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

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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.

June 13, 2016

Placing new Lumineers over old Lumineers


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Dear Dr Hall~
I have been reading all your expert information and advice about cosmetic dentistry and I am quite impressed. However, I noticed that you have not mentioned if it is possible to reapply new lumineers over existing lumineers. I have lumineers that just are not white at all and can never be whitened with any kind of bleaching due to the nature of the porcelain material. Would you recommend this “new over old” lumineer procedure and is it possible? My dentist is aware that I originally desired whiter lumineers but his tech said that was not available at that time. I do not want to insult him now because he is super nice but I feel there is no reason for “dingy” teeth in this day and age. Can you please respond with your thoughts? Thank you kindly.
– Gilda from Pennsylvania

Gilda,
Yes, you can do new Lumineers over old ones. But you wouldn’t want to, and I’ll explain why.

First, I noticed that you’re saying Lumineers without capitalizing it. Some people don’t realize that Lumineers is just one of many brands of porcelain veneers, so I wonder if you meant to refer to only the Lumineers brand. It’s the same answer whether you’re talking about Lumineers or another brand of porcelain veneers.

Lumineers are distinguished by the heavy marketing that has been done by the manufacturer. Back a few years ago, they were promoting among dentists this idea of putting Lumineers over old crowns, which is close to the same thing you’re suggesting. I think what happened is they ended up with a lot of patient complaints over how this turned out, and so I haven’t seen any of these ads for maybe five years now. Here is a photo of one of the ads in a print dental journal:

new Lumineers over old

Two main reasons you don’t want to do this.
First, it’s just as much work to put new porcelain veneers over old ones as it is to re-do the old ones. The dentist would have to prepare the old veneers some, at least, to have the final result be not too thick. So you’re going to pay the same as if the dentist just started over.

Second, the “new over old” technique wouldn’t last as long as brand new veneers and has a risk of looking funny. Bonding porcelain on top of porcelain doesn’t give as reliable a bond as bonding porcelain to a natural tooth. Even if the dentist did get a good bond, what happens if the underlying, original porcelain veneer fails? By adding another veneer on top, you’re doubling the chance of failure. It would be much better to have a brand new one.

And then the margin where the new porcelain meets the old tends to be more susceptible to staining than margin at the porcelain-to-enamel bond.

Another point about your question. Whiter Lumineers or porcelain veneers have been available since the time Lumineers were invented. Telling you that the whiter color wasn’t available at the time—that’s simply not true. I question whether or not this dentist or this tech is up to speed on cosmetic dentistry. Only about 1-2% of dentists are capable of doing a beautiful smile makeover. This team you have sound like they’re in that bottom 98%. I’d seriously consider looking for an expert cosmetic dentist if you want a better smile.

– 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.

September 30, 2015

How do you whiten porcelain crowns?

Filed under: Crowns for front teeth — Tags: , , — mesasmiles @ 5:09 am

 

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Dr. Hall,
I have several front teeth that have caps on them. I’ve had them for approximately 30 years. They are not white like I would like them. What would you recommend for whitening my “fake” teeth. I’m assuming they are porcelain, but not 100% sure on the material they’re made up of. They were put in with posts and each one is individual.
—Missy from Pennsylvania

Missy,
If you have caps (crowns) on your front teeth and they are white and they’ve been there for 30 years, I’m pretty sure they have to be porcelain. Nothing else would last that long.

Unfortunately, the only way to whiten crowns is to replace them.

There is a company that is promoting the use of porcelain veneers to cover over old crowns, but that procedure makes no sense for several reasons, one of the biggest of which is cost. With most dentists, the cost of a porcelain veneer is pretty much the same as a new porcelain crown, so why wouldn’t you just replace the crown? Even if the veneer is cheaper, it isn’t cheaper enough to make it worth it.

First of all, if these crowns are 30 years old, there is a decent chance there could be some leakage or even decay under them.

Second, pasting porcelain veneers over old crowns creates some problems. This is a tricky bonding situation, and the bonding between the old porcelain and new porcelain is hard to get very strong, and it tends to be susceptible to stain. And it’s not going to last all that long. If these first crowns have lasted 30 years, why not get new ones and try to get another 30 years out of them? That makes way more sense than bonding some veneers over them that might last another five years.

No, just replace the crowns. It’s time a dentist looked under them to see what is going on there. It’s bound to be at least stained. Have the dentist clean it all up and put on some beautiful all porcelain crowns that can be as white as you want them. Bleach the rest of your teeth first, and then get the new crowns.

But go to an excellent cosmetic dentist. This is a new smile you’re talking about, and you need a dentist/artist to do this right.

—Dr. Hall

Do you have a comment? 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.

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