Tag Archives: Dental Crowns

CEREC

CEREC Crown on a Front Tooth

I needed a dental crown on a front tooth. My dentist recently got this new CEREC machine and told me that it would give me the crown in just one appointment. We were close to the holidays so I thought that would be a good idea. It was going okay until the next day. I was going to a friends house and the crown literally just fell off as I parked my car. I was absolutely frantic. My friend called her dentist who worked with CEREC crowns. He got me in right away and said that the crown wasn’t bonded on properly. Once it was bonded on, I noticed it is slightly longer than my other front tooth. The color is a bit off as well. I went in to see my dentist the following day and he told me he’d redo the whole thing free of charge. My question is should I trust him or should I just ask for a refund and get this done by someone else?

Patricia

Dear Patricia,

Block of porcelain for a CEREC crown

It would be hard to answer that question precisely because I don’t know anything about your dentist and his specific training. I can tell you the matching a crown on a front tooth is exceptionally difficult even for skilled cosmetic dentists, so I am not surprised it does not match correctly in just one go. Often, it takes several try ins and tweeks before a front tooth is the exact shade you need.

This is even harder with CEREC crowns because these are milled out of a single block of porcelain. A dentist will need advanced skills in working in stains.

Your dentist has offered to redo the crown. This tells me he is honest and cares more about getting it right than getting money. That is a good sign. Wanting to get it right is not always enough though. If you want to give him a second chance on this, I recommend that you tell him you only want h im to place it with a temporary try in paste so you can be sure you are pleased wtih the results before it is permanetely bonded again.

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AACD Accredited Dentist in Lafayette

Dealing with Tetracycline Stains

I am almost 45 and have severe tetracycline stains. I’d really like to improve my smile so I won’t feel embarrassed to smile. However, I’ve been to three dentists and they all want to give me a mouth full of dental crowns. My teeth are very healthy so I hate the idea of grinding them down. Are there other options for my situation or should I resign myself to crowns?

Brenda

Dear Brenda,

porcelain veneer being placed

Tetracycline stains are some of the most difficult type of cosmetic cases there are. If a dentist is suggesting a dental crown for your smile makeover and you do not have a clinical need for them, that is a hint that they are not a skilled cosmetic dentist.

One of the trickiest parts of a tetracycline case is getting the dental work opaque enough to cover the stains themselves, but still translucent enough to look natural.

Inexperienced cosmetic dentists try to get around this by using dental crowns. Unfortunately, that doesn’t really help. Given your unique situation, I would say you need an expert cosmetic dentist. They will be able to cover your tetracycline stains with porcelain veneers, which will give you the gorgeous smile you want without grinding healthy tooth structure down the way your current dentist wants to do.

While there is not a recognized specialty in cosmetic dentistry, the top 1-3% of cosmetic dentists are AACD accredited. The American Academy of Cosmetic Dentistry recognized the dilemma both patients and dentist’s faced. Patients needed a way to find good cosmetic dentists. Dentists needed a way to get the skills needed to do excellent cosmetic work that is not offered in dental school. As a result, they created their accreditation program.

It takes YEARS to get accredited. There are superb cosmetic dentists out there who have not yet received their accreditation, but your situation is quite challenging. I am going to recommend you look for a dentist who is accredited.

While not all dentists in our office are accredited, we do have one dentist in our office who comes in just for those challenging cases.  There is probably a dental practice in your area who has a credentialed  dentist. If there is not, it will be worth it for you to travel to a nearby state if you want to be assured of a gorgeous result.

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Emergency Dentist

My Crowns Hurt

I had some dental bonding done years ago on my two front teeth because of an accident. Now, about ten years later the bonding is looking pretty rough so I decided to bite the bullet and get the work redone. My dentist thought doing crowns would be better and did four of them so that my teeth would match. The four teeth do match each other, but not quite the other teeth. That’s not why I’m writing, though. The dental crowns feel really weird and heavy. They hit my other teeth in a way that makes it hurt when I chew. Is it possible that I have a cavity or infection under one of them? Is it a dental emergency?

Emma

Dear Emma,

Porcelain crown being placed on a tooth

A simple x-ray will tell you if there is an infection under one of those crowns, However, you said it hurts when you bite down but did not mention it hurting any other time. This make me think that the problem is the fit of the crowns and not what is underneath them.

I’d like you to get a second opinion on the fit of these crowns. I would not consider it a dental emergency, but I would try to get in as soon as possible simply because you are uncomfortable.

