Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

November 27, 2017

Hockey Players and Dental Implants


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Hi Dr Hall

My son in college is a hockey player who just lost his front tooth due to a direct hit from a hockey puck. He started the process for an implant, meaning they removed the tooth and added a plug. He was recently told by other teammates that an implant is not a good option until he finishes playing the sport because a second trauma is possible. Is an Encore Bridge or a Zirconia Maryland Bridge a good option? He wants it also for cosmetic reasons as he will be getting married later this year. He Lives in CA and would be willing to come to see you if needed.

Thanks
Geoff from California

Geoff,
Thanks for your question! I had never heard about this concern before – placing a dental implant in a hockey player, but your son’s teammates make sense. I went to the University of Minnesota Dental School. One of our oral surgery professors was official team dentist for I think it was the Minnesota North Stars hockey team at the time, and we heard a lot about hockey dental injuries. I would listen to those teammates. Getting a tooth knocked out is one thing. With that tooth anchored on a dental implant, the implant would be ripped out of the bone damaging who knows what else and requiring bone grafting on top of everything else.

There’s no harm in having the root fixture placed, but I would hold off on putting a crown on the tooth until after his hockey career is over. Meanwhile, no, a bridge is not a temporary restoration – whether it is an Encore bridge or a zirconia Maryland Bridge. A bridge requires tooth preparation on the adjacent teeth if it is placed properly. Besides, now you’re hooking three teeth together and that is going to magnify the risk to all those teeth should he have another accident.

What he needs is a removable flipper partial to tide him over. I would go to one of our recommended cosmetic dentists to get a great match of the false tooth to his other front tooth, which might require spending a little more money. Done well, no one will know it’s a false tooth.

– Dr. Hall

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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.

October 17, 2017

A Maryland Bridge is not a temporary restoration


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Hello,
I have a 10-year-old son who is planning to undergo removal of his front tooth as a result of a bike accident and two unsuccessful root canals. I would like to know what would be the best options for him post-surgery (flipper vs. Maryland bridge or anything else?). Also, I am concerned about long term health risks involved in the surgery techniques (removal of entire ligament) and potentially toxic materials used. Could you please provide any recommendations and/or questions I can address to our surgeon? Your advice is greatly appreciated.
John from Idaho

John,
I get this from a lot of people—that their oral surgeon has suggested a Maryland bridge as a temporary restoration to replace a front tooth while waiting for a young person to get old enough to be able to do a dental implant.

For the benefit of others who may be reading this, the reason we don’t want to do a dental implant on a young person is that their face is still growing and jawbone is continuing to be laid down. Natural teeth move along with the newly grown bone, but a dental implant remains fixed. As the child continues to grow, he or she would then develop a discrepancy between the vertical position of the natural teeth and the position of the implant tooth. So we wait until growth has completed and then place the implant.

But what to do in the meantime?

I don’t fully understand the resistance to giving the patient a removable temporary tooth. A dental flipper, otherwise called a flipper partial, is inexpensive and looks fine. a flipper partial replacing a single front tooth It can be made without clasps, as shown in this picture, or with a couple of metal clips over back teeth. Yes, I suppose the child could lose it, but you could buy several of these flippers for the cost of a Maryland bridge. And there is a strong motivation for the child not to want to be seen without their tooth.

I have to believe that those dentists who suggest using a Maryland bridge as a temporary tooth replacement haven’t done many Maryland bridges. The main problem with doing a Maryland bridge in this situation is that it probably won’t stay in unless you do some tooth preparation on the adjacent healthy teeth. And if you are drilling into those teeth, that’s not what I would call a temporary restoration, because the traces, or scars if you will, will remain there forever.

Maryland bridge preparation

Diagram of a tooth properly prepared as one of the abutments for a Maryland bridge

If the teeth aren’t prepared, then the bridge probably won’t stay on for long. If it actually does stay on, you have an added complication in the difficulty in removing it without damaging those supporting teeth.

Furthermore, if the Maryland bridge is metal, the flipper will be more esthetic. The metal wings of the bridge are bonded to the backs of the adjacent teeth, which will darken them.

About your other question on the other risks of the surgery, I don’t understand the question. When a tooth is removed, usually the entire periodontal ligament comes with it. If it doesn’t, your body will resorb it, so I don’t understand what the issue is. And there are no toxic materials used in an extraction.

