Tag Archives: Porcelain Crowns

Sedation Dentist

Can I Really Wake Up with a Whole New Smile?

I was at my dentist’s office for a check up and mentioned to him that I was thinking about improving my smile. Honestly, I was just thinking about whitening my teeth, but he’s suggesting something completely different. He wants to crown all of my teeth for a complete smile makeover. He said I could even use dental sedation which means I could go to sleep and wake up with a whole new smile. I don’t know why I feel uneasy about the situation. Maybe it just sounds too good to be true to take a nap and get a prettier smile. What do you think?

Laura

Dear Laura,

Woman resting in dental chair from dental sedation

You have good instincts. Dental sedation is a wonderful tool to help patients with dental anxiety get the care that they need without fear. While it is true that you can completely sleep through your procedure, I would not recommend that for any type of cosmetic work. One thing that is important when it comes to a smile makeover is that you get to approve the work before it is permanently bonded on. You can’t really do that if you’re asleep.

If you were an extremely anxious patient, then I would say it is okay to use nitrous oxide. This way your dentist can turn the nitrous to oxygen and you will be lucid and ready to approve or disapprove anything. I can’t say I trust your dentist at this point. It’s not just the recommending sedation, which is a big red flag in this situation. It’s also that he is recommending crowning every tooth.

You just wanted to whiten your teeth, which (believe it or not) is done with a simple teeth whitening procedure. Even if you wanted a total smile makeover, what your dentist is recommending is a huge overtreatment. The typical procedure for a smile makeover is to get porcelain veneers, which does not require grinding down your healthy teeth. Plus, at the most you would only cover the teeth that are visible when you smile and use teeth whitening for the remainder so that they blend in naturally.

If a dentist is suggesting porcelain crowns for healthy teeth, it is a sign that they do not know how to do porcelain veneers. So, they’re pointing you toward a procedure they do know how to do. Unfortunately, knowing how to do dental crowns and knowing how to do a smile makeover are completely different skills. If they’re not skilled in porcelain veneers I would not expect a beautiful result.

My recommendation is that you get just the procedure you originally wanted. While it takes real expertise to do a smile makeover, any dentist can do teeth whitening. If you find a dentist who does Zoom Whitening, you can get your teeth whitened in just one appointment.

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

Dental Implants

Dentist Can’t Get My Implant Crowns to Match

I have two implant crowns that are visible when I smile. Before getting the crowns, I had a dental flipper. It matched my teeth okay. These crowns however are obviously different from my teeth. My dentist has switched them three times. He’s pretty frustrated with me and said that I am way too picky and that my teeth are between two shades and I should just be grateful that I have teeth. Am I being too picky? He also said that if he keeps switching out the crowns I could lose the implants. I don’t want to do that either. Help.

Sandy

Dear Sandy,

illustration of a dental implant

First, I can already tell you that you are not being too picky. The fact that you were happy with the dental flipper is evidence of that. Your dentist isn’t being honest with you. If the dental implants are placed correctly, then they will not come out because your dentist switches the crowns. If he didn’t place them correctly than they would be at risk either way.

Matching porcelain crowns, especially ones on front teeth are difficult to match. Even the best cosmetic dentists will need two to three try-ins before they get the match exact. Though, most dentists are smart enough to use a temporary try-in paste so that they can make those changes without dealing with the permanent bonding cement.

Unfortunately, I do not think that your dentist can do this. If he’s saying the problem is that your teeth are between two shades, then he does not have the cosmetic skill to match them. He’s just using the standard shade guide and not going beyond that. Ask for a refund on the dental crowns and tell him you’re going to have that part done elsewhere. The dental implants are fine, so do not ask for any money back on that.

color map for a tooth The standard shade guide is sufficient for back teeth. However, teeth that are visible to the light when you smile need some adjustments made. This is when your dentist would create a color map for the ceramist. It would add different shades and tints to the tooth in a way that helps it the match your adjacent teeth exactly. It takes a lot of cosmetic training and an understanding of color theory to make this work.

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

Dental Implants

Deformed and Missing Teeth

I have a problem with both of my lateral incisors on my upper teeth. One of them is completely missing and never came in. The other is smaller than it should be. I want to fix this before I go to college. I have a dental flipper for the missing tooth area currently, but my parents were told that the flipper should be temporary. They both passed my senior year of high school. I stayed with some friends until graduation. I was going to use their life insurance for college, but I received a great scholarship so now I am free to use the money to fix my teeth. Do you have any suggestions?

