Dr. Hall –
I have been working with a “cosmetic dentist” and lab to replace my old crown since November of 2006. 5 or 6 crowns later, I’m still not happy and am moving to NJ (Chatam area) in 3 weeks. I don’t know whether to just throw in the towel and settle and just cement the latest crown I have or to request my insurance company and I get reimbursed so I can start fresh with a cosmetic dentist in NJ. I just don’t know if I will be able to spend as much time on this project in NJ as I have in Miami. I want my crown to be PERFECT and I’ve been told that’s almost impossible? What do you think? Also, I would love to share pictures with you if you would be so kind to give me your honest opinion. I appreciate your time.
—Dinah from Miami
First, I’d like to explain what I consider a “perfect match” for a front tooth crown. You do not want the one front tooth to be “exactly” like the other—that degree of matching isn’t present even in nature. What you want is to have it be impossible to tell that one tooth isn’t real, and that type of match is absolutely possible.
Yes, pictures would help, if you want to send them. But first, I’m always curious when people write me and tell me that they’re going to a “cosmetic dentist.” What makes you think he or she is a “cosmetic dentist?” What are their credentials?
Over 95% of dentists are technicians, not artists. They have great difficulty with color. They went into dentistry because they like to fix things, and they are focused on function. Oh, they SAY they’re cosmetic dentists, because there’s good business in doing that kind of dentistry. But they have very low standards for beauty, and just aren’t good with color. I have seen dentists really struggle with this and never be able to get that perfect match. There are two parts to this matching process, and they may not have mastered either part. One part is being able to see the multiple colors in a tooth—the other part is being able to communicate that to a dental laboratory technician.
I still remember vividly a course I took where I learned these skills. It was a hands-on course given by master dental ceramist Uri Yarovesky, and he walked me through the process of seeing all the colors at different depths in a front tooth and then drawing a color map so I could describe them to the ceramist. And then a photograph is a great aid for the ceramist, more so than actually seeing the patient. But even after learning this, it almost always took several trips of sending the crown back and forth to the lab to nail the match. I would try the first attempt at doing the crown on the patient and then take a photograph with the crown next to the natural tooth and send that back to the lab with my drawing where I described where it was different. Repeating that several times, we would finally get to that perfect match.
To see that this is possible, check our photo at the very bottom of the page of our porcelain crowns page. You simply can’t tell which of those front teeth is the crown.
You do have New Jersey cosmetic dentist Dr. Allyson Hurley in Chatham, New Jersey who is truly a cosmetic dentist/artist. Maybe your current dentist really isn’t. If so, I’d let her start over with you and get a new crown.
But there are some dentists who say that it’s impossible to perfectly match a crown to an adjacent front tooth, and they will tell the patient that they need to crown both teeth in order to get them to match. While it is difficult, it isn’t impossible. What I would do was tell my patients that there are two ways to get that perfect match. One was to do two crowns. The other was to have multiple office visits until we nailed the perfect match. I told them that I would need to charge extra because of the extra work involved. They would always agree to the extra charge, and I would stay with the case until you couldn’t tell that one tooth was a crown.
—Dr. David Hall
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