What Should A Good Porcelain Crown Look Like? -

After chemo treatment, a tooth cracked and a root canal and crown was done. It has been 8 weeks and the crown just continues to cause pain. I have been back 3 times and it has been filed down and had the bite adjusted but still does not look like my tooth or its original color. I paid over $2,000.00 and I feel that the crown was not shaped properly. It’s flat in the interior and no point as my real teeth have. My smile and teeth are beautiful and has always been remarked on and I just don’t know what to do.

Dear Nannette,
If you are local then please stop by and I will take a look, no charge. If not, here is what could be happening:
– the crown could be a poor fit and then should be redone. Check the x-ray (or send it to me) to find this out
– the root canal could have been incomplete or not good. Again, need an x-ray for this
– the crown should look good for that price. If too much is adjusted then it will no longer look or feel like a tooth and it should be redone

I hope this helps! Don’t give up, it needs to be done right!

Smile, It’ s Natural,
Dr. Chris

Doctor,

I just got a pair of frontal crowns placed a week ago. Right now, I am suffering dole pain in on of them. Can send you a picture of the crown to get an opinion of them?

Thank you

Dear Anonymous,

What would really help is a good periapical x-ray and some clear digital photography. If you have the x-ray please feel free to send it to me. It sounds like you may have a root problem…that is what we see with “dull aches”.

Keep smiling,

Dr. Chris

I have a complete crown done ,my bite is completely off giving me a lot of head aches and pain , seams that my upper teeth are too wide when they took the impression a lots of pain and unable to chew

Dear Pilar,

A good fitting crown is comfortable, smooth and looks like a real tooth. Anything else is not acceptable. You could go back to your dentist and ask them to fix it…often they will just do a root canal therapy which does not address the problem.
You are also welcome to come have our office take a second look.

Hope that helps.
-Dr. Chris

I had a crown placed today on a lower 2nd to last molar. I can see a strip of brown between the gum line and base of the crown. Is that normal? I called my dentist and he assured me the tooth is sealed and it is normal. I don’t feel right about it. What do you think?
Kathy

Dear Kathy,

There are many reasons why a strip of brown would show up at the gumline, some good, some bad. What I am confused about is that you addressed this with your dentist and they said simply “it is ok.” In this type of situation a dentist needs to explain “what” the line is in the first place. If you have a good relation with your dentist I suggest you ask him what exactly the brown line is. Have him explain it to you. If the answer seems fishy or is not acceptable, seek a second opinion for another dentist, it always is free.

Smile, It’s Natural!
Dr. Chris

I just had a posterior crown replaced for the third time. The new crown was made by a different company according to the dentist. The crown had to be filed down in areas to fit bite. After the tooth was glued in and a mirror was given to me, I noticed a black spot next to the gum on the tooth and the white of the tooth around the spot (chip) looks lighter white in color (?). Really it looks like I have a cavity. The hygienist said that it was okay that my gum will cover it up if I brush the gum gently down with my tooth brush. I asked her about the backside of the tooth to make sure it fit well and nothing could get under it and cause bad breath. She said it was good, she promised. — When I got home I showed my husband and he said it did not look right but no one can see it unless they are looking for it, that my smile corner just barely covers it. I took a dentist mirror and looked at the back side of the tooth in the bathroom mirror and there is a black (dark) line between the gum and the white of the crown. — Now to let you know, I truly thought this was a replacement of a bad crown that I had only for about two years, which was also a replacement of a bad crown that broke. The tooth had decay underneath that the dentist and hygienist did not seem that big of deal, it was awful and smelt bad. (I stop kissing my husband because of it and I love to kiss. I did say something the the hygienist at each visit about my concern.) –The tooth fell out eating a sugar daddy at Christmas; it was great to brush the yuck out. Well, I though the new crown was at no cost but I found out today that I have been charged about $800 for the crown. the office is closed now but I will be calling them on Monday. I was hoping you can advise me on how to handle this, is it a good/bad tooth, is it wrong to ask for a tooth with out spot and back ring around back of tooth. I’m afraid the dentist will still charge me and not replace the tooth and tell me to go to a different dentist for now on. Not to overlook the fact, I’m afraid the tooth will have problems in the future. It is already sensitive to cold, I haven’t had anything hot. I’m not sure if this is normal because the other crown was like this and I just got use to drinking with a straw or taking my drink with no ice.
Thank you for your help,
Tracey
PS. I just want a good tooth/crown that I don’t have to worry about decay and bad breath. I want to kiss my husband every chance I get without having to be concerned about a nasty tooth. I do brush my teeth three to four times a day and buy plenty of mouth wash and floss — All because of a bad crown, it became a habit. I even have a toothbrush and paste at work and in my vehicle.