– 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.

October 9, 2017

Saving your tooth looks like a no-brainer to me


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Dr. Hall
I have to have either a root canal or implant in the first molar on the left side, bottom. There is no molar behind it, and I am wondering if there is a “snap on” smile version that would be less expensive, invasive and will allow me to cover the empty space, should I decide to have the tooth pulled?
– Beth from Washington

Beth,
Having the tooth pulled and replaced with a Snap-On Smile would be the worst of several options for treating your infected tooth.

Let me go through your options and their pros and cons.

You’re telling me that there is no molar behind your first molar. So you’ve already lost your second molar. Losing your first molar would leave you with no molars on your left side. I guess if you’re planning on going on a soft or liquid diet you won’t need to chew, but you really need something there. A Snap-On Smile is a temporary tooth replacement solution designed to help you, say, get through a job interview or a social function and look like you have teeth. It isn’t a functional replacement for molars. It isn’t very durable and isn’t all that cheap, either. The least expensive functional tooth replacement would be a removable partial denture.

But any type of appliance you put in your mouth that is removable and designed to be a functional tooth replacement is going to be much more stable if you have teeth in the back to anchor it. Imagine having a table that has legs only in the middle and on one of the ends, as I have pictured below. This is called a cantilever and isn’t very stable.
An unstable table with legs in the middle and on one end
This is like the situation you are creating in your mouth when you lose these back teeth. When you try to attach a tooth appliance onto the front teeth and expect it to replace back teeth, it’s not very stable. In addition, it creates a twisting force on the teeth that are supporting it, which can lead to the early loss of those teeth. There are partial dentures that are designed to absorb the stress with the soft tissue on your ridge, but they would require clasping other teeth, too, probably going on to the other side of your mouth.

The root canal treatment makes the most sense because that saves your own natural tooth. Being a molar, the tooth would likely need a crown also. But there are people who argue that a dental implant is a very predictable solution also. The root canal and the crown would be less expensive, though. To me, it’s a no-brainer to save your tooth.

– Dr. Hall

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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 1, 2016

Can broken-off teeth be restored?


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Dr. Hall,
My husband has 2 front teeth that are broken off. The roots are intact. Other than a partial plate or a bridge is it possible to have root canals and caps?
– Jen from Ontario

Jen,

Yes, it may be possible to save a front tooth that is broken off, by doing a root canal, putting a post in that root canal, and putting a crown [cap] on the post, if there isn’t too much of the tooth broken off. It depends on the kind of bite your husband has. And it depends on the attitude of the dentist. Many dentists, I can tell you, may not want to attempt that. And recently, as dental implants have become more reliable and more popular, there may be less tendency of dentists to want to try to save teeth like this.

The mechanics of fixing a front tooth like this are tricky. A lot of dentists won’t realize that the main force working against them is a rotational force on the tooth. The front teeth are kind of roundish at the root. Then if the dentist puts a round post into the root, the resultant restoration doesn’t offer much resistance to rotational forces. Over time, then, those rotational forces can work the post loose. A way to brace against those rotational forces is to put two posts into the root.

Another problem that many dentists may not realize about this situation is that the post can end up cracking the root. There is a tendency to think that a rigid post would be stronger, and it may be stronger. But when tipping forces occur against the root, a rigid post will transfer those forces to deep inside the root where the tooth is thinner and they can crack the root. So flexible posts, such as carbon fiber or fiberglass posts should be used on front teeth.

Dr. Hall

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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.

March 31, 2016

A smile makeover over a fractured tooth spells trouble for Aaron

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Dr. Hall,

I had a traumatic fall 12 years ago fracturing 2 front teeth and my smile was restored with root canals and Procera crowns by my family dentist. With age and time, I didn’t like the way my adjacent natural teeth looked with the Procera. Also, I had one left upper molar that had a pretty deep filling and was giving me trouble. I am 38 years old and that filling was almost 30 years old. I decided that it was time for a smile makeover. So I went to a cosmetic dentist here in Lexington who gave me a combination of porcelain crowns and porcelain veneers.

I love my new smile. After the restoration however, my #9 front fractured tooth began giving me trouble. It was tap and pressure sensitive, so I went back to my cosmetic dentist and she told me I need to get an implant and another restoration. I had a gum pimple at the time and was referred to a periodontist.

root fracture on tooth in a smile makeover

The x-ray of Aaron’s front tooth.