Caroline

Dear Caroline,

illustration of a dental implant

I had so many emotions reading through your question. First, I want to express my condolences at the loss of your parents while you are yet so young. Next, I want to say congratulations on your scholarship. That is absolutely fantastic, especially given all the difficulties which you experienced during your senior year. That says a lot about your perseverance.

As to your tooth, I am going to suggest that you replace the congenitally missing tooth with a dental implant. This is the most secure tooth replacement we have. It is expensive and does require surgery, but as young as you are, it will be important in order to preserve the bone structure. You may even need some bone grafting done before the implant is placed. There are other options, such as a dental bridge, but the implant is the best option.

As for the other tooth, I am going on the assumption that it is a deformed tooth and not a baby tooth still left in place. On that assumption, you will want to use either a porcelain veneer or a porcelain crown depending on how small the incisor is.

The trick with both of these procedure will be matching the color of the implant and other restoration to the natural teeth that are adjacent to them. These are very visible teeth, which means light hits them exposing all their variations.

You will need an expert cosmetic dentist to get this done right.

Best of luck to you at university. I have a feeling you are going to accomplish great things. This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

CEREC

Are Computerized Crowns as Safe as the Regular Ones?

I had a dental crown made by a computer in 2017. I think my dentist said it was a CEREC something or other. It had always bothered me. This year I went to a different dentist and they said that the crown wasn’t fit properly and would need to be redone. This dentist also wants to use the computer crowns. She also said that my old dentist removed the post by drilling and she should have vibrated it out with sonics. Here are my questions:

  1. Are the computer crowns as good as the old fashioned ones?
  2. Did my old dentist damage the bone by drilling out the post?

Aimee

Dear Aimee,

Block of porcelain for a CEREC crown

I’m going to start with your second question. It is always nice when you can get a post out by vibration, but that is not always possible. Drilling them out is also common and will not damage the bone. If you think about it, dentists are drilling on teeth all the time and they do no damage to the bone.

I am a bit curious about your dentist saying that the crown “wasn’t fit properly.” Did she give you any other specifics? Were their open margins?

Some dentists will accuse the previous dentist of doing shoddy work in order to get the patient to re-do the work and give them some business. I am not saying that your dentist did that, but I would recommend getting a second opinion before re-doing your crown.

As for CEREC crowns, they were developed several decades ago. In the early days after their development there were some issues of problems with the fit. However, those bugs have been worked out of the software and, if the dentist knows how to use the software, you will get a more accurate fit than you would with a traditional porcelain crown.

Start by getting that second opinion.

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

Dental Implants

Can a Maryland Bridge Attach to a Dental Implant

I have two dental implants that had a natural tooth between them. Now that natural tooth needs to be removed and my dentist is recommending a Maryland Bridge. Is it possible to attach a Maryland bridge to the dental implants? I was concerned about attaching the metal to the porcelain. Have you seen this successful?

Charlie

Dear Charlie,

Illustration of a Maryland Bridge

The short answer is yes, it is possible to bond a Maryland Bridge to a dental crown. That being said, it is tricky. The ideal bond is metal against enamel, not metal against porcelain.

It would have been better if your dentist had anticipated that when you have two dental implants on either side of a natural tooth it is very likely that the tooth will eventually need to be replaced. With that foresight, he could have placed the abutments parallel to one another so that you could have changed two screw-retained crowns to a dental bridge with little trouble.

As it is unlikely that your dentist planned ahead, I would suggest your best option will be to place a third dental implant in between the two others, if there is room.

If not, then you can try the Maryland Bridge, but it will take some preparation of the crowns to make it work.

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

Emergency Dentist

Is a Crack in a Dental Crown an Emergency?

I have had six porcelain crowns for close to twelve years. One of them, on a front tooth, has always had a slight defect. It never really bothered me because you couldn’t really see it. If I rubbed my tongue against it, there would be a slight depression but that is all. Now, it feels like there is a crack and I can see a horizontal line. I am afraid the crown will break. Would this be considered a dental emergency?

