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,
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.
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.
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,
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.
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,
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.
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.
I need to a get a dental crown. I’ve always gotten the regular kind so I was expecting that again. Instead, my dentist wants me to get a CEREC crown by a machine. Before I commit, I want to make sure they’re okay. I’d rather have it made by a human, but if they’re okay I guess I’ll go ahead.
Paul
Dear Paul,
You are fine getting a CEREC crown, with one possible exception which we’ll talk about in a moment. Using the CEREC machine to mill the crown, you will get a great fit. It uses sophisticated software to make sure your crown is precisely cut.
Because they are all-porcelain, they will have the same translucency as your natural teeth. They will look beautiful if your dentist knows how to use the machine well.
The one exception to this would be for front teeth. These are trickier. When your teeth are milled by a CEREC machine it uses a single block of porcelain.
Our natural teeth are not the same level of depth all the way down. Some parts are more opaque than others. Because of this you need a dentist with expertise in color theory and staining in order to mimic the different levels of color needed for front teeth.
Finding a Dentist to Do CEREC Crowns on Front Teeth
Only about 1-2% of dentists will know how to do this correctly. If your crown is needed on another tooth, you should be fine, but with a front tooth, I’d look for an AACD accredited dentist.
Dentists who’ve been accredited with the American Academy of Cosmetic Dentistry have done extensive training. In order to reach accreditation they have to pass oral and written exams as well as demonstrate their artistry .
Any dentist who has reached accreditation can give you a gorgeous crown, even on a front tooth.
I had an accident which caused me to need a crown on a front tooth. I was nervous about this because it’s my front tooth. Everyone will see it. I looked up many dentists in my community to see who was highly reputable. I found one which everyone seemed to love. The first crown he did wasn’t even close to matching the other front tooth. Even he said he needed to do it again. The second one was closer, but I wasn’t thrilled with it. He was and was going to place it anyway. Fortunately for me it didn’t fit. He went back for a third run and when that one didn’t fit he told me I’d need orthodontics. I gave up at this point even though I have a horrible temporary crown which doesn’t fit right. I need help but I don’t know what to do. Help me please.
Tanya
Dear Tanya,
These stories make me both sad and frustrated with the dental industry sometimes. First, you should know that a reputable dentist and an excellent cosmetic dentist can be two very different things. There are two different mindsets at play here. In dental school, we’re taught that the dentist knows best. Cosmetic dentists have a different mindset. They feel unless the patient is satisfied (in fact, more than satisfied), they haven’t properly done their job.
Dentists who haven’t done extensive training in cosmetic work see this as pandering to the patient.
All that being said, matching a dental crown to a single front tooth is a very challenging thing even for the best cosmetic dentists. In fact, if your smile is important to you (and it sounds like it is) you will want a dentist with both technical expertise and artistry.
Believe it or not, one of the teeth in the picture above is a dental crown. I bet you can’t tell which one. That’s the type of results a true cosmetic dentist gets.
Finding an Expert Cosmetic Dentist
The easiest way to find a top of the line cosmetic dentist is to go to aacd.com. This is the website for the American Academy of Cosmetic Dentistry. They have a find a dentist link. However, you don’t just want someone who is a member. Any dentist can become a member. You want to find a dentist who is accredited.
In their search options, there is a box to check that you’re looking for an accredited dentist. These dentists have passed stringent oral and written exams as well as demonstrated their artistry in a large number of cases they’ve done.
Anyone of them are more than capable of matching your front tooth with a perfect physical and aesthetic fit.
My dentist has a CEREC machine. We’ve used it for a crown before, but on a tooth on my bottom arch. Now I need one on my top front tooth and he’s saying “No”. He said they don’t look good on front teeth. I truly liked the convenience. Plus, he wants to crown both front teeth to make them match. Is this legitimate?
Anna
Dear Anna,
You should be aware that only the top cosmetic dentists in the world can match a single crown to a front tooth. That is even more challenging when it comes to using CEREC. If convenience is what you’re after, go with the two crowns and traditional crowns. I’ll explain why in a moment. If you want gorgeous front teeth with just one crown, you’ll need to find an expert cosmetic dentist.
Matching a Single Crown to a Front Tooth
Your front teeth are right next to each other and much more exposed to the light. Even the slightest deviations will be very noticeable. It will be quite obvious your teeth won’t match.
With even the best dentists, it will take a few try-ins before it matches perfectly. That could go faster with CEREC crowns because it’s milled right there and not sent to a lab. It will still likely take more than one try. This method will take even more skill.
With a CEREC crown, that’s even harder because they are milled from a single block of porcelain. Traditional porcelain crowns use several blocks with variations in opacity. Your dentist would have to be very versed in color theory skills which are not taught in dental school. It’s obvious your dentist doesn’t have that training.
It’s actually showing his integrity that he’s being honest with you. He could have bluffed his way through and given sad looking results.
