Tag Archives: Dental Crowns

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.

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.

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.

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 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 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.

CEREC Crown Disaster

I’d been hearing how wonderful CEREC crowns were. You could get them done in one appointment and they’d fit perfectly, designed to your tooth. I have experienced something quite different.

First, she said my tooth was in such bad shape that she had to take a generic image off the database. Then, it didn’t fit . She spent three hours grinding down on the sides and top of the crown so much that the top of the crown is flat and shorter than the rest of the teeth. Additionally, the gums are super sore where the crown is. It’s been over a week.

Is this normal?

Katelyn

Dear Katelyn,

porcelain block for CEREC crown

No , this is not normal. I’m a bit thrown off by her saying she had to get a generic image from the database because your tooth was in bad shape. Of course it was in bad shape. That’s why you needed a crown.

The CEREC Crown software is designed to build up a tooth. Your dentist starts by telling it which tooth needs to be crowned. In turn, it builds up what that tooth should look like. Then, your dentist adds the information for the remainder of your bite and the software designs the perfect dimensions.

It sounds to me that one of two things is going on: either your dentist didn’t know what she was doing with the software or there is information she didn’t pass on about your case, such your gums bleeding so much she wasn’t able to get a clear image.

Either way, her decisions after that give me some doubts about her skill with dental crowns as a whole. I’m going to suggest you get a second opinion from another dentist. If it is as bad I think, it will need replacing. In that case, don’t ask for a refund. Instead, have your current dentist pay for the repairs. It will likely cost more to get it re-done than you were originally charged.

Tips for Getting a Second Opinion

When you go to get your second opinion, don’t tell them who the original dentist is. The dental world is a small one. Often dentists are friends with one another. He or she may have a bit of difficulty saying something negative about a friend’s work.

Instead, just tell him you want his opinion, without any previous information, as to what he thinks about the CEREC crown.

Thinking Ahead

Normally, your dentist would have already relayed the information I’m about to give you, but I don’t have the highest confidence in your dentist at the moment.

You didn’t say where they CEREC crown was being placed. If it is in a place that is visible when you smile, you will want to make sure your teeth are the color you want in the long term.

While the CEREC crown can be made any color you want, the color will be permanent. If you’re not completely happy with the color of your teeth, you may want to get your teeth whitened before the crown is made. This way you will be sure to have the color you want for the long term.

Otherwise, if you don’t and decide later to whiten, the crown will have to be replaced again in order to get it to match the new color.

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

Is a CEREC Crown falling Off an Essential treatment?

I had a CEREC crown placed right before the lockdown for COVID-19.. Today, it just fell out. Our governor said you can only go to the dentist for essential treatment. How do I know if this is essential? Do I go in or wait until the quarantine is over?

Mark

Dear Mark,

porcelain block for CEREC crown
Block of porcelain for a CEREC crown

In most cases, because of COVID-19 and how easily it transmits, the CDC and Governors of many states are asking us to forego routine treatments until we have a handle on the virus. That would mostly include things like cleanings, checkups, and elective cosmetic procedures such as teeth whitening and smile makeovers.

Essential appointments are things like emergency dental care, such as you’d have with a tooth infection or other types of repairs. Your case is one of those. If a dental crown falls off, which by itself should be unusal, it is important it gets re-bonded.

If you wait until the quarantine is over, the adjacent teeth will begin to shift into the space left open. This will mean by the time you are able to contact the dentist for the re-bonding, your CEREC crown will no longer fit and you’ll have to get an entirely new one.

Don’t wait. Call your dentist.

One other thing, as I said earlier, it is highly unusual for a dental crown to fall out, especially a CEREC crown. They are milled by a computer so they are usually a tighter, more accurate fit. If your dentist rebonds this and it falls out again, I’d recommend you see a different dentist.

This blog is brought to you by Lafayette Dentist Dr. Mike Malone.

should I have gotten a cerec crown?

