Tag Archives: dental crowns

Dental Emergency

Porcelain Veneers Keep Coming Off

My dentist said that I needed porcelain veneers because my teeth were discolored, one was a bit crooked, and I would sometimes grind my teeth. The whole process has been a nightmare. They keep popping off, even if I’m eating something as simple as a banana. I would say not a week goes by when one of them doesn’t come off. It’s crazy embarrassing, especially because the only thing left is a small nub of a tooth under the veneer. He does glue them back on, but I usually have to wait a day or two to get in. I think he should consider it an emergency and glue it back in that day. Is this normal?

Penny

Dear Penny,

Crown versus veneer tooth preparation

No, this is not normal. It also sounds to me like your dentist provided you with dental crowns instead of porcelain veneers. Your teeth only have a minimum amount of surface of the front of the tooth removed for porcelain veneers. When you start talking about nubs, that sounds like dental crowns. You can see in the picture above the comparison of the two preparations.

Porcelain veneers are an advanced cosmetic procedure which requires significant post doctoral training to know how to do. Dental crowns, on the other hand, are taught to every dentist in dental school. Unfortunately, your dentist doesn’t even seem to know how to pull that off. My guess is (and please bear in mind that I haven’t examined you) that your dentist has over contoured these dental crowns and that is why they keep popping off.

If you’re grinding your teeth, you will need to wear a nightguard while you sleep to protect them, but that isn’t the problem with your crowns. When they are properly formed and bonded on they are secure. They certainly wouldn’t fall out from eating a banana. Yes, I agree with you that your dentist should fit you in the same day to bond that back on. Most dentists leave some room in their schedule for dental emergencies.

However, I think you need to have these crowns looked at by an expert cosmetic dentist. I’m concerned about the amount of crowns popping off. It may be you need these completely redone. If that is the case, don’t just ask for a refund. Ask for the dentist to pay to have this repaired by the dentist of your choice.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Dental Emergency

Porcelain Veneer Broke

I had porcelain veneers put on my teeth to cover my tetracycline stains. I’d actually gone to another dentist to have it done quite a few years ago. One of them has recently broken horizontally. I went to see my dentist and he fixed it with some glue, but it looks like an obvious fix and feels uncomfortable on my upper lip. He’s said it will be a couple of weeks before we he can get to my temporary crown. I was hoping to get this fixed faster, but he said it isn’t a dental emergency. Do you recommend I try to get in to see someone sooner or will everyone make me wait?

Stephanie

Dear Stephanie,

An image of a porcelain veneer being held up to a tooth.

There are a couple of issues here. While this situation isn’t your typical dental emergency, like an infected tooth, most cosmetic dentists would understand the importance of an aesthetic emergency. A second issue is his idea of giving you a dental crown. Why? Is something wrong with the tooth where it needs a crown? If not, then that would be a major overtreatment and completely unnecessary.

This can be repaired with another porcelain veneer. My guess is that your dentist does not have the training or skill to do porcelain veneers. They are an advanced cosmetic procedure. Instead of telling you that he is out of his depth and recommending a skilled cosmetic dentist, he is steering your toward a procedure that he is comfortable with. Every dentist knows how to do porcelain crowns.

My suggestion is that you go back to the original dentist who did your veneers and have him make you another one. If he is retired, then I would look for another cosmetic dentist in town who has training in porcelain veneers. Just make sure that they show you some examples of their work. They should have a smile gallery of cases they have done. If the results aren’t beautiful, then look for a different dentist.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Teeth Whitening

Retouching Teeth Whitening

I whitened my teeth several years ago and would like to retouch them before I have to get my dental crown. This way I can make it into the color I want. The problem is my dentist can’t tell me how to go about this. I’m hoping you can. My dentist has a 33% of whitening gel. Here are my questions. First, how many weeks should I use the gel? Second, for how many hours each day should I whiten?

Audrey

Dear Audrey,

Image of teeth whitening trays
Professional teeth whitening trays

There are not specifics that work with teeth whitening like that. However, there are general principles. I don’t know exactly how white you want them. The most basic of these principles is that the longer you wear the whitening gel, the faster your teeth will whiten. If you wear them overnight, which is the most effective time to bleach, your teeth will whiten much faster than if you just wear the trays for an hour a day.

As an example, and this is most definitely not exact, if you wear them overnight, you could do in one week, what wearing them an hour a day would take you eight weeks. Again, not exact, and it depends on how white you want them.

