Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 21, 2018

Gap between my crown and my bridge


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I have a space between my 2 front teeth, however one of my front teeth is a crown and the other front tooth is part of a bridge. Can the gap between my front teeth be closed with Lumineers or any other procedure or would I have to get a new bridge and crown, possibly all in one structure to close the gap?
– Laura from Nevada

Laura,
Your question prompts me to ask a question of my own: Why did the dentist who made the crown and/or the bridge leave a gap between your front teeth? The easy way to fix this would have been to make them correctly in the first place.

At this point, yes, you pretty much need to have probably both of them re-made—depending on how big the gap is. Both front teeth need to be the same size—you don’t want to close the gap from just one side by making one side larger.

this microetcher has a long nozzle with a button on it, and at one end a small clear plastic bottle as a reservoir

A Micro-Etcher

.
But there is a procedure you might want to try before doing that. There are ways to bond composite to porcelain, and you could start with trying that—treating this as a dental bonding case. If the dentist has what is called a micro-etcher, which is a small sand-blasting handpiece, he or she could micro-etch the porcelain surfaces next to the gap. This would be followed by etching with a hydrofluoric acid gel and then priming the surface with a silane coupling agent. A bonding resin would then be applied followed by composite bonding material to match the shade of the crown and the bridge. The composite would be shaped and polished. In theory, this should work. However, my experience with bonding to porcelain was that after a few months, we would see staining along the margin between the composite and the porcelain. But it could be worth a try to try to avoid the expense of a complete re-do of your front teeth.
I would think it goes without saying that you need an expert cosmetic dentist to do this, such as we recommend on this website.

The company that makes Lumineers, a few years ago, tried to promote the idea of bonding Lumineers over the top of porcelain crowns, but I strongly discourage that. You would get the same risk of staining at the margins, and would spend the same amount of money as you would spend just re-doing the case completely. Click the link to read more about the problems with that approach.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

September 22, 2016

Can I trust Comfort Dental?


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Dr. Hall,
I’ve had a bridge across my upper front, replacing all my front incisor teeth and anchored by the two canine teeth. About a year ago, the anchor teeth were so loose that they were extracted. I was going to Comfort Dental and after they did the extractions they suggested that I get a partial to replace those teeth plus one upper molar that is also missing. So I did that last year, but I’m finding the partial to be extremely uncomfortable and I need something different.

I asked Comfort Dental what I should do. They said they could replace my upper teeth using implants. They would use mini implants to keep the expense down for me, and they have told me it would last for ten years. I’m also missing three teeth on the lower left, and they would replace those with a flexible partial.

Because of my unhappiness with the partial they made, I became unsure that I could trust them, so I decided to get a second opinion from another local dentist. They came up with a completely different plan, which has left me a little confused, so I was wondering if you could help me. This other dentist said he wanted to do a bridge replacing the missing upper molar, since the teeth on either side of the missing one are broken down and would need crowns anyway. Then he wants to replace the two canine teeth with implants and put a bridge on them replacing all my front teeth. He said they’d be regular implants, so more expensive than what Comfort Dental was going to do for me. He said that as an option he could put a third implant in the middle of the bridge. The whole plan is considerably more expensive

I don’t have a lot of money, so I’m tempted to do with the cheaper option that Comfort Dental gave me. But after the experience with the partial, I’m not sure I can trust them.

Any advice?
Jim B.

Jim,
Yes, I can help you out with this.
First, a comment about Comfort Dental. Comfort Dental is a corporate dental clinic with about 150 locations throughout the Midwest, Southwest, and Northwest. It isn’t the type of place I would go for quality care. The corporate model of dental practice is designed to maximize profit. While many patients find them convenient and inexpensive, they tend to be attractive to dentists just out of school who are trying to get some experience before launching out on their own, so they have a lot of turnover. You are more likely to get quality care from a dentist/owner practice where the dentist is trying to establish long-term relationships with patients.

Now about the treatment plan. Mini implants are not designed to support individual teeth–they are too weak. They are cheap to place, but they are indicated primarily to help stabilize a complete denture. Giving your implants a lifespan of ten years may be generous, but even if they last the full ten years before failing, the failure of a dental implant is a serious event. What do you do after it fails? You can’t just place another mini implant because the reason the implant becomes loose is that it looses its bone support. So you have to have new bone grafted in before replacing the implant. No, you need something more solid.

The other dentist is suggesting a bridge for your missing molar. This makes sense because it sounds like you need crowns on the teeth adjacent to the missing tooth anyway. Adding a false tooth suspended between those crowns would add only about $1000 to the cost, much more practical than placing an implant with a crown on it, which could easily cost three times that.