Dear Tracey,

I am sorry to hear about your story…It sounds like you still did not receive that “permanent” crown that you were looking for. All your points are valid and here is what I suggest:
Cancel your Monday appointment, get a second opinion with a premium dentist (how do you find one of those? I will tell you in a sec). Most dentists, especially at the top level, don’t charge for second opinions – we really do want to help people 🙂
Then, depending on what that dentist says, get a new crown, leave the one you have or switch dentists.
Finding a premium dentist is not easy. Most top dentists, especially in a place like Kentucky, do not subscribe to any insurance plans ($800 for a crown unfortunately is not premium while still expensive to most people). It is always better to pay a little more and get something that won’t do more harm than good and solve your problem…
Check the http://www.aacd.com website and select a “accredited” dentist. Call and ask dentists who their “lab technician” is, ot what lab they use. You want to know that they have a relationship with a single person! Then call that person and ask who the best dentist they work with is.
I can also help you if you like.
All the best,

Dr. Chris

Is this crown good or bad? The dentist had to file it down on one side because it was too high. It doesnt look anywhere near as good, or feel as good as the temp he put in. I paid $1,000 out of pocket and I feel really unsatisfied.

This is a tough question to answer with such little information. I would highly suggest a second opinion and reading the answer I just put up to a similar question!
All the best,

Dr. Chris

Hey Doc. Received a new crown.It chipped off about 15% the next day carefully eating a smoked walnut.Dug the nut out of the tooth and gum, and chewed it on the opposite side with no problem. the nut was not hard and bad. During installation of the crown I tried to inform the dentist it did not feel right. he ignored my comment.Every time I bit down I could feel it stress and go lower down.Like having 2 thimbles the same size. the top of the peg might not bottom out.The walls not the top would be stressed causing stress chipping.What do you think?

Hello Tim,
A crown should fit comfortably and certainly not break that quickly. Sounds like make the bite (the way the crown touches the other teeth around it) was not right.
Your dentist should see if the crown can be fixed, ie, smoothed and adjusted correctly, or more likely, redone.
This problem is so common (read all the comments on this blog alone) that I might put up a “patient advocate” blog post with names of labs that patients should use to have their crown made – Good, not over priced labs.
I would suggest you tell your dentist, and if they ignore you go get a second opinion. If after that second opinion the dentist is still not interested in fixing it (which would be foolish), then you can pursue more aggressive action.

Keep smiling,
Dr. Chris

What about dental crowns that are off centered to the face? Spent almost $9,000.00 on crowns but after put in they are off centered to my face and very noticeable. Would like feed back or comments.

Dear Anita,
Off center smiles are very challenging to correct. One prime example is Tom Cruise who had the most famous off center smile. I believe he redid his teeth numerous times….
Regardless, your temporary restorations should have shown you what the final smile would look like, including the midline. This is a critical step in anterior cosmetics as it makes sure you get what you desire.
I would need to see a photo or meet you to see what options you have. Often braces are part of the treatment plan…
Stop by for a free consult!
Keep smiling,
Dr. Chris

I received an implant about 6 months ago. A couple weeks ago my dentist went to put the crown on. It was too big and stuck out. My concern was he tried to convince me it looked ok. I had him send it back to his dismay and just received the other one last night. I had him put it in but it looks ridiculous. Its too big. The whole time of the procedure he is talking how the lab bakes it and it gets bigger. I don’t care about that ! I wanted this tooth (#10) to look like the # 7 tooth. despite my instruction the tooth is too big.
What can I do ? I

Dear Michael,

The crown should look good to you. Period. “It get’s bigger in the oven” is hogwash. You spent a lot of time and money on this tooth, and it is right in the front of your face…it needs to look good!

