I recently asked my dentist about getting veneers for my top front teeth, which are quite worn and have a gap. He recommended porcelain fused to metal crowns, which I had never heard of. I did some research, and it seems to me like this is the LAST kind of crowns I would want on my front teeth. I read everything I could about the different kinds of crowns available, and asked him (tactfully, of course) if he could do something like Zirconia, or some other kind of all-ceramic crown.
He was rather abrupt in his reply. He said that he and his partner will only do porcelain fused to metal crowns, period. I tend to grind my teeth, and would prefer not to wear a night guard, and for these reasons he will not even discuss porcelain crowns with me, saying they will not hold up.
My dentist and his partner both have very impressive credentials, and their prices certainly seem to indicate that they are top-of-the-line. I’ve never had any reason to doubt him before, or question his judgment, but everything I’ve read about crowns indicates that porcelain fused to metal crowns on the front teeth never look realistic.
Is it true that occasional teeth grinding without a night guard rules out ceramic crowns for me, such as Zirconia? I have been wanting to get this done for years, and I want my teeth to look good when we’re done. Can you offer any advice?
Wilson in Sacremento
Dear Wilson,
My advice is to get a second opinion.
Even under intense stress, Zirconia crowns are strong enough to work on your front teeth. As an additional selling point, Zirconia crowns can be made thinner than porcelain fused to metal. This means that less of your teeth must be shaved away to place them, which will leave your tooth structure stronger.
Despite your dentist’s excellent credentials, he may not truly be committed to excellence in appearance-related dentistry. His credentials may really indicate that he excels at making things work well, rather than worrying about how they will look. Many highly educated dentists seem to consider the cosmetic aspects of dental repairs to be beneath their notice. Your dentist’s insistence on porcelain fused to metal crowns on your front teeth indicate strongly that he is more concerned about function than he is about the artistic quality of his work.
I strongly advice that you make no effort to push your dentist or his partner to do something they do not want to do. This is almost always a mistake. You do not have to sacrifice form for function–a skilled cosmetic dentist can certainly come up with a functional solution for you that will be beautiful as well. Rather than pushing your dentist to place something he is not comfortable with, you should consider finding a dentist whose abilities and aesthetic sense are more in harmony with your preferences.
One more thing: I ask you to reconsider the use of a night guard. As you get older, your teeth can break off at the gumline from continued grinding. If you bend on using the night guard, you may find that your current dentist will be willing to reopen the discussion about the types of crowns he will place for you.
I have porcelain fused to metal crowns on six of my upper teeth, and there is a very noticeable, very ugly black line right where the crowns meet my gums. What are my options to get rid of this? I need to find an inexpensive fix, if I can.
Edie in Norfolk
Dear Edie,
There really is not any way to inexpensively fix this issue. To fully answer your question, I have to explain a little bit about the actual structure of the porcelain fused to metal crown.
The black line you are seeing is the metal portion of the porcelain fused to metal, and it is part of the structure of the crown. The dental technician who produced the crown had to use powerful opaquers on the portion of the crown that is closest to the gum line. Your dentist could attempt to drill away the visible metal, but I would never recommend this. Even if he manages to get rid of the black line, there would still be a serious color match issue with the portion of your natural tooth that is revealed, and it would likely be impossible to use bonding to blend the crown and underlying tooth and make it look natural. It is very, very unlikely that this course of action would be acceptable cosmetically.
This leaves you with two realistic choices: live with the black line, or replace the crowns with porcelain crowns. As you are likely aware, that is not what most people would consider an inexpensive fix.
I wish I could offer you a better option, but porcelain fused to metal crowns are rarely a good aesthetic choice for front teeth. Good luck.
I just had a smile makeover done, and while I am thrilled with the results, I am a little uncertain about some of the choices my dentist apparently made. I thought my dentist said that she was going to use porcelain veneers, but now that I have had a chance to really look at my new teeth, I can see that the porcelain goes all the way around my tooth. Isn’t that a porcelain crown?
Have you heard of using crowns instead of veneers? I had another dentist take a look at the work, and he was quite impressed and said that it was normal to use porcelain crowns instead of veneers. What do you think?
Gloria in South Philadelphia
Dear Gloria,
It is indeed quite common to use porcelain crowns instead of veneers, especially on your highly visible front teeth. In fact, the difference between a porcelain veneer and a porcelain crown is a matter of degree—there is no definitive line between a crown and a veneer.
That being said, I would have expected your dentist to provide you with a detailed treatment plan before treatment. If she did so, and what she did is actually different from what the plan stated, I would ask why. There are several reasons I can think of that would indicate the use of crowns as opposed to veneers, such as existing fillings in the affected teeth or a need to alter your bite.
Most cosmetic dentists will always elect to go with the most conservative treatment in an effort to preserve as much of your natural tooth structure as possible. Crowns require a reduction of the entire tooth, whereas veneers can be placed with only a small amount of shaving. Ask your dentist to explain to you why she chose to go with the more aggressive form of treatment.
