Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 6, 2018

Matching the color on a crown for a front tooth


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Hi Dr. Hall,
I had a root canal done on my front tooth over 10 years ago. In the past few years I had noticed a blue discoloration at the top of the tooth. After trying internal bleaching, my dentist ended up doing a crown.

The first crown that came back from the lab looked very white. He redid it. The next tooth, which is in my mouth now, looks better but doesn’t match the other front tooth. The dentist permanently cemented it in, but when I got home and took some selfies I was unhappy with how unnaturally white it looks.

The dentist will give it another try but my question is — should I let him try again or go to someone else who specializes in cosmetic dentistry? I now live in Princeton, NJ and my dentist is in Brooklyn. Cost is a factor.
Thanks,
Ronnie

Ronnie,
Doing a crown on a single front tooth is a tricky procedure. The slightest variation in color between the two front teeth is usually very noticeable. And it isn’t just the overall color—any tooth has multiple colors in it. Even expert cosmetic dentists will often have multiple try-ins before they get the crown to match perfectly. When I was in practice, I charged about 40% more for crowning a single front tooth because we would typically send it back to the lab three or four times until we got it perfect and I would charge the extra fee because of all the extra appointments. Dentists with poor cosmetic dentistry skills sometimes ask patients to crown both front teeth in order to get the color right.

That your dentist would think that the crown would look right after one or two trips to the lab shows either inexperience or a low level of commitment to excellent cosmetic dentistry. I’m not meaning to imply condemnation with that comment because that is typical of the overwhelming majority of dentists—maybe 98% of them. So yes, if you want this done so that your two front teeth match perfectly, you need to raise your sights and go to an excellent cosmetic dentist such as we recommend. There are several excellent ones within reasonable driving distance of Princeton, say 15-30 miles.

However, depending on how big a factor cost is for you, and if your dentist is willing to work with you to get this right for no extra charge, you may want to stick with this dentist to save the money of having another dentist start over with you. And, I would add, if you are willing to make several more trips back to Brooklyn. To help the process, you or the dentist should get hold of a good digital camera that is capable of taking a clear photograph of the new crown in place next to your natural tooth under outside light, such as right next to a window. That will go a long way toward helping the ceramist pin down the right color. And be sure that the crown is only temporarily cemented until you have seen it under various lighting conditions.

If you want perfection—a crown so natural that you can’t distinguish it from the real tooth next to it—you need the expert cosmetic dentist. But if you are willing to accept some compromise of that ideal in order to save money—try letting your dentist have some more tries to get this closer.
– 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.

July 27, 2017

This is too much sensitivity – you need a root canal


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Dear Dr. Hall:
On June 26, my dentist prepared my cracked tooth number 30 (lower right first molar) for a crown. I had several problems with the temporary crown including very sore gum and pain with biting and cold sensitivity. However, since the pain was not lingering, my dentist placed my permanent crown on July 12. But it didn’t subside and in fact, it got worse. After one week, I visited him again and he took X-ray and did cold test and pressure test. He also knocked at my tooth which was not painful. My tooth was very sensitive to cold but it went away in less than 30 seconds. Also, I didn’t feel pain with pressure test although I felt pain when I bit on hard things. So my dentist said I had to wait and I had high chances to get better. He said sensitivity to pressure is normal even for 30 to 90 days. Now 10 days has passed and from my permanent crown placement, but I don’t see any improvement. Also, today I discovered my tooth is sensitive to hot food too although it doesn’t linger for a long time after the hot food is removed. I think once I realized this sensitivity with that temporary crown but didn’t care about it.
Are these reversible pulpitis symptoms? Does that heat sensitivity show my tooth nerve is dying? How long do you think I must wait before I see an endodontist?
Thanks a lot.
– Bita from Iowa