The one sure principle, is something you have not asked. You will need to wait two weeks from the time you finish whitening until you match the crown color. This gives the whitening the time to settle to its final color before you start with the porcelain crown.

One thing to bear in mind here. If your dentist was not able to answer these basic cosmetic questions, then how can he or she provide you with a beautiful crown? You may want to at least make sure your dentist is going to do a temporary try-in and let you make sure everything matches in a way that is beautiful before permanently bonding them on. If you’re not happy with the crown, he should be willing to send them back to the lab.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn about same day crowns.

Emergency Dentist

When a Dental Crown Feels Off

I had a root canal and dental crown put on a tooth a couple of years ago, but it has really been bugging me lately. It’s not pain, it just awkward. I know that makes absolutely no sense, but it is distracting. My dentist said he can replace it. I let him, but it did not really make a difference. I am not sure what to do. I feel like I’m going crazy. Have you encountered anything like this?

Andrew

Dear Andrew,

Man in pain, grabbing his cheek in need of emergency dental care.

When a dental crown is done correctly and nothing else is wrong that has been missed, you won’t notice the crown at all. It will just fit in with the rest of your teeth. That is not happening for you, so obviously, there is something amiss. You are not going crazy.

Believe it or not, I know a colleague, an advanced and experienced dentist himself, that went through something similar. He too was not being listened to by his dentist, so he switched. When he went in for his first appointment, he asked the hygienist to take a periapical x-ray in hopes of getting some more information. Boy did he!

It turned out that the tooth under his crown was halfway eaten from decay from the inside. He didn’t feel pain because that tooth had a root canal treatment done on it, just as yours did. It was a good thing he kept following up on this because that decay could have spread and caused a massive dental emergency with little warning.

The solution in his case was to have the tooth extracted and replaced with a dental implant. In your place, I would suggest that you go back to your dentist and ask for this same type of X-ray. Follow your gut and until you are comfortable, don’t back down. If he won’t follow up, find a different dentist.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

CEREC crowns

My CEREC Crown Doesn’t Match

Hi there,

After I got home from my CEREC crowns appointment, I noticed my crown was a different shade from the rest of my teeth. Getting the CEREC crown was quick and convenient, but the result is brighter than the rest of my teeth.

I did not want to bother my dentist again, so I tried to fix the problem by whitening the rest of my mouth. However, this did not work and the crown is still too bright.

Is there a way for my dentist to make my crown a different color? I like my CEREC crown, it fits perfectly, but I want a natural smile.

Max, from Friendship, Pennsylvania

Hi Max,

porcelain block for CEREC crowns

Your dentist can change the color of your crown, but he will have to redo it. If you get the crown redone, be sure to first have them use a temporary try-in paste so you can check it under many different light sources – natural lighting, camera light, bathroom lighting, as much as you can. This will give you the best idea of what your crown will look like when you go home with it.

If the CEREC crown still does not match, you will have to send it to a dental laboratory, which will need to be done through your dentist. A master ceramist can match the color, but it may take several attempts. This will lengthen the time it takes to get your crown, however.

The ceramist will have to cut back part of crown’s ceramic and apply a porcelain overlay. Porcelain is easier to color match. CEREC crowns are milled from a block of porcelain, making them very strong but the block is all the same color. Without any shading, it may look unnatural.

CEREC crowns are some of the newest dental technologies, and cosmetic dentists require skill to work the machine. If you want your crown redone, you may need to see a different cosmetic dentist, one who is more experienced with CEREC.

This blog post is brought to you by Gilbert Dentist CEREC crown provider, Dr. Matthew Roper, of Vista Dorada Dental.

Affordable Dentistry

Using a Cheap Alloy Instead of a Gold Crown

I have some sensitivities to metals and other dental materials. When I needed a root canal treatment and dental crown, I specifically asked my dentist to provide me with a gold alloy crown so I would have less to worry about. The root canal treatment turned out fine, but I’ve been having some swelling around the tooth. I asked to see the dental certificate and my dentist told me the lab did not send one. I requested him to get one and it turned out the materials were not what I requested. There was only 2% Gold. The rest was 35% Palladium, 30% Indium, 30% Silver, and 3% Zinc. I suspect this is why I am having some swelling, though my dentist insists there are never allergies to these materials. Am I wrong for being upset about this? I’m beginning not to trust him as the cost for the crown was in line with a gold alloy but I received something quite different. Where do I go from here?