Pamela

Dear Pamela,

Porcelain crown being placed on a tooth

While I would not say that you have a dental emergency on your hands that you have to try and get in today, I would schedule an appointment with an excellent cosmetic dentist and have them look at it. Based on your description, there has been a substantial change on the structure of your tooth. It is likely to break at some point in the near future.

You have a couple of options. Your porcelain crowns are aging. Because of that more of them may start failing. You can either replace all of them at once or one at a time as they fail.

What to beware of is a dentist who says that you have to replace all of them to get them to match. A single crown can be matched to the other teeth. However, it takes a highly skilled cosmetic dentist to do it.

Whichever dentist you end up with, make certain they are willing to do a temporary try-in and allow you to approve the crown before it is permanently bonded on. They need to be willing to re-do the crown if you are not 100% satisfied with it.

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

Teeth Whitening

Dentist SAid My Teeth are Too White

I am needing to get a crown on a tooth, but my dentist can’t seem to match it to my other teeth. He said my teeth are “too white”. It is true that my teeth are very white. I did do Zoom Whitening with my last dentist about two months ago. I’ve relocated since then. The dentist that whitened them never told me that I wouldn’t be able to match any dental work to them. Have you encountered this? How do you handle dental work?

Kennedy

Dear Kennedy,

The problem here isn’t with your previous dentist not warning you about matching dental work. It is actually with your current dentist. He sounds like your typical bread and butter general dentist who hasn’t invested much time in learning cosmetic dentistry.

Cosmetic dentistry is isn’t a recognized speciality, but neither is it taught in dental school. It is up to the dentist to decide how much time and effort they invest in learning the skills.

Teeth whitening is the most basic of all the cosmetic procedures, but many dentists don’t understand how it works. Most people know that teeth whitening will bleach out stains on your teeth that are naturally accumulated over time. However, it will also bleach the natural pigment of your teeth. Here is where that becomes a problem for dentists who don’t understand cosmetic work.

Shade Guides in Dentistry

When a dentist needs to match a tooth, they use a shade gude such as the one you see above. Before teeth whitening became very popular, a dentist could match just about any tooth using this shade guide. Enter teeth whitening…

Dentists began to find that teeth were whiter than anything on their shade guide. The companies that produce these shade guides noticed it too. They came out with an updated shade guide (see picture below).

With this shade guide, they added whiter shades that go beyond the natural tooth pigment. This is the shade guide your dentist needs to use in order to match your whiter teeth.

At this point, you have two choices. The first is to show him this post and hope he is able to add to his knowledge base. The second is to go to a new dentist to have your porcelain crown done, preferably one who understands the type of procedures you are likely to want or need.

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

Teeth Whitening

How Long Should I Whiten?

I whitened my teeth a couple of years ago. Now I’m about to get a dental crown and want to touch the teeth up before having the crown made because they’ve picked up some stains since then. My dentist said he doesn’t know how to advise me so I’m turning to your blog in the hope you can. Here are my questions: 1. How long should I whiten per day and for how many days? 2. Is a waiting period necessary between whitening and getting a crown?

Brooke

Dear Brooke,

teeth whitening trays

I am going to answer your questions. However, first I am going to express concern that your dentist seems unable to do so. As your dentist, he (or she) is actually in a better position to give definitive answers because he knows your dental history.

The fact that he can’t, gives me concern about his ability to create a beautiful looking porcelain crown for you. Most dentists are engineering-minded. They can create a well-fitted, functioning crown but the appearance will be mediocre at best.

My guess is this is a tooth that is visible when you smile. This makes it all the more important to know if your dentist is a skilled, artistic cosmetic dentist.

Basic Teeth Whitening Guidelines

The duration of days will depend on how long it takes you to get to the level of whiteness you want. Teeth will get whiter the longer you use the gel. As for how much per day, it depends. The minimum you should wear your whitening trays, with the gel in them of course, is 20 to 30 minutes. That’s about the amount of time necessary for the ingredients to get into your teeth.

If you’re able, teeth whitening is more effective overnight. This is because our saliva production goes down at night. During the day, saliva gets into the trays and can dilute the gel. However, I would not whiten to the point of tooth sensitivity. You are the best gauge for that.