Bita,
Thanks for the clear description of your symptoms! You told me what kind of pain, what provokes it, and gave me a clear history, which makes it much easier to figure out what is going on with your tooth.
I would call the endodontist today. There are a couple of red flags here and I’d get an expert diagnosis before this tooth gets any worse. It doesn’t look good.
I don’t want to be too critical of your dentist, because I don’t know the whole story of your tooth—just what you’ve told me. But just taking what you’ve told me, some additional caution in your case seems like it would have been wise, and I’ll explain why. It also isn’t normal for a tooth with a new crown to be sensitive to pressure for more than a few days, if the occlusion is adjusted correctly.
First, you had a cracked tooth. A crack can easily involve the pulp of a tooth and by itself can cause a tooth to become infected and the pulp to die.
On top of this, you had significant cold sensitivity after the crown preparation. This could have been due to an incompletely sealed temporary crown, or it could have been due to the extra irritation to which the tooth was subjected from the crown preparation, or a combination of the two. It would have been wise to have coated the tooth with some type of desensitizing product at this point. Maybe that was done.
Also, given those two things, it would have been prudent to have temporarily cemented the crown. This is a lower first molar, so the crown would have to be made out of some strong material that could have been cemented with a soothing type of cement in hopes that it would settle down, or, if it didn’t, to allow easy removal of the crown for root canal treatment. Permanently cementing a crown is usually an additional irritation which can push a borderline tooth over the edge to needing root canal treatment.
So your dentist permanently cemented the crown and the pain got worse. Your sensitivity is headed in the wrong direction and appears that it will end up in irreversible pulpitis, requiring root canal treatment.
And now it is getting sensitive to heat. I wouldn’t go quite so far as to say that it’s absolutely certainly suffering from irreversible pulpitis at this point, but if not, it’s awfully close. The endodontist should be able to tell you for certain. There would be subtle changes in the ligament of the tooth around the end of the root that most general dentists wouldn’t see but the endodontist should.

– 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 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.

August 30, 2011

Add one more disappointed dental patient to the long list.

I recently had a 7-unit permanent bridge {cuspid to 1st bicuspid} supported with implants placed in my mouth with temporary cement. Within 1 hour they fell out. I went back to the office and the dentist recemented them with permanent cement without telling me. I had not even seen what they looked like in my mouth. Now a couple of days later I am seeing that my smile is not normal because the teeth are too long. Also the teeth are very dry and not very smooth. I went back and complained and the dentist said there is nothing he can do. Removing them would destroy the bridge and pull out the implants. Is it true that nothing can be done to fix this? Shouldnt the bridge have been been put in with temp. cement for a week before it was permanently cemented. Is he liable for anything? He insisted on being paid in full before he started the work.
– Lynne from New York

Lynne,

I hate having to respond to these e-mails of patients like you who are so disappointed in how your dental work looks, because there really isn’t a whole lot you can do. And now you have this entire smile that cost you many thousands of dollars, and you don’t like it.

What your dentist told you is partly true. He said that removing the bridge would destroy the bridge and pull out the dental implants. I would put an “or” in there – it can be removed by destroying the bridge OR pulling out the implants. And maybe that’s what he actually said. It could be removed just by grinding off the bridge. That would destroy the bridge, yes, but it wouldn’t pull out the dental implants. And while I’m sure he doesn’t want to do that, he certainly could do that.

Should the bridge have been put in with temporary cement for a week so that you could see what it looked like before it was permanently cemented? That depends on whose rules you’re using. For your sake, yes, that would have been nice. But you have to realize, Lynne, that to the vast majority of dentists that isn’t necessary, because the appearance of the bridge in your mouth simply isn’t that important. The dentist looked at it, it looks fine to him, and so it gets put in.

Could you get this dentist to fix this now? Probably not. You have no leverage. If you threatened to sue, for example, this dentist would have dozens of other dentists who would back him up and say that the bridge was fine – there is no problem with it. You would be battling against the collective opinion of the entire dental profession, because to 90% of them, how this bridge looks to you isn’t that important.

On the issue of the teeth in the bridge not being very smooth, you might be able to get that fixed. Depending on how smooth you mean, the dentist might be able to polish those. Dry off the teeth and try to mark them with a pencil. If the pencil leaves a mark, then the glaze that should be on the teeth is gone. This would be considered a legitimate, functional complaint by most dentists, so you should be able to insist that the dentist fully polish these so they won’t take a pencil mark. There are special diamond polishing wheels and pastes that will be required to do this. A lot of dentists won’t know how, but they can easily look it up or talk to their dental supply representative to get these polishing instruments.

Your dentist, like most dentists, is an engineer and not an artist. If you want a beautiful smile, you need to go to an artist. And that’s the biggest purpose of this website, to educate people on the differences between a cosmetic dentist and an engineer dentist. A true cosmetic dentist would never have dreamed of permanently cementing this bridge in your mouth without you having a good look at it. And then if there was any hesitation in your voice when you talked about how you liked it, the cosmetic dentist would address all those issues before permanently cementing it.

Dr. Hall

 

 

We thank our advertisers who help fund this site.

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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