Dr. Hall,
I had a root canal done in error 20 years ago on my top front tooth. Since then I have had 3 different crowns, two with the metal backing and the current one I was told is zirconia (the best material available according to my dentist). When I had my current crown done 2 years ago the dentist also convinced me to do a veneer on the tooth next to it because the crown tooth was wider due to a gap I had closed when my first crown was done. I was hesitant but I accepted the veneer because I was promised a much better, uniform smile. Unfortunately it wasn’t so. My crown tooth was completely charcoal-colored underneath so when the crown was redone without the metal backing it allowed light to penetrate through it and now I have 3 different colors of teeth. The crown tooth looks gray, the veneer has its own color against the crown and then my other teeth. I am very disappointed and would like to redo everything. The problem is, I am told my gray tooth under the crown is too dark and that I wasn’t provided any resolution. He added something inside the crown to make it not look so dark but that obviously didn’t help much. I guess I am having a hard time believing that in this modern day and age there’s no crown material that can be made to hide the dark crown regardless of how dark. Am I a rare exception that has stunned the crown world or perhaps my dentist just doesn’t have all the resources to provide a resolution? Any suggestions or help would be appreciated.
– Lidia from California
(See Dr. Hall’s answer below.)
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Lidia,
Your case highlights one of the key differences between a good general dentist and a truly expert cosmetic dentist. Some of these color issues can be mystifying for your average general dentist. But expert cosmetic dentists deal with them all the time.
While zirconia is the strongest ceramic that is used for crowns, it isn’t the most aesthetic. To get a truly aesthetic result, the zirconia should be layered over with porcelain. But that isn’t the main issue you have. Your main issue is the need to opaque out the dark underlying tooth. Doing that is a collaboration between the dentist and the ceramist who actually makes the crown. That team of the dentist and the ceramist ideally should have faced situations like this before and will have developed a way to deal with them. The dentist, besides communicating the desired final color, needs to accurately communicate (usually with a photo) the color of the underlying tooth. When I did cases like this, I applied opaquer to the tooth so it was already there before I sent the case to the ceramist. But some dentist-ceramist teams will leave all the opaquing to the ceramist.
There is also a point to be made here about the dentist-ceramist team. Master ceramists who know how to fix this are also rare. But excellent cosmetic dentists will seek out ceramists who know how to do this. When I practiced in Iowa, I tried using the best dental laboratories I could find in Iowa and none of them could deliver the level of aesthetic quality that I wanted. I ended up forming a relationship with a ceramist in California who handled all of my aesthetic cases. I was just talking with a cosmetic dentist from Louisiana who sends his cases to a ceramist in Kentucky. Beautiful cosmetic dentistry is a team effort.
Another mistake made by many general dentists and ceramists is to over-do the opaquing, resulting in a stark white tooth with no natural color variations. To avoid this, the opaquer needs to be done deeply in the crown and then more translucent porcelain placed over that. That is why I did my opaquing on the tooth preparation, so the ceramist could use the entire thickness of the crown to develop a deep translucency. But either way will work.
Also, your dentist is to be commended for suggesting a porcelain veneer for your other front tooth—much better than the more aggressive crown that many dentists would want to do. But matching a porcelain veneer to a crown is another tricky proposition and shouldn’t be attempted by a dentist or a ceramist unless they have superb color-manipulation training and skills.
For the sake of your privacy, I don’t want to reveal your exact location, so I’ll send you via email a recommendation for an excellent cosmetic dentist within driving distance for you who can fix this.
– Dr. David 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.