One of my molars has recently become really sensitive to everything - heat, cold, even air. The tooth has a large filling, so I started to worry that maybe the filling was thinning or something, or had a hole in it. I went to my dentist, and she blew air on it a couple of times, then put some kind of gel on that was to desensitize my tooth, and that did take care of the pain right away. She said if the pain had stayed, she would have to remove the nerve of my tooth, but I want to know how she could know that with a couple puffs of air? My dentist is always in a really big hurry, so I was too nervous to ask her to explain how she knew what was wrong, or if it could be anything else. I guess I am kind of nervous that she did not really figure out what is wrong.
Oliver in Bostwick
Dear Oliver,
Diagnosing the causes of dental pain issues can be a clear cut process sometimes, and it sounds as if this was the case with you. Different sensitivities tell your dentist fairly specific things about what is wrong with your tooth. Sensitivity to air is an indication of an unprotected spot on the tooth, which can be treated with a desensitizing bonding agent. In your case, the pain was transient, meaning that it went away after the desensitizing agent was applied. That further indicated that the pulp or nerve of your tooth was irritated, but had the potential to heal without interference. If the pain had lingered, your dentist would probably have recommended a root canal treatment, because that lingering pain would have been an indication of irreversible irritation.
You say your tooth has a large filling, and that causes some concern over whether or not that filling could be leaking, or have decay under it. Certainly most competent dentists would check the integrity of the filling first, to make sure that was not the cause of the pain. If the tooth continues to trouble you, it may be time to consider a root canal treatment and porcelain crown.
The greater issue here is your lack of trust in your dentist. Trust is the key to good health care, and dental care is no exception. If you are not comfortable asking your dentist questions, she may not be the right dentist for you.
I have epilepsy, just partial seizures, and I also have a mouthguard, one of those that sticks out of my mouth, beyond my front teeth. I have crowns on my front teeth, the upper ones. I was wondering if this mouthguard is good for these crowns, or if it will crack them. If I didn’t have epilepsy and just had bruxism, will this mouthguard crack my crowns too? Also I was wondering if the mouthguards that are sold in stores, like the ones that you form to your upper teeth, are any good. Won’t these crack your crowns too? Thank you for your help on these subjects. Respectfully, Julie from Wisconsin.
Dear Julie,
The mouthguard, if it is put in right, will protect your porcelain crowns from cracking during a seizure or from bruxism or other physical contact.
The mouthguards you can buy in the stores and then you heat them and apply them to your teeth, those usually work just fine, though I would have your dentist check the fit afterward to make sure they will give you adequate protection. Or you can have a custom mouthguard made by your dentist, and this will offer the surest protection but will be more expensive. For bruxism we usually make hard flat splits that snap on your teeth. For epilepsy it may be a softer material that will cushion better. But either one will work.
I just had six crowns done in the front and the color in natural light is pretty yellow and dingy as opposed to the office. I’m just sick over this. My dentist was very clear that I chose the color, even though we only discussed color for 30 seconds. Now he suggests veneers over them if I pay the lab fees. Do you have any suggestions on how I should handle this?
- Sarah from New York
Sarah,
I wouldn’t do any more cosmetic dentistry with this dentist. There are some dentists that are really passionate about appearance-related dentistry, and those dentists will have procedures in place that will insure that you love your new teeth before they’re put on. They will have full-spectrum lighting in their offices that simulate natural sunlight because of this very problem that you have discovered—the teeth look one color in the office and another color outside. If it were really important to this dentist how you thought this smile looked, he would never have put these crowns on in the first place.
It should be the same cost whether you do new porcelain crowns or porcelain veneers over your existing crowns. And doing porcelain veneers over existing crowns has so much potential for going wrong. I wouldn’t be surprised if you would end up looking worse with that route.
I think you have two reasonable choices. The first is to just live with your result. The second is to save your money and have these re-done by a true artist/dentist. Maybe 2% of dentists would fit into this category. Most dentists are technician-minded, and went into dentistry because they like to fix things. Only a small percentage are really passionate about appearance-related dentistry. When the dentistry is functional, your not being happy with the appearance isn’t sufficient grounds before a judge or a dental peer review committee for any recovery on your part.
Hi. I have two crowns that are significantly more yellow than my other teeth. I do whiten my teeth but I cannot afford to have my crowns replaced. I understand there is nothing on the market to whiten crowns. Any suggestions?
- Michelle in New York
Michelle,
There are ways to whiten porcelain crowns, but they are more trouble and just as expensive as replacing them. There is a technique that expert cosmetic dentists know how to perform where the porcelain of the crown can be shaved down and new porcelain can be bonded over the top. Kind of like a porcelain veneer over an existing crown. But the fee for this is usually the same as for a new crown, because it is just as much or even more work as doing a new crown. Plus, the lifespan of this work is shorter than a new crown. That means that your best option is just doing the new crown.