I went on a course of antibiotics immediately (Amoxicillin 500 mg). I saw a periodontist last week and he confirmed that extraction of my newly restored tooth was needed. I requested my x-ray, showed it to my family dentist, and he doesn’t necessarily agree that extraction is warranted. He is contacting the West Virginia University, University of Kentucky, and University of Louisville dental schools to see if this tooth can be saved by periodontics or endodontics. I really do not want to lose #9, especially after a $1500 crown was placed, and not to mention IT IS MY FRONT TOOTH. Wish me luck. Please feel free to comment. I have attached the x-ray.

– Aaron from Kentucky

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Aaron,

I actually have a couple of problems with your smile makeover. Not with its appearance. You also sent a photograph of your smile and it looks great! But it leaves me wondering if your dentist took x-rays before doing this smile makeover or, if she did, if she fully comprehended what she saw or gave it proper weight.

Root fracture on tooth #9

Your tooth #9 doesn’t look good at all. I have a fair amount of expertise in x-ray diagnosis and taught x-ray technique at the University of Minnesota, and I’ll tell you what I see. Right in the middle of the root there is a horizontal radiolucent line that looks like an old fracture. This must date from back to your original accident. The root canal filling crosses this fracture line, so the dentist who did the root canal either didn’t see the fracture or figured he or she could navigate through it, remove all the necrotic soft tissue, and hopefully get healing. And it looks like this happened to some extent, at least. The end of the root looks healthy. But just above the fracture line, the tooth looks moth-eaten. It appears that some of the root canal filling material is gone. If the pimple on your gum traces to that area, that spells trouble. And my guess is that it does. The moth-eaten appearance suggests that there is infection eating away at the root of your tooth. If this is the case, the tooth is unrestorable.

Does tooth#8 need root canal re-treatment?

If this weren’t enough, the other front tooth is suspicious. If I had done this case, I would have addressed the problem with #9 before starting, but I would have also recommended re-doing the root canal treatment on #8, because the root canal filling stops several millimeters short of the end of the tooth. Now that the crown is on that tooth, I wouldn’t do anything more than wait to see if it flares up. There aren’t any signs on the x-ray of any infection here, just evidence of a situation in which infection could develop.

So yes, I think you’re going to lose tooth #9. From everything I can tell, your dentist is an excellent cosmetic dentist, so I would have her stay with this case and finish it. But I think she missed the diagnosis here and should make concessions on the fee to get this fixed right. If I had made this mistake, I would ask you to pay for the extraction and the implant but then not charge you anything for the implant crown. That would make it so the total fee you pay would be equal to what you would have paid had the tooth been extracted in the first place and an implant placed, which is what should have been done.

– Dr. Hall

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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.

March 7, 2016

On using a Maryland Bridge as a temporary restoration before dental implants

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Greetings Dr. Hall,

My 12-year-old daughter is genetically missing #10, the maxillary left permanent lateral incisor. We had orthodontic treatment done to move the teeth far enough apart to put in a replacement tooth with an implant. That was completed in December. She now has a permanent wire bonded to the backs of the top 3 center teeth.

Since she is too young for a dental implant right now, we opted to go for a Maryland bridge at the recommendation of her Orthodonist because we did not want to have her deal with an upper Hawley through her teen years. Two weeks ago (after taking impressions and slightly preparing teeth #9 & #11 about a month ago), our family dentist put in her Maryland Bridge. There was no metal on it and she cemented the two non-metal wings to the adjacent teeth. The next day we got new impressions for a new retainer and then the next morning, the Maryland Bridge fell out. She ordered a different type of cement and yesterday evening the same bridge was replaced; this morning while eating a waffle the bridge fell out again.

Now, the Orthodontist and Dentist want to make her a new Maryland Bridge with metal wings instead. Here are my concerns/ questions in which I am looking for an expert second opinion:
1. Will the metal wings on the bridge allow it to affix better to her teeth, lasting at least 5-6 years until we can get the implant?
2. Will there be damage to her permanent teeth (#9 & #11) when the Maryland Bridge is put on AND later taken off? I would like to avoid her needing unnecessary dental work on #9 & #11.
3. Cosmetically, will the metal wings make more of a difference than when they were porcelain? Since this is in the very front of her smile, it is so important that the blend is as close to perfect as can be. I am concerned that irreparable damage could occur on #9 & #11 (not to mention the self esteem of a tween girl at risk here due to this cosmetic, yet genetic flub.) Any advice and opinions are appreciated.

