Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

December 26, 2016

Ugly e.max crowns are too thick


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Good morning, Dr. Hall.
My question: Can adhesive-bonded e.max crowns be safely removed without breaking the natural tooth which is already fragile?
History: I recently had the front six teeth re-crowned with e.max. The four front teeth have now been crowned for the 5th time (all by different dentists). I was happy with the first crowns I had, but after 15 years they needed to be replaced. I have yet to find a dentist who can replicate the smile I had before. I’m now stuck with e.max crowns that are thick and bulky with dark showing around the gum over my central incisor. My dentist said he would replace them but I know with each manipulation, I am risking the possibility of losing a tooth (or teeth).
My dentist said he made the e.max crowns thicker because my gums were thick (the gums have buttressed from years of clenching). He has now asked I have crown-lengthening and have some if the bone removed before replacing crowns.
I am so afraid of losing my teeth and having to have dental implants but I so want my old smile back.
Any advice would be greatly appreciated.
– Carol from Alabama

Carol,
If I’m getting this straight, your dentist gave you thick crowns because your gums are thick. If that is his true reasoning, I wouldn’t let him re-do your case. There is a gross misunderstanding of esthetic and functional principles here. Thick crowns will cause the gums to become inflamed and puffy, so this has the potential to be a functional disaster. Plus there is no aesthetic reason for your crowns to be made thick in this situation. The dentist should make sure there are natural contours to the teeth as they come out of the gum.

Let me explain.

I found this photograph showing thick crowns with puffy gums what happens when crowns are too thick. It creates a protected space where the crown meets the tooth and in that protected space, gum-disease causing bacteria multiply freely. Microscopic food particles will get trapped there, it is impossible to clean effectively, with resulting gum disease and puffy gums.

After almost 40 years of experience in dentistry, I must say I have never heard this aesthetic principle taught or even mentioned, that thick gums mean you need to do thick crowns. Rather, what I have heard is that you always need to have a natural emergence angle where the crown meets the tooth. You should not be able to feel any bulges as you run an explorer up from the root of the tooth onto the crown – the contour should be straight and smooth.

Now, as to your actual question about removing e.max crowns. These crowns are made of a very tough material – lithium disilicate – which makes them difficult to remove. And you say they were bonded on. The only way to get these off is to grind them off. Your dentist will need a supply of diamond burs to methodically grind these off your teeth. If the dentist is good and knows what he or she is doing, there should be no damage to your existing teeth. That isn’t a problem.

But I wouldn’t trust your current dentist to do that very carefully. His idea about thick crowns doesn’t show much care for precision in knowledge, which would make me worry about his being clinically careful. I would go to one of the dentists on our recommended list–I’m confident any one of them would do a great job for you here in carefully removing the existing crowns and replacing them with a beautiful smile.

Besides the functional mistake in your new smile, there was a serious aesthetic mistake, and I want to say something about that, too. No good cosmetic dentist would have ever bonded these crowns onto your teeth without a test-drive first, either duplicating the new smile in plastic so you could wear that as a temporary smile makeover, or temporarily cementing the new crowns, so he and you could make sure that you love this new smile before it was bonded permanently.

I hope this is helpful.

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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