Then about your front teeth.

Replacing four missing front teeth is a tricky proposition. You said you had a bridge replacing these teeth, but didn’t say how long that bridge had been present. I would be surprised to learn that it had lasted very many years, because of the high stress that would be on the anchor teeth (dentists would call these the abutment teeth). Let me share with you some dental bridge engineering principles. Here is a diagram of a dental arch.

dental bridge

Let’s imagine that the first premolar on the left side of the diagram is missing and we’re going to replace it with a dental bridge. I’ve drawn a line between the proposed abutment teeth. You’ll notice that the replacement tooth is going to be suspended directly between the abutment teeth. This is a favorable stress situation. There aren’t going to be serious twisting forces on these abutment teeth.

Here is another diagram of the same dental arch, but we’re going to imagine that we need to replace all four incisors.

cantilever dental bridge

Imagine now when we put stress on the incisal edges of the very front teeth. That will produce a twisting force on the abutment teeth.

This is what you had with the bridge that you lost. It’s not surprising that you ended up losing both abutment teeth–fairly predictable, in fact.

Now implants placed in the positions of these canine teeth could be more sturdy than the original natural teeth, still, trying to support all those teeth with the two implants in the positions of the canines is risky, in my opinion. Placing a third implant somewhere close to the middle of the bridge would completely eliminate any twisting effect and would greatly increase the stability of the restoration. It could well last you for the rest of your life.

My opinion. I hope this is helpful.

– Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

August 4, 2016

A couple of teeth just fell out!


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Dr. Hall,
My mother is 85 years old. Just last week she had two teeth filled. She recently lost a tooth and has a partial for that area. Then a few days ago, another tooth fell out. Both missing teeth are from the lower jaw. Fortunately they are in different areas of the mouth. She is very self-consious. At her age, her remaining teeth and gums are probably not in the best of health. We are considering a bridge(s) but are not sure as we don’t know how healthy the rest of her teeth are. Do you have any affordable recommendations on what we can do for the area that is missing teeth?
– Diane from Colorado

Diane,
If I am understanding you correctly, these two teeth just fell out. If that is the case, your mother has advanced periodontal disease (gum disease). It doesn’t get more advanced than that, for teeth to be so loose that they just fall out.

Continuing on with that assumption, it is likely that she has no really solid teeth left, so bridges would be out of the question. A bridge anchors replacement teeth to the remaining teeth, but in doing so it puts additional stress on those remaining teeth. In your mother’s case, that would hasten their demise.

The ideal replacement for missing teeth is dental implants. However, you asked for something affordable. Your mother would likely need full-mouth restoration, and the price for doing that with dental implants could easily get to be $20,000 to $40,000.

Given the condition of advanced periodontitis, all of her teeth are likely loose and would be candidates for extraction. I would seriously look at complete removable dentures. The main disadvantage of removable dentures is that it begins a long-term process of bone resorption. But at the age of 85, that would not be likely to be a significant problem for her.

Cu-Sil partial denture

A Cu-Sil partial
(image courtesy of Dental Arts Laboratory, Peoria, IL)

Another solution would be a type of partial denture called a Cu-Sil partial that is built like a complete denture, but has holes in it to allow the existing teeth to poke through, and there is a silicone ring in each hole that snugly holds each tooth. This is a little more stable than a complete denture, and as additional teeth are lost, it is a simple matter to then close each hole and put in a new artificial tooth.

A conventional removable partial denture also puts extra stress on the remaining teeth. It’s not as much stress as a bridge, but it’s still enough to weaken the teeth, so I wouldn’t recommend that either.

Dr. Hall

Do you have a comment or a question or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

February 16, 2012

This bridge has been done three times, and has never really looked good.

Hello Dr.Hall!

I love your website, it has so much information and I hope it’ll help me to make my decisions. The reason I am emailing you is this: I don’t have my upper left lateral incisor since I was 16 y.o ( I am now 39), it was pulled out when I was 16 because it was very crooked, so my mom took me to the dentist in my country(Russia) & he pulled it out and put a bridge (crown on canine tooth).

It was so ugly that I went to another dentist same week who did a little better job & that’s how I had this bridge for about 10 years, although I didn’t like it because it was whiter then my own teeth, its bigger & bulkier.

After 10 years living in US I thought I’ll try to get a better bridge, I thought in US they do it better, so I went to my general dentist about 3 years ago & he promised me he would make it much better & I’ll be happy. After he did it, it seemed like a better one. I don’t know what was wrong with me, why I did not see right away but after some time I noticed that it still bigger, still whiter & longer then my teeth on the other side but I never told him anything. In addition he was recementing them twice after 1 month and 2 months later, after which he said I have an overbite I need to fix it with braces or it may keep falling off.

