Tag Archives: porcelain crowns

Mismatched Front Teeth

I had a root canal and the tooth needed a dental crown. My dentist has had a very hard time getting it to look natural. The first one looked way too white. Then he redid it. The next one was a more realistic shade, but still doesn’t match my adjacent teeth. He bonded that one on. At first, I thought I could live with it but I’m really uncomfortable having mismatched front teeth. He’s willing to try again. Do you think I’m being too picky? I can tell he’s getting frustrated, even though he hasn’t said anything.

Louisa

Dear Louisa,

Image of a crown being placed on a tooth

You’re not being too picky. You have every right to have matching front teeth, especially when they’re being crafted for you. However, you might be asking too much of your particular dentist. Matching a single front tooth requires cosmetic skills that are likely above his artistic and technical ability at this point.

Even many expert cosmetic dentists, will charge extra for matching a single crown to a front tooth because they know it could take three or four try-ins. A dentist should never permanently bond on the crown until they are 100% sure it matches the adjacent tooth absolutely. There are many subtleties in colors. It’s rare to get it spot on first time out of the box.

You have two choices. The first one is for you to continue to allow your dentist to try and get it right. He may and it won’t cost you any extra. However, there’s no guarantee he will.

Your other option is to find an expert cosmetic dentist and let them do your crown. They’ll be more likely to get the result you’re both hoping for and deserve. But, it will cost you some extra. It’s possible your dentist would be willing to give you a partial refund because you’re having to go elsewhere for the crown.

Finding an Expert Cosmetic Dentist

How is a patient supposed to know which cosmetic dentists have the skills and artistry to create a gorgeous restoration? The American Academy of Cosmetic Dentistry (AACD) realized the quandary many patients found themselves in. Because of that, they began an accreditation program. This requires the dentist to pass stringent oral and written examinations demonstrating their technical knowledge of their craft. In addition to that, they have to provide examples of a large number of specific cosmetic cases they’ve done within a recent time period.

Anyone who reaches accreditation level with the AACD can not only match your crown to your front teeth, but if you ever decided to go all out and get a total smile makeover with porcelain veneers, they’d give you an absolutely stunning smile.

If you were to pick a new dentist to do your cosmetic work, they should be on the top of your choice list. To find one in your area, you simply go to the aacd.com website and choose “find a dentist”. Make sure you click that you’re looking for an accredited dentist.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.

Solution for Tetracycline Stains

I have tetracycline stains. I’m finally in a financial position where I can do something about them. I’ve seen two dentists thus far. Both gave me vastly different suggestions. I’m hoping you’ll break the tie. First, I went to my family dentist. He recommended I get porcelain crowns to cover the stains. He’s done a crown for me in the past and I liked it. Though, this one was made to match the stains. Next, I saw a cosmetic dentist. He suggested I get porcelain veneers. They’re much more expensive, but I assume are more likely to give a pretty smile. Do you know which procedure would be a better solution?

Corrine

Dear Corrine,

A single porcelain veneer being held by a dental tool

I’m glad you wrote. Tetracycline stains are some of the more difficult things to treat. I’m going to have you switch gears just a smidge. While I think porcelain veneers will be a better idea than porcelain crowns for reasons I’ll explain in a moment, more important than what procedure is what dentist.

Porcelain Crowns Versus Porcelain Veneers

Porcelain crowns require a much more aggressive treatment than veneers. They require the dentist to grind down a great deal of healthy tooth structure. Plus, let’s say a few years from now you meet a top-of-the-line cosmetic dentist. It will be too late to get porcelain veneers. Once your teeth are ground down, you can’t undo that and switch to porcelain veneers. You will always have to have crowns.

A good thing to consider is why your dentist is suggesting a much more aggressive treatment than is necessary. Most dentists will suggest the least invasive treatment so as to preserve as much healthy tooth structure as possible. The one obvious reason he’d do that is he is more comfortable with crowns, which translates to not a lot of cosmetic dentistry training. I think even if you went with the porcelain crowns you wouldn’t be happy with the results.