The fact that your dentist gave you four dental crowns to replace dental bonding on just two teeth makes me wonder about his ethics. This was a massive overtreatment.

On top of that, he told you that you needed four dental crowns in order to make them match. That is not true. A skilled cosmetic dentist can even match a single crown to the rest of teeth. Even then, he couldn’t match the four crowns to the remainder of your teeth.

I don’t know if you went back to have your dentist look at these, but the pain could be solved by a simple adjustment. If he doesn’t solve the problem or tries to tell you everything is fine, then I would definitely get that second opinion.

Don’t tell them who provided your dental crowns, just that they hurt when you bite down. Dentists know each other and you don’t want them worried about critisizing a friend’s work. If he or she asks, just explain you want an unbiased opinon. They should respect that.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Pediatric Dentist

Dental Bonding for Children

My eleven-year-old broke her two front teeth quite badly. Most of the structure is gone. She only has the top and sides left. Everything else is gone. We went to our pediatric dentist and he suggested removing the teeth. I wasn’t keen on that idea so I took her to my dentist. He said that dental bonding was the solution. I was so glad to hear that she could keep her teeth, I didn’t even look into the procedure. When the results were done, her bonding was so awful. It was lumpy and uneven and in places the color didn’t even make sense. She’s horrified and I don’t blame her. I don’t know what to do. Is there any way to fix this? I’m devastated for her.

Carolyn

Dear Carolyn,

before and after dental bonding

I’m shocked that your pediatric dentist suggested you extract her teeth. That was quite extreme. I expected he would have suggested dental crowns, but that would be a bad idea as well. The pulp of our teeth shrink as we age. In an 11 year old, that pulp is still quite large. Doing a crown on their teeth can kill the pulp.

Your other dentist was on the right track in recommending dental bonding for the repair. The problem lie in he did not have the skills to do such a massive repair. Dental bonding has to be done freehand and takes a great deal of training and artistry. When done well, it will blend in perfectly with the remainder of the tooth structure, as evidenced by the image above.

My suggestion is you look for a practice that has a dentist who is accredited with the American Academy of Cosmetic Dentistry on their staff. Ideally, they should also be a practice that enjoys working with children. But, if you had to choose, go with the AACD accredited dentist. Your current dentist should be willing to give you a refund.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Zoom Whitening

Should She Finish This Smile REconstruction?

I have worn teeth because of teeth grinding. I didn’t realize I was doing it and my last dentist never mentioned it. However, when I moved I switched dentists because of the location and this dentist pointed out a whole bunch of things I didn’t know about. The grinding makes sense and does explain why my teeth have become more sensitive in recent years. She mentioned that I would need a mouth guard to protect my teeth from nighttime grinding and to repair the teeth, most of them would need crowns. We did the lowers first and it was a bit traumatic for me. I tend to have trouble with change. Plus, I have had some gum inflammation. My dentist wants to finish the procedure, but I am hesitant. My teeth aren’t hurting as much anymore and I miss my old smile. It wasn’t perfect, but it had a quirky nature I enjoyed and fit my personality. Do I really need to finish? Could I just whiten the tops?

Patty

Dear Patty,

Woman Smiling.

I have not seen your case, so it would be tricky to give you a definitive answer, but I can give some general guidelines.

First, change is hard for some. I know. Though in my experience, when a case is done by a skilled cosmetic dentist patients are thrilled when the results are finished and grateful they went through the trouble. It’s a bit like remodeling a house. It’s inconvenient, but when it is done you have the home of your dreams. This leads me to the quirkiness issue.

These are your teeth. If you want quirky in your smile, by golly, your dentist and their ceramist can put it there. In fact, because most patients want a perfect, flawless smile, my guess is they’d be thrilled at the chance to put some character in a smile.

Finally, while you could just whiten the upper teeth, dental ceramics will be harder on your upper teeth than your natural tooth structure was. If you have structural loss from teeth grinding, that would include the upper teeth. I am afraid only doing half the fix will actually make things worse for you in the long run.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Porcelain Veneers

Cavity On A Porcelain Veneer Tooth

I have porcelain veneers on four teeth. One of them now has a cavity and my dentist wants to remove the porcelain veneer and replace it with a dental crown. Is that absolutely necessary?