Dental insurance plans may have different rules for when they will consider providing benefits for replacing an old crown. Generally the crown has to be five years old, and then your insurance may help you pay for it, depending on the circumstances. If you can’t afford to replace the crowns, this may affect how much you want to whiten your teeth. Zoom whitening and other whitening treatments will whiten your teeth, but not any dental work.
I broke tooth #15 and need a crown. I don’t understand all the types of descriptions. My dentist says I need a “Porcelain fused to High Noble.” What is that? I don’t see “Gold” listed in any of the descriptions of crowns offered. What is high noble compared to noble? What about 3/4cast high noble. What is base metal? I do not have insurance, and am 60 years old. The old fillng is at least 45 years old. I will have this crown done, but want to go as economical as possible. I am retired. Any suggestions? Thank you.
- Judy from California
Judy,
I can see where all the terminology could be confusing to you.
There are three basic types of crowns: All metal, porcelain fused to metal, and all porcelain. And there are variations on these three types.
The term “high noble” refers to the type of metal, and it basically means the metal has a lot of gold or platinum in it. With a lot of noble metals, the crown can be made to exacting standards, so it gives the best fit. And it is the most corrosion-resistant and malleable. Base metal is at the other end. It is cheaper but is harder to work with and doesn’t fit the tooth as precisely. It may also have nickel in it, which provokes allergies in some people. Noble metal, as opposed to high noble, would have some gold or platinum in it, but it would be an alloy with a lot of some other metal also in it.
So a porcelain fused to high noble crown would be porcelain fused to metal, and the metal is gold or platinum. While this works okay for back teeth, in the front it tends to show a gray or black line at the gumline, and it is opaque. So it can never look as natural as an all porcelain crown. The problem with all porcelain is that it requires sophisticated bonding techniques and many dentists aren’t trained in those techniques. In our office, we prefer the all porcelain crowns because we are very comfortable with these bonding techniques. We use them all day long.
Tooth #15 is an upper left second molar. This is the least visible of any tooth in the mouth. If appearance is of no importance to you on this tooth, then you don’t need porcelain here. That would leave you with a metal crown. And, while you would save a little money by using a cheaper metal, there is only about one pennyweight of gold in a crown, which amounts to about a five percent savings in the fee and a substantial sacrifice in the fit of the crown. I can’t see where that is worth it, because it compromises the life of the crown.
Hopefully this helps you understand what your dentist is offering you.
Dr. McKay,
I have been suffering from bulimia, and am trying to get over it. Meanwhile, my front teeth are badly chipped and look terrible.
If I get porcelain crowns on the front teeth, and I still have problems with bulimia, will the acid dissolve away the porcelain? Or can I get this dental work done while I am trying to get over my problems?
- Unnamed
Dear Unnamed,
If you get porcelain crowns, the porcelain won’t dissolve away in the acid when you purge. The problem is that there is always a small area of the tooth next to the attachment to your gum that the crown doesn’t cover. And if you are still having problems with bulimia, that tiny area of the tooth will be subject to dissolving away, which can create a gap in the margin of the crown that will allow food particles and bacteria to get up inside your crown.
I’d recommend seeking professional help for your bulimia, if you haven’t already. It’s possible that your therapist may think it wise to proceed with some dental restoration as part of an overall recovery program, but I’d defer to their professional judgment on that.
I broke my front teeth in an accident years ago. After years of suffering with tooth pain, I had them pulled and dental implants placed. That procedure went fine. But I am having trouble with the porcelain crown (and the veneers on the adjoining teeth which I was told to have done to assure a consistent looking smile). My first dentist did a horrible job. But now I’m concerned about the work of the second dentist. The crowns and veneers are too white, and the crowns don’t have the shape I requested. My dentist said the color can be changed, and that they can add some porcelain to the crowns to shape them properly. As a layman, it doesn’t seem like the color can be changed after they are already done, and I’m afraid that the “added” porcelain will chip off. Should I refuse delivery on the crowns and veneers and require them to be re-made, or can they be fixed as my dentist represents? Thank you for any insight you can provide.
- Jayne in Virginia
Jayne,
As long as the crowns haven’t been cemented in your mouth, they can be changed in any way without harming their integrity. They can have porcelain added or taken away, the color can be lightened or darkened, or they can have any other change. Then the porcelain is put back in the oven and baked, and it all melds together into one cohesive restoration.
Most general dentists would not let you look at your porcelain crowns and porcelain veneers so closely before cementing on the crowns, so I would commend your dentist for his or her care in this. We are taught in dental school that the dentist knows best, and many will not seek the patient’s input as much as it appears your dentist is. So I’d stick with this approach and hopefully you’ll end up with the shape and color you want, and a beautiful smile.
What you are experiencing is often standard operating procedure when a dentist is fussy about the appearance of porcelain work. We do the same kind of thing in our office when the work comes back from the lab and the patient isn’t fully satisfied with how it looks.