I went to orthodontist, got braces, looks like he straightened my other teeth, probably fixed overbite, anyway to make a long story short when he took them off about a months ago he offered to shave of the fake tooth because its too long and catching peoples eyes, i agreed trusting him that he will stop when metal will start showing but he never stopped to ask if I think its enough or not, finally he gave me the mirror where I could see that on the bottom of that tooth metal is very well showing, he asked me why did I get upset when it looks better now. that is the last drop, I felt abused, I trusted him but all he said “lets stay friends”. I am very disappointed & upset. He was recommended by some people & he is very nice, I didn’t expect that he would handle it like this, but again he said this is a bad bridge & I should change it anyway. I think this is none of his business, he shouldn’t have touched my teeth & suggest to do things that cost a lot of $$$ when I didn’t ask for his suggestions, I think he should have offered to compensate somehow because I didn’t plan to do any cosmetic job for a few years but now I feel that I need to do something right now.

I went to my new general dentist who suggested that I need to get another bridge maybe on all four or six front teeth so they’ll look even,also because I have a few fillings on my front teeth. I asked her about getting a bridge on one side & veneers on the other side, I don’t know maybe its not a good question,but I feel that I don’t want my teeth to be shaved off so much for a bridge,she did not recommend veneers because of my fillings. an additional information about my teeth so you can imagine it: my teeth are far not white at all & because of fillings the color is not even.

So my questions:
1.should I let my orthodontist know that I am really unhappy with what he has done & ask him to compensate somehow;
2.if I decide to get a bridge on all six front teeth will they be bulky/bigger;
3. should I get a bridge or veneers?

I know its probably hard or impossible to answer my questions without seeing them, but at least tell me what you think. Another thing, after reading your website, I see you don’t suggest to go to a general dentist,so I looked up here a cosmetic dentist in my area (name withheld). I could go there also, it’s an hour drive, but I don’t mind if its a better doctor. I am so disappointed with all previous work that I had that its hard to believe for me that I ever get results that I want & also another big things that I have to pay so much $$$ & not even sure that I will be happy with that. I would greatly appreciate if you could answer me.

Thanks you so much.
– Lynda from Maryland

Lynda,
Thanks for your question and I really think I can help you.

You’re a great illustration of the point I try to make on the website that 98% of dentists simply aren’t artistic. They have an engineering mentality. You’ve had three different bridges replacing this lateral incisor, and while each one has looked better than the one before, none of them have been really attractive. This is what you find with your average family dentist. They are nice, honest people but think like engineers and each dentist probably thought the work they did for you was fine, why are you complaining? And now this orthodontist says he can’t understand why it should bother you to show a little metal – he made the tooth shorter like you wanted.

Don’t let this happen any more. This is exactly the reason I run this website, to help people like you learn about cosmetic dentistry and get the work done right. The dentist you mentioned is an excellent cosmetic dentist and he would do a beautiful job for you, as would any dentist we recommend. Yes, it certainly would be worth it to take the hour drive and get this done right.

And besides that, this bridge shouldn’t have been coming loose all the time if it was made correctly. Your dentist is blaming it on your bite, but if it were made correctly with proper retention, it would stay on, in spite of your overbite.

Don’t let your dentist put a bridge across all your front teeth. That would be a terrible thing to do. All your front teeth would be ground down to pegs, and for the rest of your life, any time anything goes wrong with any one of those teeth you will need to get an entirely new bridge.

And yes, I would ask this orthodontist to compensate you for grinding down to the metal. Even an engineering-type dentist should recognize that this is a no-no, and I’ll bet he’s having some twinges of guilt over this. I think this is the type of thing that could be mentioned in a complaint to the dental board or to a peer review committee of dentists. But I would start by just asking nicely for some partial compensation for doing the new bridge. He has a point that the bridge needed to be re-done eventually, but you have a point, too, in that you were going to wait but now you have to do it right away. So maybe if he paid for half the bridge, that would be fair. There are ways to cover over the exposed metal with metal bonding techniques, but that is too sophisticated for your average dentist and requires equipment and materials that they don’t use, unless they are fairly expert cosmetic dentists.

And when you have this bridge re-done, an expert cosmetic dentist will recommend that it be done in all ceramic, not porcelain-fused-to-metal.

Dr. Hall
Click here to read about the cost of cosmetic dentistry.

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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