection with this case. Your daughter should be excited to smile and no one should be able to tell that she has had any dental work done on her front teeth.
– 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.
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