We are going back to the dentist next week for new impressions and for a new Maryland bridge with metal wings to be made (which I am not paying any additional money for.) Also, is there a price difference generally in the bridge that is all porcelain versus one with metal wings? Just curious.

Thank you for taking the time to read this, it is TRULY appreciated. I just want to do what is best for now and especially for her future dental needs.
– Makisha from Arizona

Makisha,
I’m sure your dentist is well-intentioned, but she does not appear to be an expert in cosmetic dental bonding. And I would not let her do a metal-backed Maryland bridge, because I believe the same thing will happen, and I will explain why. There is a much easier, less invasive way to handle this.

Maryland bridges can work well, but it’s not just a simple matter of making space for the wings and then bonding it on. There has to be some preparation done, and in that preparation there has to be what is called resistance form created in the teeth to which the bridge is bonded. There have to be some grooves or something placed to keep the bridge locked onto the teeth – you can’t rely on just the bonding to do it. So when you made reference to “slightly preparing” the adjacent teeth, that spelled trouble. The number one reason that Maryland bridges come off is inadequate preparation.

Here’s a picture of a Maryland bridge preparationfront tooth with a groove similar to the type of groove that would help this Maryland bridge stay in place. This is deeper than would probably be required here, but you get the idea.

So your dentist did this “slight preparation,” and the bridge came off. She theorizes it must be the cement – let’s try a stronger cement. Nope, comes off again. Now she theorizes it must be the zirconia – if we switch to metal, it will stay on. No, it won’t work, because the problem isn’t in the materials, it’s in the design.

Now she could go back and do the proper grooves or whatever is required to get the bridge to stay on, but then it makes no sense to do a dental implant later. The main reason for doing a dental implant is to avoid having to prepare the adjacent teeth. Once they’re prepared, you may as well stick with the bridge.

flipper partial

A flipper partial replacing a single lateral incisor

The easy solution here is to do what we call a flipper partial. It’s just a false tooth affixed to a small plastic plate that fits behind her teeth and snaps on with metal clips in the back. In some cases the clips aren’t even necessary. But even when clips are used, people can’t see them. I’ve seen these hold up for many years and look extremely natural on very attractive women. A Maryland bridge isn’t an appropriate temporary restoration because the teeth have to be prepared. And if the preparation is adequate enough to hold the bridge in, it will later need to be filled in. It’s against my sensibilities to permanently prepare teeth for a temporary restoration.

So, to answer your questions:
1. Will the metal wings allow the bridge to affix better to her teeth?
No – no way. In fact, I wouldn’t be surprised to hear that the dentist has more trouble bonding the metal on than the zirconia metal-free version. Metal is harder for most dentists to bond.
2. Will there be damage to the teeth?
Yes. There already has been some damage by the “slight preparation” and there will be more damage if your dentist keeps at this, especially if she finally gets it right and prepares the teeth enough so that the bridge will stay on.
3. Is the metal in the bridge a cosmetic problem?
Yes. The metal will darken the adjacent teeth. This is why dentists are moving toward metal-free Maryland bridges.

I’m guessing that your current dentist should have no problem making a flipper partial that will work for your daughter. If you run into any trouble, get back with me and I’ll refer you to someone who can do this right.

– Dr. Hall

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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.

December 14, 2015

I’m missing a front tooth. Can I still get porcelain veneers?

Filed under: Partial dentures — Tags: , , — mesasmiles @ 6:31 pm

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Dr. Hall,
I have a partial consisting of 5 teeth. One of my front teeth is missing as well as 3 on one side and 2 on the other. I absolutely hate the dental work. It looks horrible. I had the dentist redo it 3 times. The front tooth looks nothing like the one next to it. My insurance paid for it and Im not sure if they will pay again. I would love to have porcelain veneers but I have teeth missing. What would you suggest I do to get my smile together?
– Doris from Detroit

Doris,
Even a removable partial denture can be made to look attractive and the missing tooth can be made to look like the one next to it, but it takes the right dentist using the right dental laboratory to get that done. For most family dentists, esthetics isn’t high on their priority list, and my guess is that your family dentist is working with a dental lab for whom esthetics is also a lower priority.

