I very much appreciate you taking the time to lend me your expertise regarding my 19-year-old daughter’s teeth. She fell and broke her 2 front teeth when she was 12. One needed a root canal and both had crowns. One of the crowns (root-canaled tooth) had gotten grayer over the years. We went to a new dentist for porcelain veneers.
When the veneers came back from the lab, the dentist was not happy with the color match, so he gave her temporaries and we waited for the second set of veneers. Let me start by saying that they look a lot better than before. As he was able to elongate the teeth and he recontoured her gum tissue, however she is still not happy with her smile and is disappointed in a few things. We discussed some our concerns and the symmetry of the teeth was corrected.
The issue now is there is a gray tinge to the root-canaled tooth, so it is not matching the other veneered tooth. It is also bulky and sticks out further than the other front tooth giving the appearance of having one larger tooth from different angles. The dentist said the gray is not an issue that can be corrected because of what he had to work with and remarked that we have come a long way as to how they looked prior. Are our expectations of having two matching in color and depth to appear natural unrealistic? We have spent about $4000 and had higher expectations. As you know a smile is everything—especially to a 19-year-old!
I have before-and-after pics that I can send, if that would help.
Again, I appreciate your advice.
Best, Michele from New York
(See Dr. Hall’s answer below.)
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To answer your basic question, no, it is not unreasonable to expect these two teeth to match. And doing that doesn’t require that sophisticated a level of skill with cosmetic dentistry. But I can clearly see from the photos you have sent that you are in the wrong dental office.
First of all, let me say that from the photograph you included of the prepared teeth, these are not porcelain veneers—they are porcelain crowns. Some dentists must think using the words “porcelain veneers” sounds cool or sophisticated and I get emails from patients saying they were told they were getting veneers when they are crowns.A veneer is a thin porcelain wafer that covers the front of the tooth. These that your daughter got cover the whole tooth, all the way around.
Or, is the dentist trying to put porcelain veneers OVER the two crowns? That makes no sense because it would be the same amount of work to remove the crowns and re-do them, which is what needs to be done here.
But 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. When you have one broken front tooth and need a crown, getting that to match the other front tooth perfectly—that is difficult and takes a fairly skilled cosmetic dentist teamed with an excellent ceramist to do it. That type of case is one of the required cases in becoming accredited in cosmetic dentistry. Dentists who aren’t that skilled, confronted with having to do a crown on one front tooth, will sometimes try to talk the patient into letting them do two crowns in order to get a perfect match, which is fairly easy. But here you have a dentist who can’t even get the two crowns to match.
The dentist is having a problem with the one tooth having a grayer color to start with. There are several things that can be done. If I were doing the case, I would have cleaned up and bleached that underlying tooth to get a closer match between the two. Then I would have used some opaque buildup material to finish making that tooth approximately the same color as the other. But even not doing any of that, there is enough tooth structure removed that a moderately good ceramist should be able to lay some opaque porcelain down first to cover the gray color and then put a more translucent layer 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. And then making the two teeth the same size, I’m having trouble imagining what could be the difficulty there. The only thing I can think of is that the dentist and ceramist, struggling with covering up the gray underlying color, 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 will send you privately a recommendation for a dentist in your area. 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. This case isn’t that hard.
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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.