You will want to wait a week or two between the time you complete your teeth whitening and you have your porcelain crown made. If it is going on a front tooth, wait the two full weeks. If the crown will be more toward the back, one week is sufficient.

This blog is brought to you by the Lafayette Dentists of Camellia Dental.

Maryland Bridge

A maryland bridge between two crowns

I have two dental crowns that are on top of dental implants. I am now losing the tooth between them. Is it possible to have a Maryland Bridge placed there and attach it to porcelain crowns?

Kay

Dear Kay,

Diagram of a Maryland Bridge
A Maryland Bridge

While technically the answer would be “Yes, you can place a Maryland Bridge between two porcelain crowns.” it is not easy. Ideally, you would want to bond the wings of the bridge to tooth enamel, which would give you your strongest bond. Bonding to porcelain crowns is tricky, Very few dentists even know how to do that and it may not hold up.

Hopefully, your dentist had foresight. Realizing you had two dental implants with a tooth between them, he or she should have thought about what to do if the middle tooth needed to be replaced.

Planning ahead, you would place the implants in a way that the abutments are parallel to one another. Then, instead of cemented crowns, you would use screw-retained crowns. That way, when the middle tooth needs to be replaced, your dentist would simply unscrew the two crowns and replace them with a single dental bridge.

If your dentist didn’t plan ahead for that, you always have the option of having a third dental implant placed there.

Whatever you decide, it is going to take a dentist with advanced skills, so choose who does your procedure carefully.

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

CEREC

can I fix the color of my cerec crowns?

I had a CEREC crown done on one of my canine teeth about three weeks ago. We never really discussed the shade while I was in the office, but as soon as I got home, I realized that it was a bit lighter than the rest of my teeth. Well, once I saw it, I couldn’t un-see it, and now every time I look at myself, all I see is that darn tooth. It looks fake.

I didn’t want to bother my dentist with this at first, so I started playing around with at-home whitening products to try to get the rest of my teeth to match, but I’m just not getting them as bright as that CEREC crown. This probably sounds crazy, but I’m starting to wonder if he can darken it just a bit, so it’s a better match. Is that even possible?

Thanks,

Stan

Dear Stan,

CEREC crown restorations and materials

There are a couple of things about your case that give away that your dentist isn’t really what I would call a cosmetic dentist. Every dentist who is serious about cosmetic dentistry, when they place a crown on a front tooth, will make sure you get a good look at it before it is permanently bonded on. He didn’t do that.

The other problem is that it is a CEREC crown. The CEREC material is a block of material that is a set shade. Unless the dentist is an advanced cosmetic dentist, he won’t know how to use color theory and stains to match a front tooth.

To match a front tooth, a true cosmetic dentist has the ability to customize the shade. Each tooth in your mouth has differences in color from the neck of the tooth to the tip, and it is quite a process to mix different materials to get a crown to match the surrounding teeth.

Tints and Stains Exist

There are tints and stains that can be applied to the CEREC to customize the shade. But on a ceramic, that has to be baked into the crown, so that has to be done before the crown is put in your mouth, obviously.

Sounds Like You Will Have to Have Your CEREC Crown Replaced

You deserve to be happy with your smile and he biffed the color. Hopefully, your dentist will agree to re-doing the crown. However, this time, make sure you get to look at it BEFORE they cement it. Check it out under various lighting conditions—seriously. Look at it in the chair. Get up and go into the bathroom and check it there. Venture to an outside window and view it in natural sunlight. If it isn’t right, don’t let them cement it.

Request a Lab-Made Restoration if All Else Fails

There are crowns that have a core that is made like a CEREC crown and then have porcelain baked over the top. If you want a natural-looking crown on a front tooth, this is the way to go. Although you’ll have to wait two weeks for the lab to make it, the lab technician will be able to tint the crown to match your existing teeth. But the dentist also needs to have a good eye for color and the ability to describe the color variations in your tooth, and your dentist doesn’t sound like he is that much into that. For the best results, you’d really want to switch to someone who specializes in cosmetic dentistry for these sorts of things, but you’ve already started with him, so as long as you’re keen to continue, give him the chance to fix his work too.

If he can’t, look for a dentist who has been accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists are the top cosmetic dentists in the country.

This blog is sponsored by Lafayette, LA Dentist Dr. Mike Malone.