One disadvantage of a removable partial is that it has to have clasps that attach to your remaining teeth. With the old style partial, those clasps used to be metal and they could end up showing when you smile. There are newer plastic materials, however, that are transparent that give a much more attractive result. You could check out the Valplast partial as an option.

There are a lot of options on how to handle your case, and how it would be done depends on your budget and what you want to accomplish. If you’re happy with how the rest of your front teeth look, then it’s just a matter of replacing the missing front tooth and the other five back teeth. The economical way to do that would be with a removable partial denture. The nicest way to do that, which would be much more expensive, would be with dental implants.

You could also take the opportunity, since you already need major work, of combining the tooth replacement with a smile makeover. You mentioned porcelain veneers. A skilled cosmetic dentist will be able to seamlessly blend the different materials—implants and porcelain veneers—into one, beautiful, harmonious look.

About your insurance—on major dental work such as dentures, crowns, and bridges, they usually have a five-year rule—they’ll give you benefits for replacing the work if it is more than five years old.

You’re in Detroit. Check out our recommended cosmetic dentists in the Detroit area. Either of them could do a great job and give you a beautiful smile.

I hope this helps.

Dr. Hall

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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.

October 26, 2015

The cheapest, easiest, fastest way to fix a front tooth that broke off at the gumline

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Dr. Hall,
I recently broke my front tooth off, right below the gumline. I am looking for the cheapest, easiest, fastest way to fix this. I am 100% against implants.
– Harley from Nebraska

Harley,
Are you really asking me this? I don’t think you really mean the question the way it came out.

For the cheapest, easiest, fastest way to fix your broken front tooth, go to Walmart, buy a tube of Superglue, and glue your tooth back in. Cheap, easy, fast.

Problem is, the repair will only last for a couple of days. But long-lasting wasn’t on your list of requirements.

Another solution, not as cheap but also easy and fast and, as a bonus, long-lasting, would be to have a dentist bond a glob of composite onto the broken part of the tooth, making a little mound. That would last a long time. It wouldn’t look very good, though, but looking good wasn’t on your list.

Let’s re-order your priorities and make it first, something that will look good, and second, something that will hold up long-term. To accomplish that, there are two options. And neither one is cheap, easy, or quick.

It could be possible to repair the tooth by placing a crown on the remaining root. But that would only work if there isn’t a lot of stress on this tooth. If you have a deep overbite or even just a strong bite, it would be hard to get the crown to stay on. But if you have a gentle bite, it could work. You would need to have a root canal treatment on the remnant of your tooth, then have a good, strong post that’s not completely rigid. Either a carbon fiber post or a fiberglass post would work. The stress on a front tooth is mostly lateral. If you have a rigid metal post going down into the root and then put stress on the crown of the tooth, that stress will transfer to the root through the post and tend to cause a root fracture. If the post has a little flexibility to it, however, it will not transfer stress to the root and thus not tend to fracture the root.

And better yet, I would place two posts side by side, to help resist rotational forces that would tend to weaken the bond to the tooth over time. All posts are perfectly round, so any twisting force on them will tend to dislodge them.

However, if there is any significant stress on this tooth, the only solution that will hold up over a long time would be replacing the tooth with a dental implant. This could cost twice as much as a root canal, posts, and crown, and would take substantially longer because of the healing time required. But it would look good and last much longer. Doing the crown first could have you ending up with the dental implant eventually because the crown would fail.

Bottom line—sometimes the cheapest dental solution is the most expensive, the quickest solution takes the longest, and the easiest solution is the most complicated. It’s generally best to just fix it right in the first place and then be done.

– Dr. Hall

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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 5, 2015

How to repair an Encore bridge

Dr. Hall,

I had an Encore bridge done in 2012 and the tooth has now come off the bridge, but the back of the bridge is still attached to the gum and the other two teeth. Can the tooth be re-attached to the bridge and where can I go in CA ,or a nearby state, to have it done and at what cost since my insurance has been used already this year? It is a top tooth next to the front teeth.
– Dori from California

Dori,

The Encore bridge is tricky to do in the first place, and repairing it is even trickier. You can’t just do the bonding over again. The dentist has to thoroughly clean off all the old bonding material. Then the surface of the porcelain tooth has to be re-etched so that it will bond to the luting composite. This requires either having hydrofluoric acid, or what is called a micro-etcher, which is a mini sand blaster to treat the surface of the porcelain, or both. Cleaning off the surface of the resin framework is not as critical and that could just be scraped clean. If the porcelain is properly prepared, it should adhere to the framework. Though I wouldn’t expect it to last as long as the original. You got three years out of the first installation–I would expect less than that this time. So I’d start saving up to have a dental implant placed as a long-term solution.

