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I had porcelain crowns put on my two front teeth, and

I had porcelain crowns...

I had porcelain crowns put on my two front teeth, and permanently cemented, about two weeks ago. One of the teeth has an implant and the other a root canal, with very little tooth left. The shape and feel of the teeth are perfect. In the dentist's chair, in bright light, the teeth seemed like a perfect match to the two teeth on either side and the rest of my teeth. But after I left the office, and looked at them in regular light, I see that the color is off--they are grayish. My husband thought the same thing, but several other people said the teeth look fine. Of course, every time I look in the mirror, I see gray. I wouldn't care so much, but my son's wedding is coming up in about a year, and I keep thinking of the pictures.

Doctor's Assistant: Have you noticed any swelling in the gums? When was your last visit to the dentist?

No swelling. I went back to my dentist, who has done, literally, 12 other crowns for me. He is willing to do the crowns over, but says the best thing would be to do all 4 front teeth to get the best color match. The neighboring teeth are also crowns. I am worried about removing these four crowns. Will the underlying teeth be damaged? Then Ill have to do root canals/ implants. I have also noticed that the front teeth do not seem to have been glazed properly. When they are dry, there is no gloss, unlike the two crowns next to them. When is it "good enough"? Thanks.

Doctor's Assistant: Anything else in your medical history you think the dentist should know?

Two front teeth: one root canal, one implant. The two neighboring teeth: both are crowns, no root canals. Thanks.

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Customer reply replied 9 months ago
Photo added.
Answered in 19 minutes by:
11/12/2017
Lara Coseo
Lara Coseo, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 697
Experience: Awarded, licensed dentist with over 13 years experience
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Thank you for giving such a detailed description of your concern. I am guessing that the two front teeth crowns are porcelain fused to metal? Meaning the crowns have a metal core with porcelain over it. Is that correct?

Typically, these are the crowns of choice to block out anything undesirable underneath (like a metal implant abutment, or a discolored tooth from a root canal). They are the traditional option, but they are not the only option. In general, over an implant and a tooth with a root canal, the core of the crown must be opaque to block out the underlying structure. However, it does not have to be metal opaque. There are some opaque materials that are used in dentistry which are tooth-colored or white.

However, any opaque material under the porcelain will give the overall tooth a more opaque look, which will appear different from the adjacent teeth, which are natural enamel, which has translucence and some light reflection that is unique to natural teeth. This may be why your dentist is recommending the front FOUR teeth to be redone, so that the four teeth can all be made from the same material to get the same coloring and same translucence.

I've just seen the photo, and I can see the discoloration you're describing. I think it is reasonable of you to ask for them to be remade and to have a lengthy conversation with your dentist about how to make them match better. It would be a good idea to ask if he works with a dental lab that allows the patients to go to the lab for a "custom shade". This means you, the patient, go to the lab, and they make the shade match your adjacent teeth in person, as opposed to the traditional way of the dentist writing a shade on the lab form for them to match.

I do agree that you would get the absolute best cosmetic result by doing the front four. But I understand your concern about the underlying tooth structure on these, and without x-rays or seeing the teeth after the crowns are removed, I can't give you any predictions on whether or not they would have a high risk of future problems like the front two.

Does that make sense?

Sincerely,

Dr. Lara

Lara Coseo
Lara Coseo, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 697
Experience: Awarded, licensed dentist with over 13 years experience
Verified
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Customer reply replied 9 months ago
Dr. Lara,
Thank you for your detailed response. I think the crowns are both all-porcelain. The underlying implant abutment itself is white, and I think the remaining tooth structure on the other one is also light colored.
My dentist has said he will remake the two front teeth for free, and only charge for the two side teeth. But cost is really not an issue. He believes the implant and the two side teeth are strong, so is not worried about damaging them by removing the crowns. He agrees the second front tooth is vulnerable, and can't guarantee it won't be damaged.
I am wondering whether I should just go ahead and have another implant done for the second front tooth. Then, they'd both match, and I wouldn't have to worry about that tooth failing.I just know that in the past, when I've had extensive cavities filled, the disturbed teeth had to get root canals and crowns. My mouth is full of those!
In any event, I'll have some time between when he preps the teeth and the permanent crowns are ready. Usually, if there are going to be problems, they'll show up within a month.
Thanks for your advice. It helps to have someone look at the picture to see the color in normal light.

Oh! Okay. Good to know (that the abutment and underlying structure of the root canal tooth are both white)! That makes a difference, but that also should have made it easier for those teeth to match... I do think, in the photo, that your lateral incisors (the teeth on either side of the two front teeth) appear to be quite different in their colors. That may make these two front teeth stand out more because he couldn't match both of them, as they are different doctors. Does that make sense?

Dr. Lara

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Customer reply replied 9 months ago
that was also what he said. The the front teeth match one of the lateral incisors but not the other.
Frankly, I have been seeing this dentist for the last 17 years, and he has always done terrific work for my husband and me. We are friends with him and his wife, and his kids went to school with mine. He is known as one of the best dentists in Washington, DC. He has always been a perfectionist about aesthetics. But he is getting closer to retiring, and I wonder if he is still keeping up with the latest techniques and reinvesting in his practice. Maybe he's slipping.
I'm wondering whether I should go to a different dentist, one who specializes in cosmetic dentistry and is up on the very latest techniques. I'd feel so disloyal to Harvey, though. Not to mention, I'd be out the $5000 I've already spent on the two crowns (yes-dentistry is expensive in D.C.!).
What do you think?

I think it sounds like He has done the right thing by giving you the option to replace the two front ones at no charge, and because those two laterals are different colors, it makes sens that you should replace them for a really good cosmetic result. He may be getting tired of dentistry, but it doesn't sound to me like he's cutting corners on anything (except maybe giving you the option to replace all four from the beginning). From what you've shared with me, I don't see any reason to switch dentists at this point. Stick with someone you know and trust, since he is giving you the right option and would redo the front two at no dcharge. The only thing you might want to ask him abou is that "custom shade" i mentioned, where you would personally go to the lab to have them match your teeth perfectly.

Dr. Lara

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Customer reply replied 9 months ago
Thank you so much! That's really what I wanted to hear. I love my dentist and really don't want to switch. I'll talk to him about going to the lab.
This is a great service you offer. Real dentists giving good advice.
I'm a recently retired lawyer. I wonder if there's a similar place for us! :)
Thanks again. I'm now following your blog!

It's funny that you say that. There is definitely a place for attorneys on here. I only became an expert on JustAnswer after chatting with a vert about a problem my dog was having. While I was waiting for his responses, I thought, "Hey, I wonder if there are dentists on here?!?"

It's a good service, and a nice way to be able to help people even though I'm no longer practicing. :)

Hope all goes well with your restorations and the big wedding!

Sincerely,

Dr. Lara

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