Now, let’s discuss the cosmetic dentist who suggested porcelain veneers. While he’s suggested a good procedure, how do you know if he’s a skilled and artistic cosmetic dentist? Cosmetic dentistry isn’t a recognized specialty so every general dentist can just call themselves a cosmetic dentist regardless of their skill level.

Choosing a Cosmetic Dentist

The American Academy of Cosmetic Dentistry recognized the problem which patients face in finding legitimately skilled practitioners. To help, they started an accreditation program. This tests both the technical skill and artistry. They have to pass stringent exams, both oral and written. In addition to that, they have to show a series of cosmetic procedures they’ve completed in order to demonstrate their artistry.

Those who pass reach what is known as accreditation level. Only about 1% of dentists in the world reach this level. This is the type of dentist you want to take care of your tetracycline stains. Not only are they incredibly skilled, but almost all of them have a beautiful smile guarantee.

This blog is brought to you by Dr. Jerome Cha.

Avoiding a Dental Implant Horror Story

I keep hearing you have to be careful with who does your dental implants or it can be a complete disaster. I’ve read countless horror stories online. How do I find the best dentist to do my dental implants? I don’t want to end up another story on the internet.

Celina Y.

Dear Celina,

Illustration of dental implants in three parts

You’re wise to check ahead of time. I don’t know if you’ve already talked to your dentist about this. It could be that your dentist will be the best dentist for you, but let’s go through a few things first.

The Best Implant Dentist Will Have Extensive Post Graduate Training

There are several very reputable schools for dental implant study. General Dental school does not give enough training in such an advanced procedure. Never hesitate to ask a dentist where he received his (or her) implant training. Here are some of the best programs for that study:

  • The Misch International Implant Institute
  • The Las Vegas Institute for Advanced Dental Studies (LVI)
  • Dawson Academy

The Best Implant Dentist Can Do Both the Surgery and the Restorative Crown

Many mistakes are made regarding dental implants because of simple miscommunication between the dentist and the surgeon. If the surgeon places the implant in the wrong place, then what? You’ll have to have the implant completely re-done, which would mean the additional procedure of bone grafting and then a second surgery. Believe it or not, this happens more often than you’d think.

When the dentist and the surgeon are the same, there isn’t that danger. The dentist knows exactly where the implant needs to be placed for optimum security and aesthetic value.

The Best Implant Dentist Can Give You a Beautiful Restoration

You don’t want to just have a secure implant. You’ll also want a beautiful restoration. Check out your dentist’s smile gallery to make sure the dental crowns they craft are natural looking.

If your implant is being placed in a visible spot, and you’re not completely satisfied with the color of your teeth you’ll want to get them whitened before you have the implant crown made. Once the crowns completed, the color cannot be changed.

This blog is brought to you by Dr. Jerome Cha.

Dentist Refuses to Give Son Porcelain Veneers

I’m looking for options for my 10-year-old son. A neighborhood child chased my son with a dog. He was so terrified he ran too fast and tripped, chipping his front tooth. He’s really embarrassed to smile. I want to get a solid fix for him, like a porcelain veneer. Our dentist refuses. I suggested a crown. He refused that too. I need options. What CAN I do for my son?

Olivia N.

Dear Olivia,

I’m sorry your son had such a horrifying experience. Hopefully, the neighbor boy’s parents are taking some initiative in helping with this expense. I hope this experience hasn’t soured him on dogs.

There is a good reason for not giving your son either a porcelain veneer or crown, though I do understand you want a solid treatment.

Your son’s bite is still developing. If you did one of those other treatments, though fantastic for adults, you’d have to replace them every few years. That’s an unnecessary expense. Plus, with a crown, you’d be forced to ground down perfectly healthy tooth structure. Fortunately, there is a great solution.

A Conservative Repair for a Chipped Tooth

A smile with a chipped front tooth
Before Dental Bonding
A smile after a chipped tooth is repaired
After Dental Bonding

Traditionally, a chipped tooth is restored using dental bonding. This uses composite resin to fill in the chip and blend it naturally with his natural tooth structure. If it makes you feel better, this solution is the go-to for adults in this situation as well.

One word of caution. This is done free-hand. If your pediatric dentist isn’t a skilled cosmetic dentist, you’d be better served having a general dentist who is willing to treat children do the procedure who’s an experienced cosmetic dentist to ensure his restoration will look natural.

