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My dentist ground away the porcelain leaving a spot of metal showing

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Dear Dr. Hall,
I have had a Maryland Bridge for more than twenty-five years. I am a horrific grinder and have to put off getting a bite plate. I had 2 crowns put in a few weeks ago and the dentist worked on getting a comfortable bite. In the process of doing this he took a bit off of the Maryland Bridge tooth. Next day I noticed a silver dot showing through the Bridge tooth. Went back to the dentist and he said it was from me grinding which I disagree with. He placed a bonded composite filing over it. The silver dot is showing through again.

After twenty-five years of having the bridge could this silver dot of the tooth appear overnight from grinding? Again, I realized this the morning after he adjusted my bite and took off some of the tooth. I don’t know how to approach this because he said it was a result of my grinding. Thank you for any help you can provide.

Sincere thanks,
Maria from New Jersey


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Maria,
Well, I can’t see the Maryland bridge or the spot that is now showing through, but you and I both know that if it hadn’t been for the dentist adjusting your bite this wouldn’t have happened. He might be technically correct—he just thinned the porcelain and overnight your grinding finished removing the last thin layer of porcelain over this spot. He doesn’t want to admit that his grinding had a role because that would obligate him to possibly having to replace this Maryland bridge. And because of his authority relationship with you, you feel very uncomfortable contradicting him.

Here’s what I would suggest. Find a dentist who will give you a second opinion. Many dentists will do that for no charge. Ask them to tell you if there are signs of grinding of the porcelain right around this spot where the metal is showing. If you drag a metal explorer over glazed porcelain, it won’t leave a mark. But if the porcelain has been ground on with a dental bur, the explorer leaves a distinct mark on the porcelain. So it’s pretty easy to tell when porcelain has been ground on. Then, armed with the opinion of another professional, that will give you the courage to go back to your dentist and hopefully get him to fess up. It would help if you’re not too accusatory. This is an understandable mistake by your dentist. I will bet that almost every dentist has had an experience adjusting the bite on a porcelain-fused-to-metal crown and ending up with some of the metal showing through. While I never had that happen on a front tooth, I had that happen to me several times on back teeth. Here is a photograph of three crowns on back teeth where the porcelain was adjusted down to the metal on two of them:

photo of three porcelain-fused-to-metal crowns on back teeth, with metal spots showing through on two of them.

Is it possible to repair this without replacing the Maryland bridge? Maybe, but it’s tricky. Your dentist put composite over the spot, but it doesn’t sound like he did anything special to prepare the surface of the metal, and without that the composite will not bond at all to the metal and thus won’t last more than a few hours. There is a dental bonding cement called Panavia that will bond to metal. The way to try to repair this spot would be to grind away some more of the metal to give some room for some thickness of material. Then it would be best to etch the metal with a small sand blaster called a micro-etcher. This will make the spot larger, but you do what you have to do—you’re trying to save the bridge. The metal then needs to be primed and a thin layer of opaque Panavia would then be placed over the metal, cured, and then the correct shade of composite would be placed over that, shaped, and polished. And then you would cross your fingers and hope that this works.

Good luck,
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.

Can a dentist remove composite without damaging the tooth?

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Dr. Hall,
I was wondering if there are any methods to remove all the composite bonding on a front tooth without damaging the existing enamel, eg laser or air abrasion and whether these methods might cause any damage?
Catherine from London, UK
 


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Catherine,
Yes, it is fairly easy to remove composite from a tooth without damaging the tooth, so long is that bonding material is placed on enamel, not the softer dentin of a tooth. I’ll give you three methods that could be used.

  1. Sandpaper disks that a dentist uses for polishing composite are probably the easiest. They have the advantage of leaving a smooth, highly polished surface. Since they are flexible, they bend to accommodate the shape of the tooth.
  2. There are also high-speed carbide drills that are made for polishing. When they are used with light pressure, they are faster than sandpaper disks and still very good at removing composite and not damaging the enamel. However, because of their shape, they tend to leave streaks of material on the tooth. So when I would use these burs, I would finish up with a sandpaper disk to be sure I had it all removed.
  3. And then yes, air abrasion works well here also. However, most dentists don’t have air abrasion equipment in their offices. Little sand-blasting nozzles will also work here. Many cosmetic dentists will have one of these units, which is called a micro-etcher. Again, though, this is a slow method and would be best used as a finishing step, and not for removing the bulk of the material.


When I was in practice, often just before Halloween we would offer to do decorative bonding for patients, creating vampire fangs for patients that would be removed right after Halloween. So we had a lot of experience with this task of removing composite from the surface of enamel. You can read the page I’ve linked here to see a little trick we used to make this removal go quickly.

I will also add that often Lumineers are promoted as being reversible. Since no tooth structure needs to be removed before they are placed, it is argued that they can be removed if you change your mind. This, however, is theory and, for all practical purposes, is a fantasy in my opinion. Lumineers and other brands of porcelain veneers are made out of porcelain, which is very hard. Removing them without damaging the tooth is extremely tricky. My advice to a patient if any dentist tries this pitch on them is to ask them to show you photographs of a case where they removed the Lumineers. I will bet that they won’t be able to. But if you ask an expert cosmetic dentist who is truly good at what they do, my guess is that their experience would be very similar to mine—they have never had an instance where a patient ever wanted a new smile removed—they are so thrilled with their new smile.
 

– 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.

How can I hide the metal clasps from my partial denture?

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Dr. Hall,
I have an upper and lower dental partial that have metal clamps which connect to my teeth. Is it possible to have the metal pieces colored pink to match my gums? I am very self-conscious when I smile and the metal is showing “gleaming.” Is this procedure possible and what will my price be? Thanking you in advance for your assistance with my current situation.
– Patricia from New York


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Patricia,
Unfortunately, I don’t believe there is any way to make the metal clasps on your removable partial pink. These metal clasps need to be flexible, and anything your dentist would bond to it would break off under the bending stress.

However, the gleaming that you get from light reflecting from the clasps can be toned down dramatically with a little sand blasting—something very simple to do. If your dentist doesn’t have a little “micro-etcher” device to do this job, his dental laboratory certainly would, and this is such a simple procedure that, if they didn’t offer to do it for free, the charge should be minimal. You could maybe even stop off at the dental lab yourself and have them do this. It will change the metal from being shiny and gleaming to a matte finish that doesn’t reflect much light.

photograph of a removable partial denture replacing three back teeth on each side of the mouth, made entirely of plastic

A Valplast Partial

For others who are in the market for new removable partial dentures, the new plastic clasps that can be either pink or transparent are much less obvious to people, and while these partials may not be as sturdy, I believe they are sturdy enough and are way more aesthetic. There are various brands of these. The photograph here is of a Valplast partial. DuraFlex is another brand.
– 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 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.

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 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.

How to repair an Encore bridge

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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.

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

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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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