Finding the Cosmetic Dentist Who Can Do Gorgeous CEREC Crowns
Truthfully, because of the difficulty of this type of case, to get a beautiful, natural looking result which will match your other front tooth, you’ll need to go to a dentist accredited with the American Academy of Cosmetic Dentistry.
AACD accredited dentists have gone through stringent oral and written exams as well as proven their artistry with a large number of cases they’ve done and provided evidence for. All of them have gone through extensive training in advanced cosmetic procedures after graduating dental school.
What it boils down to in this particular case is what’s more important to you— a convenient, fast result, or a natural looking attractive result.
It is definitely your smile and your choice. Don’t feel pressured to go a way you don’t want.
Both my sister and I received root canals within the last year. My dentist put a crown on mine, which meant filing down the tooth to a nub. It’s not that attractive either. It’s toward the back so isn’t completely visible but it still bothers me. My sister sees a cosmetic dentist. When he did her root canal, he put a porcelain veneer on hers. It looks so much nicer than mine and she hardly had any of her tooth structure removed. Did I make a mistake not going to a cosmetic dentist?
Betty
Dear Betty,
You should know there isn’t a recognized specialty in cosmetic dentistry, which means every cosmetic dentist is just a general dentist who prefers to also do cosmetic work. However, before we get into choosing a dentist to do cosmetic work, let’s talk about a root canal restoration.
Whether or not you get a dental crown or a porcelain veneer restoration depends on a few things. First, the location. If it’s a back tooth, a crown is more important. After a root canal, a tooth becomes more brittle. The crown will protect it from the biting forces which affect your back teeth.
If it’s on the front teeth, you may have a choice. Most of the time crowns are done because there was so much decay on the tooth there is not enough structure left for anything but a crown. However, if the tooth needed treatment because of trauma and is still fully intact, then you could get a porcelain veneer. This is more effective because of the type of forces your front teeth undergo.
However, you’re talking about getting a porcelain veneer on a single front tooth. This requires a cosmetic dentist with superior aesthetic skills.
When You Need a Skilled Cosmetic Dentist
Most of the skills required to do a beautiful smile makeover are not taught in dental school. The dentist has to invest post-doctoral time in learning the skills required. However, there is an aspect that can’t be taught— an artistic eye.
Like any art form, there are different skill levels. So, how do you find the right dentist? The American Academy of Cosmetic Dentistry realized the quandary patients found themselves in. To remedy that, they began an accreditation program.
To become accredited, dentists have to pass stringent oral and written exams. Additionally, they have to provide evidence of a list of cases they’ve done showing they can give beautiful results. Any AACD accredited dentist can give you a gorgeous smile makeover. They can also match a single porcelain veneer to the rest of your teeth.
If you’re ever in the need or porcelain veneers, make sure you go to aacd.com and find an accredited dentist in your area.
My dental bonding for a chipped tooth needed to be replaced. I had a new dentist who suggested I get porcelain veneers instead. He’d do four so they could match. Then, when he saw one of them had a cavity, he said I’d need crowns. So, now I have four crowns on my very front teeth and even though he said he had to do four in order for them to match, the two very front teeth look a weird grayish color. What do I do?
Valerie
Dear Valerie,
There are so many things which went wrong here I hardly know where to start. First, any dentist who says you have to do more than one crown or veneer is not a qualified cosmetic dentist. Yes, it takes skill and artistry to match a single front tooth, but isn’t that what you’re paying them for when it comes to remaking a smile—skill and artistry?
Second, you can still have porcelain veneers bonded to a tooth which has a cavity as long as that cavity isn’t so large that it would require a crown under normal circumstances. That would have prevented you from having to grind down healthy tooth structure.
Sadly, the only way to do this is to have the two front teeth re-done. Hopefully, he’s the type of dentist who cares about the quality of his work and will be willing to replace the crowns free of charge.
However, that’s not enough. You need to make sure he’s willing to get a professional try in the paste. These are clear enough to show the color of the underlying teeth on them, giving you a clearer picture of what the crowns will look like once they’re permanently bonded. Then, he needs to let you try them in and get a good look them in several types of lighting and you’ll approve them before they’re bonded.
If he’s not willing to do that, you aren’t likely to get any better results. In that case, it’s in your best interest to find an expert cosmetic dentist.
Finding an Expert Cosmetic Dentists
Unfortunately, now that you’ve had crowns placed, you have to replace them with that forever. However, a skilled cosmetic dentist can give you gorgeous porcelain crowns. There are two places you can look to find a qualified cosmetic dentist in a reasonable distance from you. The first is at AACD.com. Do a search for an accredited cosmetic dentist. You need to check that you want them to be accredited and not just a member. There’s a difference.
The second is mynewsmile.com. This site only lists artistic and skilled cosmetic dentists who can give you a beautiful smile. You’ll be safe with anyone on their list or anyone who’s been accredited.