I would be more than happy to take a look for you, or you could send me a high rez photo.

Keep Smiling,
Doc Chris

My tooth was cracked and my dentist suggested a crown. It didn’t really bother me much, but i thought it was better to take care of it now before it breaks. When the permanent crown came in, it was too small, so my dentist had to drill down my tooth more. It wasn’t comfortable, but my dentist insisted that it would not feel that way the next day; I just needed to get use to it. It has been over 2 months and I am having pain when I chew. The tooth may also be cracked (though hard to see in my bathroom mirror). I am concerned that it all stems from the fact that he had to further drill my tooth after the permanent tooth was made and so it’s not a perfect fit. When I called about it, I was first told to wait 6 -8 weeks (even though it had already been 2 months) and that I would likely need a root canal. I find it hard to believe that my tooth that didn’t bother me before now hurts and I need a root canal. Any suggestions?

Dear Dee,

A crown should fit without much adjustment. The tooth should not be touched when the crown is delivered. The fit would have had to be terrible for any dentist to have to cut the tooth down more. Big red flag.
After the crown is cemented it should feel good. A little sensitivity is ok for maybe 3 weeks. The bite should be perfect. On rare occasions sensitivity may last longer, but not pain.
A cracked tooth is difficult to treat, so it requires meticulous attention to detail.
Sounds like the dentist wants to just wait till you need a root canal treatment to “get rid of the problem”. This will not solve the “reason” behind the pain/pad fit and will only result in possible complete fracture of the tooth and loss of the tooth. This is, of course, a guess as I have not seen you.
I would recommend you get a second opinion (soon) from a dentist.
Keep Smiling,
Dr. Chris

Hey Doc!

I am so glad I found this website. I am desperate. Here is my long story. Last September, I broke a tooth. My dentist put on a crown. A few weeks later, I was throbbing in pain. He sent me to the endo for a root canal. After the root canal, the pain continued and got worse. He adjusted the bite several times, but to no avail.

He sent me back to the endo who made a discovery. I had a food trap that was so deep, he could hardly get the food out with his equipment. Underneath the food was a huge ulcer. He told me to go back to the dentist.

The dentist assured me there was nothing wrong with the crown. He acted annoyed, and was very defensive about the contact. But he said he would give me a new crown anyway.

When I got my temporary, he said I shouldn’t need to be numbed and he wouldn’t find anything wrong. Well, low and behold, he found the “ulceration.” When he formed my new crown, he said he made the contact wider so I could clean the food out easier.

Well, now I am in more pain than ever. I went to a periodontist, who drained my abscess from the food trap. He told me the contact was way too wide, making it impossible for the dental floss to clean it out. He said I needed to go back and get a third crown.

I cannot tell you how upsetting this is. I’m not sure if third time will be a charm. I want to go to another dentist, but that would mean paying for a new crown altogether. But if I go back to my current dentist, I’m not sure if a third crown will do the trick. Plus, it’s so awkward going back again!!! Please, please, gove me some advice. Thanks so much!!! 🙂

Dear Ann,

What an ordeal! This type of scenario (bad crown, problems, second bad crown, etc.) is all too common. There obviously is something going on that has not been addressed properly. I would be very surprised if a 3rd crown would fix it!
Long story short, you need to see a top quality dentist to solve this issue asap. You are loosing bone and tissue that makes the fix even more difficult. Yes, it will cost more, but it will be done right.
So, go see an AACD Accredited dentist! They take pride in their work, stand 100% behind it and know what they are doing.

