Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

April 23, 2018

What to do about gray crowns


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Hi Dr. Hall,

Due to a recent fall, I broke my 2 front teeth as well as the one to the left of my front teeth. I had 3 root canals and 3 porcelain crowns placed. I’ve had 2 attempts as the first permanent set were off in color, too big and thick. The 2nd permanent set matched in color and were closer in size and thickness to my natural shape. After they were permanently cemented they all had a grey hue close to the gumline on the tooth. The dentist has reluctantly agreed to redo my crowns stating he would try to make sure the core is as white as possible. I’m not sure what to think or if he can even fix the issue because he did say he couldn’t promise this issue would be resolved? What are your suggestions? Thank you!
– Nancy from San Antonio

Nancy,
Your problem is simply that your dentist doesn’t know enough about cosmetic dentistry.

One of the issues that family dentists have the most trouble with is color, so the problem he is having is not unusual.

If you have two or more crowns on your front teeth, this is a pretty simple color task for an expert cosmetic dentist. The fact that these crowns were too big and thick and the color was off on the first try makes me worry about the level of skill here. On the second try, having them be too gray at the gumline is not a great confidence builder, either. This isn’t a difficult situation. My advice would be to be fussy. It is possible to get the color and shape exactly right and in the right hands, no one should be able to tell that these are crowns on your front teeth and not your real teeth. Don’t settle for anything less than that.

You’re not giving me any clinical details about the types of crowns we’re dealing with, and there are several possibilities for getting this grayness that you’re seeing. Let me make an assumption of what I think is the most probable scenario. My best guess is that your dentist is using pure ceramic crowns of one type or another with a metal post and core to reinforce the inside of the tooth, and the gray color of the metal is showing through the translucent ceramic. There are several ways to deal with this. If I were doing your case, I would have used a fiberglass post and a composite core that was close to the color of your natural teeth. That’s the easiest way to get a natural translucency to the crowns. If we’re stuck with the metal core, then what I would have done would have been to bond an opaque layer on top of the metal to block out the metallic color and then bond the crown on top of that opaque layer. Another option would be to give clear instructions to the laboratory technician about the color and extent of the metal core, and let the technician incorporate opaquing into the crown.

The problem with many family dentists is that they don’t understand translucency and the impact of interior colors on the external appearance of the tooth.

Your case bothers me, though. You’ve had this accident, and you would think that you should be able to go to your family dentist and he would know enough to fix this. Or, if he didn’t, that he would know enough to refer you to someone with more expertise in cosmetic dentistry. But that is the state of cosmetic dentistry in America. Dental academia trivializes cosmetic concerns and the powers that be in the profession are adamant that cosmetic dentistry isn’t a legitimate specialty. If there were a higher level of respect in the profession for aesthetic skills, there would be more inclination to either refer these cases to a specialist, or maybe to train general dentists better in these color skills and you wouldn’t have situations like yours. Your case doesn’t require a high level of aesthetic skills—only a moderate level. The fact that your dentist has missed this twice and now is unsure that he can fix the color shows a fundamental lack of understanding of basic color management.

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.

November 12, 2016

My porcelain veneers are turning gray


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Dr. Hall,
I had 4 upper front teeth veneered and two of these front teeth have turned a light gray! They don’t look like they looked when the dentist first placed them on in August. One is more dark than the other, this particular tooth was already darker and when it was filed down seemed to be even darker underneath. The dentist told me that we would just need to make the veneers thicker so it doesn’t bleed through. I don’t know if this is the case or if something else is wrong but I’m very upset as I have three different colors; my real yellowish white teeth, my gray veneers and my white veneers! This was the whole reason that I wanted to get veneers in the first place to correct old looking teeth. She has already replaced one veneer because when it was put in it was put in slightly crooked, so I just got that fixed. I almost don’t want this dentist to touch any more of my teeth but I don’t want to walk around looking ridiculous I don’t know what to do.
Sincerely
– Michele from Massachusetts

Michelle,
There are two parts to your question: 1) What went wrong; and 2) What do you do now.
Actually the second part is easier, so I’ll start with that. Your dentist clearly is in over her head. There’s the issue of the four veneers not matching. Her suggested solution is the wrong solution—don’t let her make the veneers more thick. One veneer got on crooked. And you only hinted at one fundamental mistake she made when you said that your real teeth are yellowish white and then you have two white veneers and two grayish veneers. Having four front teeth that are noticeably whiter than the rest of your teeth isn’t attractive and any true cosmetic dentist would not have done that to you.