(I then recommended an expert cosmetic dentist in her area. I’m not going to mention the dentist here, as it would make Dori personally identifiable. But I’m confident that the dentists I list here would have the expertise needed to do this repair.)

Dr. Hall

Note – I wrote a post about 3 1/2 years ago about the lifespan of a Maryland bridge where I included some comments about the lifespan of an Encore bridge.

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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.

June 9, 2012

Why can’t my dentist get this color right on my implant crown?

Dear Dr Hall,
I was not happy with the color of the crown attached to my implant, so I returned to my dentist who said he thought it was fine and sent me away to “think about it.” I returned and he very reluctantly agreed to re-do the color. I recently had the revised crown attached again, but the color is worse – it is now quite noticeably darker. Both times I visited the lab for color assessment. And both times the dentist did not bother to check the color before attaching the crown. I am very disappointed, but do not want to return to this dentist as he obviously is not able to improve. He also had considerable difficulty with attaching the crown which resulted in considerable discomfort and left me wondering whether the attachment to the implant has been damaged. Post-procedure, I cannot eat on that side of the mouth at all. This implant has cost me a considerable sum. I would like to know what my options would be for correcting the color of this crown, and if the attachment has been damaged, would I need to get a whole new crown and implant, and who should pay for this? Is it possible to place a veneer over the crown? Thank you for your help.
– Mary from Australia

Mary,
Your case is a great illustration of the great difference between dentists when it comes to aesthetics. Only about 2% of dentists, from my experience, are very good at aesthetic dentistry, and I have people all of the time having a hard time believing that and wanting to know why. (And that 2% is in the US – probably less in Australia). But dentists become dentists because they like to fix things – they’re just not into works of beauty.

Your dentist clearly has a low degree of interest in the aesthetics of his work, and that is the reason this isn’t working. And you have given clear indication here in your e-mail of his indifference. Any dentist who is seriously trying to do beautiful cosmetic dentistry will be very attentive to your opinion and if you thought the color didn’t match well would not try to tell you that it was fine. Such a dentist would actually make sure the color was right in your eyes before cementing the porcelain crown and would not hesitate to send it back to the lab. But your dentist did not have enough confidence in his own color-matching skills to match the color himself but instead sent you to the laboratory. And then, after being burned once and having to re-do the crown, rather than trying it on and making sure you liked the color this time before permanently cementing it, he just puts it on.

You have figured out that you cannot rely on this dentist to get this right. If you want this done right, you have to find a dentist who actually wants to be good at aesthetic dentistry. I wish you had told me where in Australia you are and I could give you some guidance on that, because good cosmetic dentists are few and far between in Australia.

When a dentist sends you to the laboratory technician for the “color check”, that is a pretty good sign that the dentist knows he or she isn’t very good at tooth color, and those cases often end up looking very poor. All the technician can do is look at the tooth that needs to be matched and take notes about the color. Then he or she dismisses you, goes into the laboratory, and tries to follow the notes that were made. The dentist is supposed to have a higher level of skill than the technician, and should know how to make those notes and instruct the technician. And nowadays, with digital photography, it is very easy for a dentist to hold up a shade guide tooth to your tooth and snap a color-correct photograph and e-mail it to the technician, with notes. The technician can then use that photograph and the notes during the fabrication of your crown, and this is often the best way to get an accurate match.

Do not – absolutely do not try to get a veneer placed over the crown. The crown is difficult enough by itself. Get the crown re-done. If that is done correctly, it will not damage the implant at all. Trying to do a veneer over it and get the color right makes it all the more complicated. Besides which very few dentists know how to properly bond a veneer onto a porcelain crown. That could turn this from a simple bad dream into a true nightmare.

If you need any more help with this, please write back.
– Dr. Hall

P.S. – I see you found our website by searching on “dental catastrophe.” I had not thought of that search term before, but it is appropriate!

Click here to read my blog posting about how to ask for a refund from your dentist.

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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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