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Dark tooth color under my crown shows through

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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

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

The difference between Hollywood white veneers and natural white

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Hi, Dr. Hall
I hope you can help answer my question. I recently got veneers and asked for white white, the Hollywood smile. As far as size and shape, he got that perfect, but my teeth are only one maybe 2 shades whiter than what I had before getting veneers. What I wanted was either a bl2 or bl3. I know this is considered fake looking, but this is what I wanted. I even showed pictures at my appointment. At the time, I did not know the names of the shades. In my appointment, after I showed him pictures of the color I wanted, he told his associate, do an A1. I assumed A1 was that bright “fake” white. He never showed me a color chart.

I now have had them for 5 days and am so unhappy and depressed as I feel I wasted money. My teeth were in good condition beforehand, straight and a tiny bit yellow, more an off white. I expressed my concerns with the dentist, and now he is saying that the color he actually submitted was an bl1 and has no idea where the A1 came from. I am 100 percent certain he said A1 at my appointment to his associate because I have never heard that before and I didn’t know any shade names. Could he be saying this because he does not want to redo them for me? I would hate to think he could be lying. I can guarantee I do not have a bl1 color. They look a dull natural white, very close to what I now see an A1 is. He is saying that my veneers could look darker than what I wanted because of my teeth underneath, but I whitened them at the dentist and again at home and they were not that bad beforehand. Even if they were black, I think a bl1 would have made my teeth look more white than what they are now. I want to add the veneers I had were the no preparation veneers. Please help! Thank you!

Mary from Studio City, California


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Mary,
I think you have this figured out—your dentist just doesn’t want to re-do the veneers. You could call him on his mistake by asking him to photocopy the work order he gave the dental laboratory and give that to you. If he alters it before copying it that would compound the mistake and give you tangible evidence that he has tried to deceive you, so I’m pretty sure he’ll refuse to give you this if you ask. And blaming it on the color of the teeth underneath is just admitting that he didn’t know what he was doing. A competent cosmetic dentist and dental laboratory will always take into account the shade of the underlying teeth and if the veneers are to be dramatically whiter than the underlying teeth, some opaquer is built into them so that they get the correct final result.

I am impressed that you’ve done your research and know all these names of the shades from dental shade guides. You now apparently know more about shade guides than your dentist did when he started your case!
a display of four teeth on tabs. Each tooth is labeled with a shade designation: bl1, bl2, bl3, and bl4

Here’s a little background on this tooth shade matter. Dentists, in dental school, are schooled in what is called the classical shade guide, where the whitest shades are A1 and B1. So if you were to ask one of these dentists what is the whitest shade of teeth, they would tell you either A1 or B1.

When tooth bleaching became popular in the 90s, shade guide manufacturers realized that they had to expand the shade guide to incorporate the new bleached teeth shades. Ivoclar, the maker of the second-most popular shade guide, was the first to respond and they invented the bleached shades 010, 020, 030, and 040. Later the names of these shades were changed to bl1, bl2, bl3, and bl4. That’s the bleached shade guide that you are referring to.
Vita, the manufacturer of the most popular dental shade guide, was a little slower to respond, but they finally came out with bleached shades M1, M2, and M3. Today, many cosmetic dentists use a combination shade guide made of the traditional Vita shades A1 to D4, with the Ivoclar bleached sides bl1 to bl4 tacked on.
a shade guide with the bleached tooth shade bl1 to bl4 on the left, and the rest showing the 15 natural shades A1 to D4

In my practice, we would always carefully discuss this issue of the final shade of the teeth that the patient wanted. Most patients wanted a natural white, but there were a number of them who wanted what you wanted. Some cosmetic dentists call this a “Hollywood white” color. In my office we called it “ballistic white.” Before they came out with the bleached teeth shade guides, we would communicate this to the laboratory as a B-zero color, and we made sure the laboratory understood what we were talking about.

Your dentist made a fundamental mistake in your case, and needs to make this right to you. There’s no point arguing about how it happened. The point is that you didn’t get what you asked for in a Hollywood white smile.

