Tag Archives: Porcelain Crowns

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Can you get stained teeth from silver fillings?

I have two fillings that I want taken out and replaced with white fillings, both because of how they look and because of the mercury. I’ve been trying to lead a more healthy lifestyle, and a lot of the holistic magazines I read now mention removal of silver (mercury) fillings as part of reducing your “toxic load”.

Anyway, my dentist said that maybe those teeth won’t look very good when we are done, because the silver fillings might have stained my teeth? They are molars, but are visible when I laugh or talk.

Is this right? What makes the stain? That kind of freaks me out, because what if the toxins are now soaked into my teeth. I am also kind of worried about how strong these teeth will be after the procedure. About seventy percent of the teeth are filling, and my dentist said that the material in the composite is not as strong as the silver filling material (he will never call it mercury). Are these teeth going to be at risk for breaking or cracking?

Maggie in Colorado Springs

Dear Maggie,

Over the years our practice has removed many amalgam fillings and replaced them with white fillings, and we have never seen a case where they did not look significantly better. It is true that the amalgam fillings can cause some discoloration in your teeth, but it is usually very minimal, and in back teeth or molars should be barely noticeable.

The real issue at hand is that it sounds like your dentist is not comfortable with this procedure, and is kind of trying to talk you out of it. Putting white composite fillings in the back teeth is very different and more challenging than placing amalgam fillings, and if your dentist has not had training in this procedure, he may not be comfortable doing it. Most dental schools do not teach placement of composite fillings, so unless your dentist has pursued training beyond dental school, he may not be comfortable doing them, especially in the back of the mouth.

One point that should be made very clear: it is ALWAYS a bad idea to push a dentist out of his or her comfort zone. If you get the feeling that your dentist is not comfortable with a procedure you want, then it is best to seek the services of a different dentist.

One other thing–you state that more than half of the teeth in question are fillings, and in that case, we would strongly suggest porcelain crowns rather than fillings. For smaller fillings, replacing amalgam fillings with white composite fillings actually yields a stronger end result, because the composite bonds to the tooth. But removing and replacing fillings that large may well result in the cracking you are worrying about. Porcelain crowns are the safer option.

This blog post is provided as a courtesy of the dental office of Dr. Malone, Lafayette Louisiana cosmetic dentist.

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My porcelain-fused-to-metal crowns are ugly

For more than twenty years I have had crowns on my two front teeth. They are porcelain-fused-to-metal crowns, as was normally placed back in the day. They have never looked all that great, but in recent years they have really started to look terrible. There is a dark line right where the crowns meet my teeth, and it is really noticeable because  I have a really big smile.

Is there anything that can be done to get rid of that line? If I have to replace the porcelain crowns, do you think Lumineers would work for me?

I appreciate your help with this.

Mallory from New Haven, CT

 Dear Mallory,

There really is not anything that can be done to disguise that black line, which as you have pointed out is one of the major drawbacks of porcelain-fused-to-metal crowns. You also touched a little on the other issue with porcelain-fused-to-metal crowns when used for front teeth — they don’t look very good. Porcelain-fused-to-metal crowns are too opaque to look realistic in the front teeth.

You will need to get them replaced with porcelain crowns, and Lumineers might be an option. But the best advice I can give you is to see an experienced, artistic cosmetic dentist for this procedure. Any dentist can claim to do cosmetic dentistry, but you’ll want one who has training, experience and talent. Smile makeovers require a rare balance of artistry and science, and only a small percentage of dentists have it. Make sure you choose the right professional, and you may have a smile you love for the first time in many years.

This blog brought to you courtesy of Dr. Mike Malone, Lafayette Louisiana cosmetic dentist.

Porcelain Veneers

Traumatic mouth injury treatment

About a month ago, I took a nasty shot to the mouth during a hockey game without my mouth guard in place. Five weeks later, all of my front teeth on the top and bottom are turning black. I also feel like there is something sticking out where it shouldn’t be, like maybe the root of a tooth? It is between my lip and gum, way up by my nose, just to the right of center. I don’t even know enough about dental structures to try and guess what it might be, beyond the broken off root of a tooth.

Clearly I need to get this treated, but should I start with a doctor or a dentist? What kind of treatment do you think they will suggest? I’ve been Googling, and it looks like maybe porcelain veneers, or dental implants if I am going to lose the teeth. Any way you can give me a ball park on how much this might cost? I have dental coverage, but it isn’t that great.

Thanks for your help with this.

Josh from Houston

Dear Josh,

It sounds like the nerve tissue inside the affected teeth has been killed by the trauma. If that does turn out to be the case, the usual treatment would be root canal treatment. In regards to the darkening, there is a way to bleach those teeth from the inside after the root canal treatment, but not all dentists are aware of this procedure. If they cannot be satisfactorily bleached, porcelain veneers or porcelain crowns would be options, though you may want to reconsider hockey if you make that kind of investment in your smile.