This blog is brought to you by Dr. Jerome Cha.

My Dentist Says I’m Being Unreasonable

I saved up for years to get a smile makeover. My dentist and I decided on Lumineers so that we wouldn’t have to grind my teeth. I did read that you should ask a dentist to try the Lumineers on first to make sure you like them before he bonds them on completely. I told him that’s what I wanted. He said okay. But, when the time came he didn’t try them on. He just bonded them onto my teeth without me even looking at them. I didn’t realize that’s what he was doing. I thought it was the try-in. When I first saw them I burst into tears. They’re so bulky they look like horse teeth and the color looks chalky, not natural. It’s so obvious these aren’t my teeth. I told him I didn’t want them and he said they’re already bonded. What?? Now I can’t fix this and I want my money back, but he’s refusing and saying I’m being unreasonable. Am I?

Miranda D.

Dear Miranda,

A Woman Giving a Thumbs up in the dental chair

Not only are you not being unreasonable, but your dentist has behaved unethically. He completed a procedure without your permission. If you turned him into the dental board, he’d get in a lot of trouble. You have a fantastic case for a full refund.

The biggest problem you’re facing at this point is your dentist is likely a decent general dentist but is in over his head with cosmetic procedures. There are a few things that lead me to believe this. He made several mistakes that the best cosmetic dentists would never make.

How Do You Know if You Have the Best Cosmetic Dentist?

First, his dependence on Lumineers is an error. Lumineers are highly marketed to inexperienced cosmetic dentists as being easy to place because they don’t require tooth preparation. Unfortunately, the result will often end up like you’ve experienced with bulky teeth.

It’s a common misconception that your teeth have to be ground down for porcelain veneers. That’s not true. Dental crowns require grinding. Veneers usually require mild tooth shaving.

Second, he didn’t use a try-in paste. Even without you requesting him to let you approve the veneers before they’re permanently bonded he should have done that. Good cosmetic dentists ALWAYS do that. In fact, most of them have a beautiful smile guarantee.

Third, he didn’t care that you weren’t satisfied. A true cosmetic dentist would be horrified if a patient was so dissatisfied with their work it caused them to cry. They would instantly offer to do them over.

You need to get a little forceful about your refund. Remind him he bonded them on without your approval and you’ll be taking it to the dental board. That should be enough to light a fire under him. Then, go to a dentist who’s accredited by the American Academy of Cosmetic Dentistry. If they’ve reached accreditation level, you’ll get a stunning smile.

This blog is brought to you by Dr. Jerome Cha.

Dental Crowns for a Tooth Gap? Run Away From This Dentist!

I need some advice. I have a tooth gap which I finally decided to take action on it. I spoke to my dentist about repairing. The gap is between my two front teeth. It’s not huge, but it is always on my mind when I smile. I want to feel confident. My dentist suggested I get two dental crowns put on my front teeth. I’m not keen on that because the teeth are healthy. Grinding them down to nubs means I’ll always have to wear dental crowns, right? Are there any other options that are less invasive?

Jill R.

Dear Jill,

I’m really relieved you wrote and asked before moving forward with your dentist’s disastrous treatment plan. It’s incredible to me that you recognize the fallacy in this type of “solution”. Yes, you’d be stuck with dental crowns for the rest of your life. Why get rid of all that healthy tooth structure when there are much simpler solutions. However, because your dentist didn’t suggest them it likely means he’s not comfortable doing them. Dentists are proud creatures. If you pressure him into it, he’ll do it rather than admit he’s not good at it. The results will be disastrous. This is not the best dentist for you. I’d really plan on you finding a new one.

So, planning on getting a new dentist for this treatment, what options are available to you?

First, you could close the gap with orthodontics. It used to be that even adults were stuck with a mouth full of metal if they wanted to straighten their teeth. That’s no longer true. In fact, you can straighten your teeth without anyone even knowing that you’re doing it. The aligners truly are invisible, even at a conversational distance.