Benjamin

Dear Benjamin,

identalloy certificate

I’m going to say up front that I do not believe your dentist did not receive the certificate. By law, the labs are required to send them and the dentist is supposed to place that in the patient’s chart. It appears he wanted to increase his profits by giving you a cheap substitute believing that you wouldn’t have a reaction. I have learned not to say there are NO allergies to something. Each human body is remarkably unique and there is always the possibility that someone will have an allergy to something, even if very rare.

For a dental crown to be considered a gold alloy, it has to meet two qualifications. First, it must be made of at least 60% of a combination of gold, platinum, palladium, and silver. Yours was above that number and meets the first qualification. Second, it must be at least 40% Gold. Yours was only 2%, which is well below the qualification.

I’m going to suggest you ask him to re-do the dental crown with the materials you requested. If he refuses, tell him you will report him to the dental board. He violated the standard of care in two ways. One by misrepresenting what he provided you and two by not having the certificate (or pretending not to). Then, I want you to find a different dentist. One you can trust.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
Click here to learn how we keep our dentistry affordable.

Affordable Dentistry

Affordable Crown Costing Me a Fortune

I needed a dental crown and my dentist was going to charge $1000. I found another dentist about twenty minutes away who only charges half of that, which was much more affordable for me. Initially, that was great news, but it has fallen off six times since I got it, two months ago. Each time, the dentist puts it on again free of charge, but I still lose a minimum of two to four hours at work, depending on how long I am there. I get paid hourly, so this is cutting into my income quite a bit. Plus, my boss is not too pleased. Now, the stupid thing has broken and we have to start over. He said, I would only have to pay half price since I haven’t had it that long, but still, that is another $250 on top of MORE time lost at work. Is this normal?

Kelly

Dear Kelly,

Gilbert CEREC Crown

I’m sorry, let me understand something. He’s offering you a half-price crown because it didn’t last that long? Really? I believe you said you have had this crown a little over two MONTHS, right? A dentist crown at a MINIMUM should last five YEARS! Most go much longer than that. Do not pay him any more money or go back to this dentist. Instead, I want you to get a refund on the original crown. He does not know what he is doing.

Aside from the crown breaking years before it should even begin to show signs of wear, there is the issue of the bonding failing over and over again. Most dentists go their entire careers without a dental crown falling out. This dentist can’t seem to go much more than a week, and that is just with one patient. I probably sound harsh, but you are getting poor quality care and I don’t want you to go through any more with this dentist.

Cheap Versus Affordable Dental Care

There is a huge difference between a cheap and an affordable dentist. Let’s say, for argument’s sake that you go ahead and have the crown redone at half price. Now you are up to $750 not including lost income and time away from work. This time, the crown lasts two years before you need another one. That’s another $500. Now you’re up to $1250. The next crown lasts a generous 5 years (woohoo!). That’s another $500 and you’re up to $1750. If you’d gotten the original crown for $1000, you could have had a hassle-free crown that lasted up between 10-15 years, assuming your current dentist does good, standard work. As you can see the “cheap dentist” was much more expensive.

While there are good affordable dentists, you won’t usually see their prices so dramatically lower than everyone else. When a dentist is that much lower it is usually a red flag. Often that happens for one of two reasons. Either they are terrible at their job and have to keep their prices low enough to constantly draw in new patients, because he has no patient retention. Another possibility is they are new dentists and need to get patients. That’s fine. We all start somewhere. For a price that low, they’d have to cut corners to keep profits reasonable enough to stay in business. Those cut corners could negatively impact your outcome.

I would go back to your dentist, tell him your financial situation and ask if he or she would be willing to allow you to make payments toward your new crown.
This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
We offer dental sedation.

Teeth Whitening

Dentist Can’t Match My Crown

I need some advice. I don’t know if the problem is the dentist or the lab, but my dentist cannot get my dental crown white enough to match my teeth. I’m new to the state and am using a different dentist than I normally would. However, this is my first dental crown so I don’t really know what to expect. I only came to him because of a dental emergency and he was available. I was in a car accident and had serious damage to a canine tooth as a result. He says he is using the whitest shade possible. I do whiten my teeth, but they don’t look unnaturally white. Just whiter than what he’s offering. It’s a noticeable difference though. Is it worth it for me to drive to my old state to get this to match or am I asking for the impossible?

