Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

January 24, 2019

My dentist wants to do crowns for my tetracycline stains


We thank our advertisers who help fund this site.

Dr Hall,

I have severe tetracycline staining on all my teeth. As I’m getting older, it’s starting to bother me more and I really would like to improve my smile. I’m 48 and have very healthy teeth. I’ve only had 2 cavities so far. I’d like to explore porcelain veneers, but every dentist I go to wants to give me a full mouth of crowns. What can I do?

Your help is much appreciated!
– Gregory from Seattle

Gregory,
Severe tetracycline staining is definitely one of the most challenging aesthetic problems a dentist will face. It is caused by taking the antibiotic tetracycline before the age of 12 which is when the permanent teeth are forming. A gray-brown color becomes embedded deeply in the teeth and, when the staining is severe as it is in your case, that color is very dark.

There are a couple of problems with trying to cover this stain with porcelain veneers. One is that to make the porcelain look lifelike it needs to be somewhat translucent. A translucent porcelain veneer, however, will allow the dark underlying color to show through. Click the link for an example of a case that was brought to my attention. Or, the dentist and/or the laboratory technician, in an attempt to prevent that, will use too much opaquer, leaving the veneers looking chalky and fake. Another is that dentists who aren’t experienced in treating tetracycline stains will cover the fronts of the teeth only, leaving dark shadows showing through on the edges.

This is why you truly need an expert cosmetic dentist for this. With dentists who aren’t passionate about cosmetic dentistry, their weakest skill is often color manipulation. So I wouldn’t go to any dentist to treat your tetracycline stains unless they can show you before-and-after photographs of a successful tetracycline case that they have treated. Or, if the dentist is AACD accredited, you can be pretty confident that they have the skills needed to do this right and give you a beautiful smile. If you have any doubts about the dentist, insist that you get a clear view of the case with a try-in before the veneers are bonded. Make sure that you see with your own eyes that he or she has successfully given you a beautiful smile that you are proud to display before they are permanently affixed to your teeth. Don’t accept any excuses like, “Oh, once they are bonded on they will look better.” I also have confidence in all the dentists I list on this site.

There are properties of some porcelains where they scatter light in a way that creates a perception of translucency while they are blocking out underlying color. These opalescent porcelains are used by some of the more sophisticated dental laboratories teaming up with expert cosmetic dentists. But don’t expect 98% of dentists to know about this.

The way that your everyday family dentist may get around all these difficulties is to grind your front teeth down to stubs and put crowns on them. You clearly don’t want that, and I would never want to do that to a patient when there is a much more conservative solution. And, in some cases, even the crowns won’t fully block out the very dark underlying color.

Good luck,
Dr. Hall

Do you have a comment 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.

April 23, 2018

What to do about gray crowns


We thank our advertisers who help fund this site.

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

Do you have a comment 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.

June 10, 2016

Getting porcelain veneers and crowns to match


We thank our advertisers who help fund this site.

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 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.

Powered by WordPress

Follow this blog

Get every new post delivered right to your inbox.


Categories