I had a crown placed which led to pretty severe gum inflammation. My dentist couldn’t figure out why so he sent me to a periodontist. She couldn’t figure out what the cause was either. Off I go to a prosthodontist. This doctor thinks it is because the dentist placed the crown too deep. He also said if I don’t have it treated I will develop gum disease. But, he said the surgery will likely lead to cosmetic damage to the gum area. I feel stuck. I don’t want gum disease, but I don’t want a cosmetic issue either. What do I do? Would this have happened if I’d gotten a CEREC crown instead?

Mary

Dear Mary,

CEREC Crown being placed on a tooth
Sometimes a dentist gets in over their head

It’s a shame this happened to you. I think your dentist should help cover this as his actions led to the problem. One thing that worries me is the prosthodontist acting like if you treat your gum disease, you’ll end up a cosmetic freak.

The truth is, whatever damage was done to your gums cosmetically speaking, is already done. Now your choices are repair this to help you prevent gum disease or leave it and end up with gum disease. It’s pretty much a no-brainer, but they didn’t put it to you that way..

Maybe they said it that way so you wouldn’t think they botched something after the procedure.

In the meantime, I’m going to suggest you rinse with an antibacterial rinse, like Peridex. This will help you with the gum inflammation.

CEREC Crowns Versus Traditional

You asked if this would have happened if you’d had a CEREC crown instead of a traditional crown. In reality, while CEREC crowns are milled by computer, which does make the fit as accurate as possible, the placement of the crown is still done by the dentist. If he placed a traditional crown improperly, he’d likely do the same with a CEREC.

The only other advantage to getting a CEREC crown would be having it done in one appointment instead of needing a temporary crown and two appointments. The dentist really matters more than the type of crown.

This blog is brought to you by Lafayette, LA Dentist Dr. Mike Malone.

family dentist versus cosmetic dentist

I had composite bonding done on a chipped tooth. The dentist who did them retired. My new dentist said they couldn’t replace the bonding and suggested a dental crown. He said because it was a front tooth the only way to get it to match was to do two crowns. I trusted. him. Now I have two crowns on healthy teeth and, while the match each other, they’re grayer than the rest of my teeth and look fake. What do I do?

Cameron

Dear Cameron,

a before and after picture of dental bonding for a chipped tooth.

The biggest problem you have here is you’ve got a family dentist who doesn’t understand cosmetic dentistry. You needed composite bonding repaired. He didn’t know how to do that. Instead of telling you that, he says it can’t be done and you need crowns. Why crowns? Because those are what he’s familiar with.

A second issue is the fact that he said you needed two crowns in order to get them to match. A skilled cosmetic dentist can match a single crown to a front tooth.

In your place, I’d suggest you do one of two things. First, tell your dentist you need these crowns re-done. But, only allow him to do it on some conditions.

  • He’ll need to use a temporary try in paste so you can see the crowns in your mouth to make sure they’ll match and you are pleased with them.
  • If you’re not thrilled with them, he needs to be willing to re-do them until you are happy with them.

If he doesn’t agree to that, then my second suggestion is you ask for a refund. He told you the teeth would match and they don’t. He also lied to you about the possibility of just getting the dental bonding repaired. You have the right to a refund.

Once you secure that, it is time to find a good cosmetic dentist to do this properly.

Finding an Expert Cosmetic Dentist

I’m going to suggest you look for an AACD accredited dentist. You can look them up for your area at aacd.com. These are in the top 1% of cosmetic dentists in the country. There aren’t many of them, so it may be hard to find one depending on where you live.

If that’s the case, there is a second resource. Look on mynewsmile.com . They screen cosmetic dentists for both their technical knowledge and training, as well as their artistic ability. Any of their recommended dentists can provide you with two gorgeous crowns

You may want to consider whitening your teeth if you are going to get the crowns replaced, this will essentially give you a bit of a smile makeover.

This blog is brought to you by Lafayette Cosmetic Dentist Dr. Mike Malone.