You could also have cracked the roots of some or all of the affected teeth. In that scenario, those teeth could likely not be saved, and you would have to have them extracted and replaced, preferably with dental implants.

The protrusion up near your nose definitely needs to be looked at. You don’t mention that any of your teeth were displaced, so I am assuming that it is not a tooth that was driven out of place. All of this care should be done under the care of a highly skilled cosmetic dentist.

We can only offer the most general information about costs, but generally speaking root canals on front teeth would cost a few hundred dollars for each tooth. If veneers or crowns are necessary, figure on $1000 to $2000 per tooth. Dental implant costs usually exceed that per tooth.

This blog provided courtesy of Lafayette Louisiana cosemtic dentist Dr. Malone’s practice.

Porcelain Veneers

Do I really need to see a cosmetic dentist? What is the difference?

I was recently in an accident that fractured my one of my front teeth and the tooth next to it. They did not break off, but both were very noticeably cracked. I was out of town and had to go to an emergency dentist for a repair, and the bonding is not the right color at all. I had to have a root canal on the front tooth, and the dentist said that too will likely darken over time, and become brittle.

So I need to have some cosmetic work done. Before this accident, my smile was a real source of pride for me. My teeth have always been great, and most of them still are white and straight and beautiful. I’ve consulted my regular dentist, who says that I can get just the damaged teeth done with porcelain crowns. I’ve been reading, and it seems like to make the repair look right, I should get six or even eight crowns or porcelain veneers. I am also reading that I should consult with an accredited cosmetic dentist to do this work. Is that really necessary? I like my regular dentist, and he seems confident in doing the work, but he is not an accredited cosmetic dentist, and does not really advertise much as doing cosmetic work. I don’t want to have him stick a couple of crowns on my front teeth that look out of place. I would rather have them all done, even with the expense, than spend the rest of my life dealing with a mismatched smile.

What do you think? I want my smile back! It is one of my few claims to beauty, and I am willing to invest to get it back again. What should I do?

Thanks for your help,

Tracy in Cedar Rapids, Iowa

Dear Tracy,

First, consulting with a cosmetic dentist in this case is essential. You sound like you really just want to get your smile back to what it was before the accident, and a really skilled cosmetic dentist should be able to help you do that. The brief statement you made about the reading you have done indicates that you are eager to be educated about this and want to make the best decision. Experience has shown that the most important decision you make for this kind of dental care is in choosing the right dentist.

Nearly all dentists are what we call “technician” dentists. When things break, they are very good at fixing them, but may not be overly concerned with nuances of appearance. You had a beautiful smile, and you want it back again. The key to reclaiming your smile is in finding the right professional to help you do so.

Porcelain crowns and porcelain veneers may be possibly treatments, but it is also possible that a skilled cosmetic dentist could do dental bonding on the cracked tooth that is still viable. A great cosmetic dentist will get you beautiful results while leaving as much of your natural tooth structure intact as possible.

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Porcelain crowns for front teeth?

I have been talking to my dentist about what to do to restore my smile. I have significant wear on my top teeth, and a gap between my two front teeth that has bothered me most of my life. Before I talked to my dentist about this, I did all kinds of research on the different kinds of available treatments, especially looking at different kinds of porcelain crowns. I really think–and my dentist confirmed this–that porcelain crowns will be the best way to fix my teeth.

The thing is, we don’t agree on what kind of porcelain crowns would be best. Both my dentist and his partner say they will only do porcelain fused to metal crowns. Everything I have read makes me believe that porcelain fused to metal crowns will not look as nice as I want them to look when we are done. Their reasoning for this is that I sometimes grind my teeth, and can’t stand wearing a night guard. They both say that the all ceramic Zirconia crowns like I want are not strong enough to last if I continue to grind my teeth. Both my dentist and his partner have impressive credentials, which is the main reason I chose them.

In your experience, do all ceramic crowns like Zirconia tend to sustain damage if used on an occasional grinder? It is not all the time, just intermittent.

I have waited a really long time to get this done, but I just can’t get excited about the porcelain fused to metal crowns. My dentist is all ready to get it done, but I think they will look fake, and I don’t want to spend that amount of money on something that is not exactly what I want.

I could really use your help on this.

Thanks,

Jerry in Indianapolis

Dear Jerry,

I think you’re going to need a second opinion. The Zirconia porcelain crowns that you mention are indeed very strong, certainly strong enough to withstand great stress. If your teeth grinding is not constant or severe, they might well work as a great option for you. An added bonus is that the all-ceramic or all-porcelain veneers can be made thinner than porcelain fused to metal crowns, and so less of your natural tooth structure has to be removed to place the crowns.

It is possible that despite the impression credentials your dentist and his partner take more of an engineering approach to restoration rather than an artistic one. It is also possible that your grinding problem is worse that you think it is. I strongly encourage you try again with the mouth guard. Teeth grinding can cause very serious, life-long issues.