Dana

Dear Dana,

Porcelain veneer being placed on a tooth

I am going to recommend you get a second opinion on this for a few reasons. First, in order for a tooth to need a dental crown for decay, the amount of decay would have to be pretty substantial. I would say over 20% of the tooth would have to be decayed to justify needing a dental crown. If that is not the case, then why would he recommend one?

The most likely reason is that he is not comfortable treating a cavity with porcelain veneers. The margin is where a tooth with porcelain veneers is most susceptible to decay. If that is where your cavity is he may not have the tools or skills to bond the composite to a porcelain veneer.

That leads me to the second reason you need another opinion. If he’s recommending a crown unnecessarily, then his cosmetic skills are limited. This does not bode well for the crown either.

I would say only about 2% of dentists can match a dental crown on a front tooth to a porcelain veneer. In fact, You would need one of the best cosmetic dentists around, like an AACD accredited dentist. If he is pushing you toward a crown, he is not the dentist to do the work.

Getting a Second Opinion

I’d like you to see an expert cosmetic dentist and have them look at the tooth with the cavity. It is important you make this a blind second opinion. By that, I mean do not tell him who your dentist is or what the diagnosis and recommendation were. If he or she asks, tell them you are keeping that to yourself in order to get an unbiased opinion.

This blog is brought to you by Lafayette, LA Dentists Drs. Thimmesch and Foreman.

Porcelain Veneers

My New Teeth Keep Popping Off

For our anniversary, my husband told me I could get a smile makeover. I’ve dreamt of one for several years. My teeth are chipped here and there, stained, and I have a few that are shorter than the others because of teeth grinding.

My dentist ground my natural teeth down to tiny yellow nubs and gave me temporary veneers. Then, my permanent ones came in. All totaled I have eight veneers. They look okay. Certainly at least whiter than my old teeth. The big problem I am facing is they keep popping off.

While she always puts them back on for me, I am living in constant fear of being humiliated in public. This week, two fell off while I was eating bread at a restaurant with a friend. I spent the entire rest of the day crying from the shame. It is always the veneers that have a slant on the back that seem to come off.

My dentist is blaming it on my teeth grinding, but I wear a nightguard for that, which I was told would protect both my natural teeth and my veneers. What do I do now? We’re a military family and about to get transferred to another base in the states. I’m afraid no dentist will want to deal with my freakish nub mouth. What do I do? I thought this would be a wonderful experience and it has turned out to be a nightmare.

Angie

Dear Angie,

This is a cosmetic denistry horror story for the books. I am so sorry that this was your experience. I believe this dentist has committed malpractice. First, I’ll tell you why and then we’ll go over what you can do about it.

The first thing you should know is that she did not give you porcelain veneers. What she provided was dental crowns and called them porcelain veneers. This is unethical. Here is how I know this.

Image of teeth prepared for porcelain veneers
Tooth preparation for porcelain veneers

When your teeth are prepared for porcelain veneers only a small layer on the front of the teeth is removed. Directly above I posted an image showing what this type of tooth preparation looks like. This is not what you described.

Image of tooth preparation for dental crowns
Tooth preparation for dental crowns.

Instead, I think your teeth look more like what you see in this picture– little nubs. This means she gave you porcelain crowns. Unfortunately, once that tooth structure is gone, there is no way to get it back. This weakens your teeth and makes them more susceptible to breaking later down the road.

Second, she hasn’t been able to bond your dental crowns on properly. While there are a number of dentists who would not know how to properly bond porcelain veneers, every dentist has been taught how to place and bond a dental crown. The fact that she can’t keep yours in shows a serious lack of basic skills. It also violates the basic standard of care.

Your dentist is legally liable for the damage done to your teeth. I don’t want you to just ask for a refund. Instead, I believe she needs to pay to have this repaired properly. I want you to find an expert cosmetic dentist in your new area and have them repair your smile makeover. When y ou get to your new base. Look up on mynewsmile.com to see which cosmetic dentists they recommend in your area.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

CEREC

Problem with CEREC Crown

I went to my dentist because of pain with pressure and sensitivity to hot and cold. My dentist suggested a crown and we decided on a CEREC crown for the first time on a back tooth. I’d had other crowns before so I wasn’t new to the gig. I like how fast it went and having the crown that day. A few days later though, I still had the same problem. I went back to see the dentist and he checked to make sure it was on right. He felt it was and told me to give it eight weeks. That was discouraging because I was going on vacation, but what else could I do? I bought some pain meds and left town. I was in so much pain and practically lived on those pain meds. At about the eight-week mark, it did start to get better. That’s a lot of pain to go through with a crown. Normally, I have the pain go away with immediate relief. Is this a pattern with a CEREC crown?