You really only have one choice of what to do from here—you need to find an excellent cosmetic dentist and get this fixed in their office. Doing beautiful smile makeovers requires a passion for appearance-related dentistry, which your dentist doesn’t appear to have. It also requires several years dedicated to post-graduate training, which your dentist also doesn’t appear to have. There is too much wrong here to have hope that your dentist is going to be able to get it right.

I’m going to assume that your dentist is an ethical person but just in over her head on this one. It shouldn’t be difficult to get some kind of refund for the work that has been done. You paid for a beautiful smile. You didn’t get it, so you should get a refund.

And then your new expert cosmetic dentist may want to start over from scratch. The first step would be to bleach your natural teeth to an acceptable color, to get rid of the yellow you mention. Then, after a delay of a couple of weeks for the new bleached color to stabilize, do the four veneers. They don’t have to be thick to block out any underlying color. If the one tooth is particularly dark, an easy way to manage that is to prepare it just a little deeper than the others and then apply a layer of opaquer over the prepared tooth, before taking the impression, so that all the prepared teeth now look the same color. Or, working with an excellent esthetic dental laboratory, they can make the one veneer with an opaque liner—but that is a little trickier to do because it requires great color communication between the lab and the dentist.

As far as what went wrong with your first set of veneers, it would be easier to tell if I had a photograph. If they are an uneven gray, it could be micro-leakage getting under the veneers because of their not having been bonded properly. If the gray color is even, then something has happened to the glazed surface of the veneers. Maybe they weren’t properly glazed in the first place, maybe they aren’t really porcelain, or maybe that glaze has been damaged somehow since they were put in. Glazed porcelain is very color stable, much more so than natural tooth enamel, so something had to have gone wrong for them to undergo any color change at all.

It couldn’t be the underlying color bleeding through because if that were the case, they would have been gray from the start. But you said they have turned gray.

My best wishes. I hope you get the beautiful smile you paid for.

And how to find an expert cosmetic dentist? That’s the purpose of this website. If you go to our list and don’t find someone near enough to you, get back to me.

– 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.

June 10, 2016

Getting porcelain veneers and crowns to match


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Dr. Hall,
My question is, how hard is it to get all veneers to match, when the tooth stubs are dark. I’m getting one crown, and the rest of the smile is porcelain veneers. In my case, the crown looks whiter than the adjacent veneers. Shouldn’t there be a way to make them more matched? Love my dentist, but I think it could be a dental lab issue. I paid a lot of $ & I’ve seen many cases where everything matches. Thanks!!
– Carol from Pittsburgh

Carol,
This is an issue that a lot of family dentists have trouble with. Dental schools tend to trivialize cosmetic dentistry and teach that it is easy to do–any dentist can do this. But there are some basic color concepts that they really don’t teach the dentists. And then the vast majority of dentists don’t have a passion for appearance-related dentistry, so they don’t take the trouble to get this extra training.

Porcelain is naturally translucent, just like enamel, which makes it an excellent dental material. But porcelain veneers are thin, and porcelain crowns are several times thicker than veneers. So if the underlying teeth are dark, as yours are, that dark color is going to shine through the porcelain veneers much more than it would with the crown. That is the basic problem here.

There are two basic ways around this. One way is to accomplish this with the porcelain. Another is for the dentist to apply the opaque to the teeth before sending the case to the lab.

Opaquers can be added to the porcelain, but this requires quite a bit of skill on the part of the laboratory, to make the entire case turn out correctly. If the crown is translucent, the veneers need to be opaqued in a way that makes them appear just as translucent as the crown. It can be done, but is tricky. It also requires good communication between the dentist and the laboratory–the dentist needs to either provide photos of the prepared teeth or a detailed description of their color so that the laboratory can make the proper adjustments. There are excellent esthetic dental laboratories that can do this well.

In my practice, I preferred dealing with the opacity issue myself, as part of the tooth preparation. I would shave a little extra from the dark teeth and then apply an opaque layer of composite onto the teeth. The deeper the opaque layer is, the more room is available to create the needed translucent effect with the porcelain. The composite bonds chemically to the porcelain veneer luting cement giving a strong, attractive result.

– 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.

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