In either case, if you are determined to go with the Zirconia crowns, then you would be best served to seek another dentist. It is always a bad idea to push a dentist to do something he does not want to do. For whatever reason, your dentist and his partner are not comfortable with the Zirconia crowns, and you are fortunate that they have the professional integrity to be completely honest with you about this. Insisting on a treatment plan your dentist is not comfortable with often ends badly, so if you are certain the Zirconia crowns are what you want, you’ll need to find a dentist who is comfortable placing them in your situation.

 

Porcelain Veneers

Porcelain crowns for a smile makeover?

This may seem like it is coming after the fact, but I am curious about something. I recently had a smile makeover done. I thought I was going to have all porcelain veneers placed, but when I look at the backs of my teeth, it looks like the porcelain goes all the way around. Is it normal to place porcelain crowns instead of porcelain veneers for purely cosmetic reasons? I thought crowns were just for teeth that were damaged. I guess the reason this concerns me is that maybe my teeth were in worse shape than I though, if they needed crowns.

I’ve since seen my general dentist, and she seemed very impressed with the work, so I am not concerned about the quality of the workmanship. Is this standard, to have crowns instead of veneers for a cosmetic smile makeover?

Thanks for your insight,

Ben in Oregon

Dear Ben,

Porcelain crowns and veneers differ only in degree–there really is no specific line of demarcation where a veneer becomes a crown. The fee for a porcelain veneer is usually the same or nearly the same as that for a porcelain crown, because the effort to place each type of restoration is about the same.

It is actually quite common to see porcelain crowns used on the front teeth for cosmetic reasons rather than protective ones. If your teeth were not weakened or damaged, your dentist might have decided to go with crowns to control your bite.

It is surprising that the dentist did not discuss this in detail with you during the course of your treatment. Typically, smile makeovers involve a great deal of give and take between the dentist and the patient, because the dentist will want to make absolutely sure he or she knows exactly what the patient wants.

The simplest solution is simply to ask your cosmetic dentist why he decided to go with porcelain crowns rather than veneers. Crowns are the more aggressive form of treatment, and require more reduction of the natural tooth structure. Veneers require only a little bit of shaving on the front of the tooth. For that reason alone, I would expect your dentist to have a sound reasoning for choosing the crowns. Most dentists will always pursue the least aggressive form of treatment and strive to preserve as much of the natural tooth structure as possible.

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Black line with porcelain fused to metal crowns

I have porcelain fused to metal crowns on six of my top front teeth. What can be done to get rid of the the black line where the crowns meet my gums? It was not this bad when they were first placed but over the last two years it has really become noticeable. What are my options, from least expensive to most expensive?

Vienne from New Hampshire

Dear Vienne,

There really is not any inexpensive way to address this issue. The entire structure of your crowns is the problem. A dentist could try to drill away the black line and cover it over, but there is likely a serious color match issue between the roots of your natural teeth and the color of the veneers. Trying to blend those colors together in that tiny space would be incredibly difficult if not impossible, and the results would almost certainly be very unattractive.

Essentially, you have to options: live with the black line, or replace the porcelain-fused-to-metal crowns with all ceramic or all porcelain crowns. Be absolutely certain you chose a skilled, artistic, well-trained cosmetic dentist to do this procedure for you. I would hate to see you spend thousands of dollars to still be unhappy with the results.

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Porcelain crowns for “peg laterals”.

My new dentist says I have “peg laterals” and suggests that I have porcelain crowns placed to correct them. My old dentist always said I would need braces to close those gaps in my teeth. I am confused about what to believe! My old dentist retired, and I don’t really know this new one very well yet. What are “peg laterals”, and what is usually done to correct them?

–Anthony in Topeka

Dear Anthony –

It is hard to develop trust with a new dentist. I would suggest you talk honesty with your dentist about your concerns regarding these apparent differences in opinion about how to address your dental issue.

Simply put, “peg laterals” are when your lateral incisors (the teeth on either side of your front teeth, or central incisors) are too small. This discrepancy in size makes them resemble small “pegs”, hence the term “peg laterals”. Without an examination, I could not presume to tell you how your particular case should be addressed, but I can tell you that you should really trust the dentist you choose to help you.

In some cases, a porcelain crown can be used, if there is adequate space surrounding the peg lateral. If there is not, some orthodontic work might be necessary to create a space for a natural looking crown or veneer. In your case, it could simply be that your teeth have shifted, and therefore the professional advice you have received has changed.

Whatever the case, it is very, very important that you trust your dentist. If you are unable to have an honest conversation with him about the best way to fix your peg laterals, then it is definitely time to seek a different dentist. We strongly recommend you find the services of an expert cosmetic dentist to help you with this – make sure they are accredited through the American Academy of Cosmetic Dentistry, and that they have pursued specialized training above and beyond that required by general dentistry schools.