A fundamental principle of smile makeover dentistry is that the case is a failure if the patient doesn’t love how it looks. Every ethical cosmetic dentist I know would re-do the case if they missed the shade like your dentist did, leaving the patient unhappy with how the case looks. I think you just need to get tough with him, not accept any excuses, and I believe that he will relent and re-do them for you. Since, as you said, he got the shape right, I’m assuming that he is competent in cosmetic dentistry and you don’t need to switch dentists to get this done right.

But if you keep getting resistance, get back to me, and I will help line you up with a dentist for a second opinion. A call from another dentist will usually convince a reluctant dentist to rectify a mistake like this.

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.

A case of two crowns on front teeth turns into a nightmare

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Dr. Hall,
My daughter fell and broke her two front teeth when she was 14. One tooth needed a root canal treatment. Both teeth needed crowns. She’s now 20 and the tooth with the root canal has been getting more gray, so we went to a new dentist to have the one crown replaced.

Besides doing the new crown, the dentist contoured her gum tissue to make the teeth longer. But we’re still not happy with a few things.

The problem is that this tooth still has a gray tinge to it. It is also bulky and sticks out further than the other front tooth. The dentist said that he can fix the gray and he points out that it looks much better than when we started, which is true. But we’ve spent about $2000 and we had higher expectations. Are we being reasonable? I don’t want my daughter to be self-conscious about her smile.

I have before-and-after photos that I can send, if you think that would help.

Thanks for your time,
– Melanie from Oregon

(See Dr. Hall’s answer below.)


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Melanie,
To answer your basic question, no, it is not unreasonable to expect these two teeth to match. It just requires a little more knowledge about color manipulation, and, unfortunately, that isn’t part of the curriculum of a lot of dental schools. So you need to find a dentist who has enough passion about appearance-related dentistry to have taken some post-graduate education where he or she would learn these things. I can clearly see from the photos you have sent that you are in the wrong dental office.

Here’s the before photo you sent of the damaged teeth. This was a nasty accident.

before close-up photograph of a smile showing two front teeth broken off at angles

Michele’s daughter’s two broken front teeth

And here is the after photo.

After close-up photograph of smile, with two crowns. One looks brighter and bulkier than the other.

Here are the two crowns

And here is a view of the two crowns from above, showing how much the one crown sticks out from the other.

Close-up photograph of the crowns, taken from above, showing one of the teeth sticking out further than the other.

After photograph taken from above.

The bottom line is that these crowns are in no way near acceptable. They are so far off that I have no hope that your dentist could get this right.

One solution (which I don’t recommend) would be to re-do both crowns. But I don’t think that your dentist would even get that right, seeing that he thinks that the answer to crowning a grayer tooth is to make the crown thicker.

There are several ways that expert cosmetic dentists address a situation like this, where you are crowning a severely discolored tooth. One is to communicate, with photographs or an excellent description, the amount of discoloration in the tooth and leave it entirely up to the ceramist to mask it. The ceramist should have at his or her disposal a selection of more opaque ceramics that can cover up the gray. An opaque layer would be in the most interior part of the crown, and then more translucent porcelain placed over that. The problem some dentists have in working with a ceramist is that they aren’t that fussy about their cosmetic dentistry and so haven’t sought out a good ceramist who produces highly aesthetic work.

When I had a case like this, though, my approach was to cover up the discoloration myself and send to the ceramist a case that was much easier to match. If all root canal materials were cleaned off this one tooth and then the tooth were bleached, that would get the color matching much closer. Then the dentist could cover over what remained with a white opaquer. But your dentist might not even have a bleaching agent that could bleach a root canal tooth or any white opaquers because he’s not really that into cosmetic dentistry.

And then making the two teeth the same size. That’s pretty fundamental, that your two front teeth should be the same size. Apparently, your dentist and his ceramist, struggling with covering up the gray underlying color and not having appropriate opaquers at their disposal, have decided to make the one crown thicker in order to cover that up and they actually think that will look okay.

In my opinion, this dentist should give you a complete refund so that you can go to someone who can get this right. I can recommend a dentist in your area, if you’d like. If you get any resistance to giving you a refund, go to the dentist I recommend and see if they will help you with that. Or check back with me and there are another couple of things you could do. You should demand perfection with this case. Your daughter should be excited to smile and no one should be able to tell that she has had any dental work done on her front teeth.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

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 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.

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

Michele,
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 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.

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 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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