However, if the only thing wrong with your teeth is that small gap, then you may feel that full blown orthodontics is a bit of an overtreatment. In that case, you can just do dental bonding to close the gap. It uses a white composite filling material to match the color of your teeth. It takes an artistic cosmetic dentist to do this procedure because he will sculpt it by hand.

This next option only should be considered if you’re interested in a complete smile makeover. Using porcelain veneers, you can completely change the shape and character of your smile. It can change not just the shape, but the size and color, as well as cover things like chips and gaps. Like dental bonding, this procedure also requires an expert cosmetic dentist. Ideally, you’d want a dentist who’s reached accreditation level with the American Academy of Cosmetic Dentistry (AACD). Accredited Cosmetic Dentists are among the top 1% in the world in both skill and artistry. Any smile they create for you will be stunning. In fact, most of them even have a beautiful smile guarantee.

I hope this helps you in your decision making. This blog is brought to you by Dr. Jerome Cha.

My Porcelain Veneer Is Turning Dark at the Top

I need some advice. I had a large chip that my dentist repaired with a porcelain veneer. It always looked okay, but for some reason it’s turning dark at the top near the gumline. I don’t know why. I’ve only had it for two years. The dark line is really visible and is making me feel awkward about smiling. Do you know if this is normal? My dentist never mentioned this as a possibility.

Serena A.

Dear Serena,

I can think of a couple of possibilities for what is happening. If you truly have a porcelain veneer (and I’ll explain why I’m not positive that’s what you have in a moment), then it means it’s not bonded on properly. A porcelain veneer should sit flush against your gums so that nothing can become trapped there. If it’s not properly placed there can be a ledge. This will attract food and bacteria. If it’s not dealt with it will lead to decay. Poor bonding can also leave a space between the veneer and your tooth which will allow things to seep between them. Not only will this also lead to decay, but your veneer will turn dark from the things gathering beneath it.

However, if you had a very large chip it’s possible you were given a dental crown instead. Porcelain veneers are used for smile makeovers and only cover the front of your teeth. Dental crowns are used to cover the whole tooth when there are large chips or decay over a majority of the tooth.

If you were given a porcelain-fused-to-metal crown, it would explain the dark line as well. These will begin to show the metal at the top of your gums eventually. However, it generally takes more than two years for that to happen. There are a couple exceptions to that time rule. One is if you have gum disease. Another is if you brush hard. That can cause your gums to recede.

Either way, the only way to fix this is to have either the crown or the veneer re-done. If it is a crown, be sure to have them give you an all-porcelain crown this time, so you don’t have to worry about a dark line eventually showing up. However, if there is gum disease you’ll want to address that as well. If it’s a veneer, the problem resulted in an error on the dentist’s part. They should repair it for free.

I hope this helps.
This blog is brought to you by Dr. Jerome Cha.

Can the Shape of My Bite Really Keep Me from Porcelain Veneers?

I’ve wanted a smile makeover ever since I was old enough to realize my smile was ugly. I have an overbite, which makes my front teeth practically cover my bottom teeth. They’re misshapen, some of them have small chips, and they’ve all got tetracycline stains. I saved for years to get the top of the line smile makeover. Now, when I finally tell my dentist, he tells me I can’t because of my overbite. Instead, he wants to do four to six crowns on my upper front teeth. To say I’m disappointed is an understatement. I just wanted to double check he had the right idea before I give up my dream.

Hazel L.

Dear Hazel,

Don’t give up your dream. Give up your dentist. I hope I’m not coming across harsh, but I want you to get the best smile possible. It sounds to me like your dentist is in over his head when it comes to cosmetic work so he’s made up some lame excuse to not have to admit he doesn’t know what he’s doing.

If you were to get porcelain crowns, he’d have to grind down your front teeth to nubs! Why get rid of all that healthy tooth structure? Plus, he’s talking about 4-6 crowns. Most smiles are much wider than that. Can you imagine how weird that would look beside tetracycline stained teeth? No. Don’t do this.

Your bite actually makes you a fine candidate for porcelain veneers. Your teeth are covering your bottom teeth. Crowns would have to surround your entire tooth, causing the dentist to have to beware of what he does on the back side, so it doesn’t negatively impact your bottom teeth. Porcelain veneers don’t go on the back of your teeth, just the front.