Brooke

Dear Brooke,

I don’t think you’ll have to do anything as drastic as going to another state. I think I know what the problem may be here. Understand that this is mostly guess work, but I feel fairly confident with it. This dentist is probably a great bread and butter general dentist. He knows how to fix teeth and he does it well. However, he is more interested in the engineering factor than cosmetic work. He probably doesn’t really do any cosmetic work. This is the problem.

Old Vita Shade Guide
Old Vita Shade Guide

General dentists use a shade guide to help them match the crown they are making to your current shade of teeth (see above). He is probably using the same shade guide he’s always used. The problem with that is the popularity teeth whitening gained in the 90s. Teeth whitening does not just remove stains. It can also make your teeth whiter than even their original shade. That means the old shade guides were no longer as useful. Dental supply companies realized this and soon came out with an updated guide that included shades for whiter teeth (see below).

New Vita Shade Guide
New Vita Shade Guide

I would ask this dentist for a refund and then go to a dentist who does more cosmetic work. They will have the updated guide and can match your teeth.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Dental Emergency

When Does a Tooth with a Root Canal Treatment Need a Crown?

I have a root canal treatment that has never been crowned. Recently, I read that is a mistake. Should I get this crowned? I used to have dental insurance, but now I don’t so I don’t want to spend the money if I don’t have to. What are your thoughts on it?

Bruce

Dear Bruce,

I’m very glad this question came up because I have seen some people just crown every tooth that had a root canal. In some cases that can do more harm than good. Much of the answer to this question will depend on which tooth you are talking about. If it is a back tooth, such as a molar, then I would say to crown the tooth. It will protect it from the type of biting forces those teeth face. With other teeth, it gets more complicated.

illustration of a a front tooth

The biting stresses on a front tooth and their adjacent teeth are mostly horizontal because of the tearing stress. This means the neck of the tooth is the most vulnerable. By the time you prepare a tooth for a dental crown, it loses a minimum of 30% of its diameter, putting additional stress at the neck of the tooth. If that tooth also lost a significant amount of structure before the root canal treatment because of decay, there will be even less structure there.

If you place a dental crown on a front tooth that doesn’t have the necessary diameter to support the forces it is subjected to, it could end up breaking at the gumline. Some dentists try to overcome this by placing a post in the tooth, though that can increase the chances of the root fracturing, which will require an expensive repair.

The issue with front teeth after a root canal is that they tend to turn dark, which becomes an appearance issue. Our smiles are one of the first things people notice about us so we want them to look as nice as we can. Here is my advice on how to keep its white color longer and what to do when it does turn dark.

Helping a Tooth with a Root Canal Keep its Color

Your dentist needs to thoroughly clean out any root canal material and cement from the crown of the tooth, these are huge contributors to the dark appearance. Next, he or she should place a white fiberglass post into the tooth. Fiberglass is more flexible and will help with the stress. Finally, fill the remainder of the open area with white composite filling material. Doing this will extend your tooth’s color.

If it does eventually turn dark, instead of crowing it, I would suggest a porcelain veneer placed on that tooth. That removes far less structure, which will be better for the tooth viability in the long run.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
We treat dental emergencies.

CEREC crowns

Help! My Crown Keeps Coming Out!

Hi there,

Last year, I had a same-day CEREC crown done on one of my teeth. I was happy with it at first, but since then, it has fallen out several times. Each time I go back to the dentist to get it fixed, but it always falls out again. Finally, I went to a different cosmetic dentist. He replaced the setting for the crown, and said that I should get a new all-porcelain crown, as it would stick to the cement better. I just want my tooth to stay put, like it’s supposed to. I’m not sure what else I can do.

Nephenee, from South Carolina

 

Hi Nephenee,

No matter what material your CEREC crown was made from, it will stay permanently once properly placed and bonded. Making a new crown will not fix the problem, as it is not the crown’s fault it keeps coming out.

Crowns need strong cement and to be properly shaped to stay in place. If your dentist over-prepared your crown and shaped it too much, no cement will be able to hold it in.

It’s likely your crown was prepared with inadequate retention form in mind. You will need a crown specialist to properly shape your tooth and cement it in place. Look for a dentist with experience in dental crowns, or another CEREC dentist in the area.

This blog post is brought to you by Gilbert CEREC crown provider, Dr. Matthew Roper, of Vista Dorada Dental.