Hi Dr. Hall
I just went through 6 months of getting two new zirconia crowns done on my two front teeth. My general dentist did not do a good job of matching my natural shape or look of my natural teeth and felt bad about it and so sent me to this prosthodontist.
I asked for sedation on my last visit where hopefully these were to be my permanent set. He could have shown me the teeth prior to sedation – or not cemented them permanently before I had a look. In his light they looked okay, and being groggy I didn’t think much of it when he said these were permanently cemented in and that he and his staff decided they were the right shade.
They are NOT! They are darker – grayer than my other teeth and I’m super upset about it, as I’ve always had a nice white bright smile ! He says I asked for this color – besides I was sedated so it’s really MY fault that I’m stuck with these. He will only change them to a prior color we had tried and they were opaque and looked like two pieces of chalk. Why can I only choose between bad and worse?
To change them, he wants thousands more dollars and as I said, gives me a choice of two wrong shades.😡 I don’t think I should have to pay since I never did approve these to begin with. Two dentists have looked at them and both were taken back by the choice of color! The shape is okay, though shorter than I’d like because that’s how my natural teeth looked. But the color makes all my other teeth look darker and I don’t want to smile at all! I have called, texted and complained, pointing out the obvious shade difference and I’m being ignored! I’m so angry as these cost a LOT of money and he should be an expert, right?
So several questions here I guess. I can’t believe I’d be stuck with these after all this time of making them. Please give me your professional opinion.
(See Dr. Hall’s answer below.)
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There’s a lot to say about your case and I hardly know where to begin.
Let’s start with this—there are two main aspects to your problem with this dentist:
1. You were sedated when the crowns were put on and thus unable to fully approve the color.
2. You’re dealing with a dentist who doesn’t seem to care much about how these crowns look or what you think of them.
And of these two problems, the second is the more difficult one. In fact, the first one very likely wouldn’t be a problem if you didn’t have the second.
When I practiced, I did a lot of sedation dentistry, but I never wanted my patient to be sedated when I seated any work on the front teeth, because it was very important to me that the patient be happy with how it looked. When you’re sedated you’re in no condition to consent to anything like that. To an excellent cosmetic dentist, your opinion about the appearance is critical.
It appears that with your case, your dentist didn’t care much that you weren’t able to approve the color. You need to understand that to many dentists, your opinion about the appearance of the work they do on you doesn’t matter. This attitude is actually the most pronounced in some prosthodontists. With their extra two or three years of training, they fancy themselves experts in cosmetic dentistry. They are often taught during that advanced training that they are the best judges of how the dental work looks and that it is pandering and unprofessional to listen to what the patient wants. This is what I call the prosthodontist mentality.
The mindset of an excellent cosmetic dentist is completely different. It was the case with me, and I have had this feeling expressed to me by other cosmetic dentists—if they had a case like yours where the patient was unhappy about the appearance of any work they had done, they would be embarrassed by it—so embarrassed that they would re-do it for no charge.
So let’s go over the mistakes that were made in your case.
The first was going to a prosthodontist for a cosmetic dentistry procedure. Only a small percentage of prosthodontists are great cosmetic dentists. Prosthodontists are trained in the mechanics of crowns. They think, because of their extra training in doing crowns, that they are specialists in cosmetic dentistry. But great cosmetic dentistry requires a certain attitude. For the case to be a success in the mind or a true cosmetic dentist, you have to love how it looks and want the world to see it.
Another question that comes to my mind is why your dentist sent you to this prosthodontist. He or she needs to shoulder some of the burden of this cosmetic dentistry horror story. Have you spoken to your dentist about the ugly color of these crowns? While this prosthodontist may not care what you think of how this looks, he should care what your dentist thinks of it, and so this may be some leverage you could get. The prosthodontist, as a specialist, will rely at least partly on referrals from other dentists. Your dentist should be putting some pressure on the prosthodontist.
Another question is why zirconia crowns were placed on your front teeth. By zirconia I am understanding pure zirconia or what is called monolithic zirconia. Zirconia comes in blocks that are milled to the desired shape and to fit perfectly onto your teeth. As such, they have one color throughout. Natural teeth, however, have gradations of color from the gumline to the incisal edge and often have subtle splotches of other very slight color variations. To create a beautiful crown for a front tooth, zirconia needs to be layered over with porcelain. The porcelain is applied to the surface and baked on, and it can be manipulated to produce color variations and to perfectly mimic a natural tooth. Maybe this is what was done for you but the dentists didn’t explain this difference to you.
Finally, if you really need to be sedated when a cosmetic case is seated, a way around this would be with the provisional restoration “test drive.” Almost all excellent cosmetic dentists will create provisional (i.e. temporary) restorations that will be made to your liking. You will get to wear this while the permanent restorations are made by a ceramist. Once you let the cosmetic dentist know that you love how these provisional restorations look, they will send the appropriate information to the ceramist who will duplicate that look in the permanent restorations.
Here’s What You Should Do
The most important thing you can do is not let this prosthodontist do any more work on you. He apparently has very little interest in pleasing you. You need to be in the hands of a dentist who not only has the skills to give you excellent, beautiful crowns, but understands that you are the true judge about whether or not they are beautiful and cares about you. What you need is a refund for your cosmetic dentistry horror story.
Getting that refund, however, could be a problem. It may depend on how far off the color is. If it is really bad and you can get other dentists to agree with that, they may be able to put enough pressure on this prosthodontist to move him to issue some kind of refund to you. Could you get a complete refund? I doubt it, but maybe. I’d be grateful for anything you can get. For more information on this, check my post on how to get a refund from a dentist.
And then you need to go to a true cosmetic dentist to get this done. Don’t rely on any referral from another dentist. You didn’t share where you are, so I can’t tell you if there is one I’d recommend close to you. Otherwise, you can look for an accredited cosmetic dentist or ask me for help.
– 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.