In your place, I’d look for a top of the line cosmetic dentist. Tetracycline stains are more challenging than most. The dentist will want to get the veneers to look bright, translucent, and natural, but still cover the stains. It will take someone with an advanced skill set and artistic eye to do that. Find a dentist who’s reached accreditation level with the American Academy of Cosmetic Dentistry (AACD). They’ll be your best bet and can certainly give you the gorgeous smile you’ve always dreamed of having. In fact, quite a few of them have a “beautiful smile guarantee“.

This blog is brought to you by Dr. Jerome Cha.

Are Dentures “Really” the Worst Thing I Can Do?

I have teeth which have been a constant problem my whole life. It seems like every couple of months I’m back with a new problem even though I brush and floss as instructed. I told the dentist on this last visit that I’m just tired of it and want to just get dentures. He pretty much shouted that’s the worst thing I can do, and suggested I take better care of my teeth. I don’t know what else to do besides brushing and flossing two times a day.  Are dentures truly my worst decision?

Steve O. – Pennsylvania

Steve,

Admittedly, that wasn’t the best way for your dentist to handle the situation.  Like in every other profession, sometimes dentists lack in people skills.

You can be doing everything you’re supposed to with your dental care and still struggle with your teeth. Your dentist should know this, too. Sometimes our genetics work against us and our teeth will be a problem no matter what. There are some extra steps your dentist can take, such as fluoride treatments.

As to whether dentures are your worst possible decision, it depends. If you’re losing your teeth and cannot afford a better option, then dentures are better than nothing.  In your situation, here are the steps I’d recommend.

First, I’d try to save any teeth you can. Natural teeth are truly your best option. Even the top of the line tooth replacement, dental implants, which are like having natural teeth, have risks that you won’t have with your natural teeth.

Second, get crowns or implants on the teeth which can’t be saved. If you get to keep part of the tooth, get a porcelain crown. If the tooth is extracted, get an implant.

I realize that not everyone can afford a dental implant. In that case, I would say a removable partial denture would be okay. However, there is a downside to dentures.

When your teeth are removed, your body recognizes the roots of your teeth are gone and automatically begins reabsorbing the minerals in your jawbone. Eventually, you won’t have enough bone structure there to retain dentures. This is most common when you have a full set of dentures. You’ve likely seen patients in this situation. Their face has a sunken, aged appearance.

Implants solve this problem because it places a prosthetic root into your jawbone, so your body recognizes those minerals are still necessary.

The key here is to save what you can. Then, when you can’t, go down the list for the best replacement you can afford. I’d also talk to your dentist about getting some extra fluoride.

Another trick for fluoride is to make sure you’re drinking tap water and not bottled water. Bottled water is defluorinated. Your tap water should contain fluoride.

Also, don’t beat yourself up about your teeth. Sometimes, you can do everything right and still have problems with your teeth. You can’t change your genetics.

This blog is brought to you by Dr. Jerome Cha.

Do I have to have my teeth ground down for a smile makeover?

I wanted a smile makeover. My dentist said I need to get porcelain crowns. Do I really have to have all my teeth ground down to get a makeover? I thought crowns were for infections in your teeth. I don’t even have any cavities.

Olivia P. from Kansas City

Olivia,

NO, NO, NO, don’t get porcelain crowns if you don’t have a large cavity, especially for a smile makeover. Your dentist is insane.  My guess is he doesn’t know how to do porcelain veneers and he isn’t man (or woman) enough  to admit it.

There are cases when you have to mix porcelain veneers and porcelain crowns, but that is when you have teeth with large cavities. Otherwise, in general porcelain veneers are a better option. Either way you want an expert cosmetic dentist. The obvious ignorance of your dentist means you need to find another one.  You can stick with him for your basic dental care, but go to someone with more expertise for your cosmetic work.

Look for someone who is AACD accredited (American Academy of Cosmetic Dentistry). They are among the top 1-3% of dentists in the world. It is worth a bit of a drive to get a gorgeous smile.  Be aware there is a difference between being a member of the AACD and being accredited by the organization.

This blog is brought to you by Tulsa Cosmetic Dentist Dr. Jerome Cha.