Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 21, 2018

Gap between my crown and my bridge


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I have a space between my 2 front teeth, however one of my front teeth is a crown and the other front tooth is part of a bridge. Can the gap between my front teeth be closed with Lumineers or any other procedure or would I have to get a new bridge and crown, possibly all in one structure to close the gap?
– Laura from Nevada

Laura,
Your question prompts me to ask a question of my own: Why did the dentist who made the crown and/or the bridge leave a gap between your front teeth? The easy way to fix this would have been to make them correctly in the first place.

At this point, yes, you pretty much need to have probably both of them re-made—depending on how big the gap is. Both front teeth need to be the same size—you don’t want to close the gap from just one side by making one side larger.

this microetcher has a long nozzle with a button on it, and at one end a small clear plastic bottle as a reservoir

A Micro-Etcher

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But there is a procedure you might want to try before doing that. There are ways to bond composite to porcelain, and you could start with trying that—treating this as a dental bonding case. If the dentist has what is called a micro-etcher, which is a small sand-blasting handpiece, he or she could micro-etch the porcelain surfaces next to the gap. This would be followed by etching with a hydrofluoric acid gel and then priming the surface with a silane coupling agent. A bonding resin would then be applied followed by composite bonding material to match the shade of the crown and the bridge. The composite would be shaped and polished. In theory, this should work. However, my experience with bonding to porcelain was that after a few months, we would see staining along the margin between the composite and the porcelain. But it could be worth a try to try to avoid the expense of a complete re-do of your front teeth.
I would think it goes without saying that you need an expert cosmetic dentist to do this, such as we recommend on this website.

The company that makes Lumineers, a few years ago, tried to promote the idea of bonding Lumineers over the top of porcelain crowns, but I strongly discourage that. You would get the same risk of staining at the margins, and would spend the same amount of money as you would spend just re-doing the case completely. Click the link to read more about the problems with that approach.

– 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.

March 11, 2014

Repairing a porcelain crown

Dr. Hall,
My son has his four front teeth capped with the caps that have a white color in the front and the silver on the back. One of the crown is chipping revealing the silver under the white front. No dentist in or around town says they can help me without replacing the crown. Is there anything that can be done to simply make the front all white again without replacing the whole crown?

– Bobbi from New Mexico

Bobbi,
I have a couple of things to say about your son’s situation.

Yes, there is a way to repair a crown that is chipping and showing the underlying metal, but you’re going to need to go to a dentist with particular expertise in cosmetic dentistry and bonding technology. In Las Cruces that would be Dr. Brian Gilbert. Do a Google search for “Bright Star Dental” and you’ll find him. Over 95% of dentists are not going to know how to do this or have the equipment needed to do this.

The process is very similar to the technique I wrote about several years ago for repairing a porcelain bridge. The underlying metal has to be etched with a small sand blaster and then treated with a metal bonding agent like Panavia. The fractured edges of the porcelain have to also be etched either with the same sand blaster or hydrofluoric acid or both and then my preference is to treat it with a silane coupling agent. Then the metal has to be coated with an opaquer. The crown is then ready for bonding with composite restoratives, to match the color and surface luster of the porcelain.

But there is more to this situation than just repairing the crown. The question that comes to my mind is, Why is this crown chipping? You are writing on behalf of your son, which suggests to me that he is still young, meaning these crowns haven’t been on him for that long. The crowns are porcelain fused to metal, which is pretty strong. When they chip, it is usually because of some flaw in the making of the crown. And you say, “is chipping.” I’m going on sketchy details from you here, but your putting it that way suggests that this is a process that is occurring over time, not a single event. Is it going to chip some more? Something is either wrong with this crown, that it would do this, or there is something happening with your son that is particularly abusive to this crown.

And then I have the question, why were porcelain fused to metal crowns placed on your son’s front teeth in the first place? Dentists who care much about the appearance of their work will put all-porcelain crowns on front teeth almost exclusively, not porcelain fused to metal. I’m really questioning the dentist who did this work.

I’m admitting that my advice here is based on my trying to fill in the blanks with things that you haven’t told me explicitly. If I am filling in the blanks correctly, then here is what I would advise doing. First, I would go back to the dentist who did this and see if he or she will make this right by replacing this one crown for free. If that doesn’t work, then I would go to Dr. Gilbert and have him repair the crown. Then, when your son is college age, if he isn’t that age yet, I would replace all of these crowns with natural-looking all-porcelain crowns.

I’d be interested in hearing more about your case, if you care to write back.
– 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.

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