Tag Archives: Porcelain Crowns

CEREC

Dental Crown Keeps Falling Off

I have a dental crown that has fallen off four times. It was this last time that the dentist mentioned that we’ll need to do a gingivectomy in order for there to be enough tooth to keep on the crown. Is this legitimate? I’m frustrated about this crown and don’t really want to mess up my gums in the process.

Evan

Dear Evan,

Porcelain crown being placed on a tooth

 

I’m not keen on your dentist. I’ll tell you right away that most dentists go their entire career without a dental crown falling off, but to have the same one fall off four times…

As to the gingivectomy, this is done by removing some of the gum tissue in order to expose more of the tooth structure. While this is sometimes needed, I’m curious as to why he would not have noticed the need for it before he did the first crown.  That he is just noticing this now tells me that he is either incompetent, or you don’t really need the procedure and he’s using that as an excuse to make you a new crown.

The first thing I recommend is that you ask for a refund for both yourself as well as the insurance company if any of it was billed to them. This should not be an issue because you don’t have a functioning dental crown. Keeping it in your mouth should be the minimum standard.

Then, I want you to get a second opinion about your dental crown from another dentist  Don’t tell them what your original dentist said. Let them give their unbiased diagnosis.

I think another dentist should be able to get this straightened out fairly easily.

This blog is brought to you by the gentle dentists of Lafayette, LA, Drs. Foreman and Thimmesch.
Click here to learn about one-visit crowns.

 

CEREC

Can the Hygienist Damage My CEREC Crown?

I am worried that my hygienist is going to damage my CEREC crowns. I went in to have my teeth cleaned. I have three CEREC crowns . I didn’t want her using a Cavitron on them.  She got angry and, though she didn’t use the Cavitron, when she scaled my crowns,  she was so rough that I was in a lot of pain and I was worried she was going to break them.  Are CERECs stronger than regular crowns? If not, how do you recommend I protect them?

Richard

Dear Richard,

Porcelain crown being placed on a tooth

 

Both CEREC crowns and traditional crowns are about the same strength. That isn’t the problem. My concern is twofold. The first is the attitude of your dental hygienist.

Hygienists often get special requests and there have been quite a bit lately about not using the Cavitron. Though there have been some instances of its use resulting in damage, in careful hands it is safe and does a great job. That is also beside the point.

A hygienist is there to perform a service and taking requests like this is part of that.  Whenever possible, it is best if the hygienists honor these. To act like you are an inconvenience is unacceptable. Yes, she had to work a little harder but it is part of her job.

My second concern is the roughness she went about doing the job. Doing the scaling the way she did could nick the margins of your dental work. It can even cause some problems to your natural teeth or gums.

I wouldn’t let a hygienist like that near my teeth. I would tell the clinic you are not okay working with that hygienist. Tell them why. If they’re not okay with you choosing to use a different one, I’d switch dentists. The health of your teeth and dental restorations should be prioritized, as well as your comfort in the dental chair.

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

 

Porcelain Veneers

Dentist Gave Me Crowns Instead of Veneers

I’d been talking to my dentist about porcelain veneers. Every email communication he gave me said porcelain veneers. When I went in  for the procedure, he ground my teeth down quite a bit and gave me what he called temporary veneers. After getting the permanent one, I started having  pain with my canine, but the dentist said it was normal. The pain got so bad that I had to go to an emergency dentist. He said the tooth has a massive infection. He also  told me that I didn’t get porcelain veneers but dental crowns. I checked with my insurance and he did bill them for dental crowns. That doesn’t make sense because all we talked about were veneers and there both pages on his website. I was very specific about what I wanted. Since that visit, I’ve needed three root canals. Is there anything I can do about this?

Whitney

Dear Whitney,

Comparison of crowns to veneers tooth prep

I am glad you wrote. I believe you have a case for a malpractice suit here based on everything you’ve said. If he had the two procedures on his website, then the dentist obviously knew the difference between porcelain veneers and dental crowns. There might be some excuse for him if he really didn’t understand the difference but that does not appear to be the case.

He has the information on his website. He was emailing you about veneers while he charged the insurance for crowns. Essentially, he gave you a procedure without your consent, which is a big no-no in dental care.

Sometimes patients ask for a cosmetic procedure that their dentist  did not get the post-doctoral training in. Porcelain veneers is an advanced cosmetic procedure that to do well requires post-doctoral training. Rather than being up front with their patients that they are uncomfortable with veneers, they will sometimes recommend a procedure they are more comfortable with, like crowns.

Unfortunately, instead of being upfront, your dentist just gave you the crowns. Worse, he didn’t even do that well. The large number of root canals you need suggests to me that he was a bit over aggressive when he did your crowns. I would talk to the emergency dentist who treated you and see if he will back you up if you decide to take this to court.

If that is more than you want to do, I would start by telling your dentist that you know he gave you an different treatment than he asked for. Tell him that you don’t want a refund, but rather for him to pay for this work to be redone by the dentist of your choosing. Then, make sure you choose an expert cosmetic dentist. If he gives you trouble, tell him you understand the strength of your case. You can even have a lawyer write a letter on letterhead. This is cheaper than a lawsuit and may be enough to convince the dentist.

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

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.