Keep Smiling,

Dr. Chris

Hello Dr. Hahn,

I like your blog. I think we have something in common…we are both promoting good restorative dentistry…though we might approach it from a different perspective and in a different way. I invite you to take a look at might site when time permits. Feedback from a professional like you would be appreciated.

http://bamdental.com/pudelabaw.html

Thank you,

Jose

Thank you Jose.
Good luck with your site. Bringing awareness to the public is always a good mission…
Ciao,
Dr. Chris

hello Dr.Chris,
i was wondering if you can take a look at this crown tooth#14 and if your opinion is also that is not the right color or if it is too big for the teeth near it.thanks, cristina

Dear Cristina,

I could certainly take a look at it for you. The challenge is that top quality dentistry and average dentistry are light years apart. A crown may be completely “acceptable” in a functional way yet still be big and ugly. Top quality crowns cost more because they require top quality laboratory technicians, time and effort. Often people want top quality crowns but then expect their insurance to pay for everything. In reality, dentists here in Kentucky get so little reimbursement from insurances that top quality is impossible.
So, I would certainly be able to look at the crown and give you my opinion, but if you want a beautiful, perfect crown it will probably need to come from a dentist that is out of network with insurances.

Keep smiling,
Dr. Chris

How likely is it that if a crown that was placed about a month ago is replaced that the tooth will break.

thank you. Tina

Dear Tina,

I think just about every patient is worried that their tooth will break if it is worked on. The good news is that teeth very rarely break while being worked on! Removing a crown from a tooth is not very difficult, most of the time, so replacing it, especially if it does not fit well, is no problem.
Hope that helps.
Keep smiling,
Dr. Chris

Hi, I recently received two porcelain crowns that I believe are ill fitting. I did have some decay under one pvc that was replaced & did have composite filling (large one) before new prep. I received the crowns & was surprised that the margin did not encompass all of the tooth structure. Particularly at the medial & distal areas on both teeth. These are quite large gaps & my dentist said,” the teeth are wider at the top than at the bottom…therefore the fit is as it is…..with gaps”. Am I wrong in thinking that, a tooth with compromised structural integrity should be completely covered by pvc to have the best, long-term outlook? I already had decay so, I feel that this is going to open the door for possible complications in the future. Should he have taken more tooth structure at prep to ensure complete coverage? By the way, my sensitivity is through the roof with hot/cold even after tenure tx.

Dear Lori,

I think it would help to have a photo or see the teeth in person – I am not exactly sure what I am looking at. But, that being said, crowns generally encompass the entire tooth structure for multiple reasons. On occasion we leave the margin above the gumline on enamel, the hard tooth structure, so that we have a better seal and stronger restoration. This only works if there is no color issues.
Sensitivity never is a good sign. In my experience it usually is related to open margins or a failed cementing procedure. The bite, or how the teeth meet, could also be “off”.

In the next week or two I am actually posting a very generous offer to all patients that had dentistry performed that they do not like! You may want to consider taking advantage of this. I can’t give it away yet, but it will give patients a “second chance” and fix bad looking dentistry.

Come in to my office and I will take a quick look, no charge, so that I can give you a better opinion!

Keep smiling,

Dr. Chris

An old bottom molar crown fell off (lower left 1st molar) from a previous dentist. It had been bothering my gum for a few years. The dentist was able to reuse the old crown as a temporary until I went back in to get the new crown put on. The new crown doesn’t look as much like a tooth. It seems to get narrower coming up from the gums and feels smaller and more like a pocket on the surface. The dentist also told me that his technician told him that he should file down the outside of my upper left 1st molar. Now my upper molar feels flat until I get to the interior side of the molar where there are some ridges. Is this normal? I’m wondering why I would need to have my upper molar filed after 4o years. Thanks.

Dear Chaz,

There are some great questions in your comment!
First of all, good thing that old crown came off. Over-contoured crowns that irritate tissue in my opinion are the worst thing you could possibly have in your mouth. Getting rid of that “thorn” will certainly help your immune system and overall health.
Secondly, without seeing the crown I can’t really comment on the shape, but, in general, a small crown is significantly better than a bigger crown. You need good solid contacts when you floss (floss should click through the contacts). Also, a perfect fit at the gumline is simply essential.
When your technician told the dentist to adjust the opposing tooth he simply noted a spot where the crown was thin. The dentist did not reduce enough tooth structure in that spot. The old crown either wore down in that spot or was just under prepared in the first place. It happens to all dentists and usually a LITTLE polishing off the opposing tooth is not a problem and even sometimes essential to fix the bite. You should not be able to feel the difference – if you do then it probably was not a little…
I hope the dentist polished not just the new crown but the tooth he/she adjusted!
So, if your bite does not feel right then it needs to be adjusted or serious problems will develop.