Morgan

Dear Morgan,

Block of porcelain for a CEREC crown

I would like you to see a different dentist and have this looked at, including an x-ray. CEREC crowns are equally effective as traditional crowns. The biggest difference is the same-day service. When there is the type of pain you were having, just crowning the tooth will not necessarily solve the problem on its own. The fact that it was still hurting afterward bears this out in your case.

With it gradually getting better over that length of time, it sounds more to me like the pulp of your tooth was dying. I’d like to know if the original problem was some type of dental infection.

Usually, when there is a sensitive tooth that also needs a crown, the first thing to do is remove any old fillings or decay. Then place some glass isomer or bonded build-up material and give it a bit of time. This is to see if the tooth settles down. If it doesn’t and the pain persists, that is a signal the tooth needs a root canal treatment.

Have this looked at elsewhere so you don’t risk an infection flaring back up.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dental Implants

Dental Implants for Hockey players

Help! My son is a recent professional hockey player. He recently had a tooth knocked out. We’d done some research and read that dental implants are the best replacement. However, his teammates who have been in hockey longer have told him that implants aren’t a good idea. But, we don’t want to leave the space open because he’s getting married in a little over eight months. Do you have any suggestions?

Karlee

Dear Karlee,

I’m glad you wrote. What his teammates are trying to prevent is secondary injury. When you get a dental implant, a root is surgically placed into the bone of his jaw. Then, after a time of integration with the bone, there is a dental crown bonded to the root implant. Here’s the problem with that for your son.

If he has another puck or hockey stick to the mouth, which is likely in his sport, because of the bonding of the crown and implant, it will likely damage the bone in his jaw, requiring serious reconstructive surgery to fix. However, that doesn’t mean your son has to go without a tooth until the end of his career, and certainly not for his wedding.

Here is my suggestion. When a tooth root is missing in a jaw, your body begins resorbing the minerals from the bone in the area. This will lead to serious problems, so you don’t want to leave the area of the tooth root empty. Because of that, go ahead and get the implant surgery done. This will place the root form into his jaw and protect him from bone resorption. However, do NOT have the dental crown bonded.

Instead, he can use a temporary tooth replacement that is removable, such as a dental flipper. It will give him a tooth for the open space, but if his mouth is hit again, it will give without any consequences to your son’s jaw.

Once he is no longer playing hockey, then he can have the dental crown permanently bonded onto his dental implant giving him a secure tooth.

Best of luck to both of you and congrats on the upcoming wedding.

This blog is brought to you by Lafayette, LA dentists Drs. Foreman and Thimmesch.

CEREC

CEREC Crown is Too Bulky

I had a dental crown break after three years. I needed to replace it but have been quite busy lately. Because of that, I went to a different dentist who advertised same day crowns using a CEREC machine. However, the tooth with the CEREC crown is way too bulky. It’s uncomfortable, doesn’t line up with my other teeth, and I find myself biting my tongue unintentionally because the crown is “in the way”. The dentist has tried filing it a couple of times, but it hasn’t really improved much. Where do I go from here?

Madeline

Dear Madeline,

porcelain block for CEREC crown
CEREC restoration

This must be so frustrating for you. Here you were trying to save time and it has ended up even more of a hassle. I have two concerns here, beginning with your original crown. It should not have broken after a few years. These are designed to protect the tooth underneath and keep them from breaking. As a result, they should last you many years. Your dentist should have recognized that and offered to replace it. Hopefully, it was a matter of flawed material, which can happen to the best of dentists, and not that he was incompetent in how he placed it.

As for the CEREC crown, it sounds to me like your dentist is new with this software. Usually, the dentist would take images of your tooth that needs to be crowned and the CEREC software would build-up an excellently fitted tooth from there. However, you didn’t have the original tooth because your need was to replace a damaged crown.

There are ways to build up a tooth from scratch that will fit perfectly using the software, but it seems to have been beyond the scope of your dentist’s knowledge.

This crown does need to be replaced. The issues you listed can lead to serous problems, including tumors on your gum where you keep biting it, gum disease from a crown iritating the area, and even TMJ Disorder from your bit getting thrown off.

Have your dentist replace this crown at his or her expense. However, I don’t think they are going to be able to get the results you want with her understanding of the software. I think you are going to have to go the “traditional” route and have this porcelain crown made in a dental laboratory.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.