Keep smiling,

Dr. Chris

hi, I have all my teeth capped and when I close my top teeth to my bottom it dosent close all the way and my lower teeth have some of my old teeth exposed above the gum line is that supposed to be like that please help thank you!.

Dear Allison,

Without seeing your case I can’t comment in too much detail. The way teeth come together, or the function of the mouth, is incredibly important. All teeth should touch! Note that teeth move towards the path of least resistance, meaning if they are not touching an opposing tooth they will move around. This can and often does result in TMJ problem. So, if your dentist invested a lot of time and you a lot of time and money into this reconstruction, he/she should work with you to get this right!
On the bottom teeth comment – if you have “bonded” restorations then I would keep the “margins” of finish lines in enamel, or the outer layer of tooth structure. Bonding to root surface is really not good and not recommended. It sounds like your dentist probably kept the margins in enamel, which indicates that he/she did it right. The problem is that you should have been informed of this before it was done! My patients are informed of this before I do it so they understand why, and if they are selecting a very white shade or don’t want any exposed tooth structure then I need to change the type of restoration from bonded to cemented.
The only way to know for sure is a second opinion. I would recommend one for you.

Keep smiling,

Dr. Chris

Thanks for all the wonderful feedback, and sorry to bother you with something definately relatively minor, but my mother has a 4-5 year crown that the dentist now says decay has crept in due to gum recession. After looking at it myself, the crown does seriously overhang the tooth at that spot, and seems to usually touch the gum(before/after the dentist measured the gum recession). The decay looks healthy and does not hurt(hot/cold/pressure/other), but is apparently sticky when probed. My mother does brush/floss all the time, but this appears to be a small crack between the gum and the upper crown that may have originally been tiny or just not there. Luckily the gums do not not seem irritated(unlike some similar things above).

I’m guessing this was a bad crown(hangs over tooth/gum), and is it fixable? The current dentist mentioned nothing about an overhang, and is this overhang of the crown over the tooth/gum at the gum line a sure way to decay the root?

Thanks for the great above diagnoses, and a lot of what I’ve read above has really helped me with this specific problem.

Dear John,

The problem your mother has is quite common. While I cannot attest to the quality of the crown without seeing it (pictures?), I am pretty sure how the decay happened.
Bad fitting dentistry simply accelerates the decay process by giving the bacteria and acid a place to work. In older individuals the saliva has lost much of its protective potential due to medications that either dehydrate the patient (anti-histamines) or make the saliva, and body for that matter, more acidic. Acid causes these exposed root surfaces to quickly become soft and decayed.
For this reason fluoride is good for patients that have root decay. I am more on the holistic side and don’t recommend fluoride lightly, but when problems like you have mentioned appear then it really helps.
Take a look at the medications your mom takes. Get top quality, good fitting dentistry, and then make sure she brushes properly, drinks lots of fluid (maybe even use a saliva substitute like “rain”), and use products to rebuild tooth structure like fluoride and MI Paste.
I hope this helps!
Keep Smiling,
Dr. Chris

I just got 2 crowns done today on the lower teeth (molars). They seeded too high so he drilled them down. Now I see 2 small pin heads of silver. Because they are on the bottom it looks like I have food in my teeth! Is there anything that can be done? I am changing dentist already because this one was not so good – but I need to finish up with these crowns with this dentist if there is an issue.

Dear Jessica,

It turns out that this happens way too often in many dental practices! I JUST wrote a blog post about this:

You should read it…
If the crown does not fit, SEND IT BACK (speaking to the dentists here). Adjusting a crown until you cut through it is not only a waste of time but extremely poor dentistry.

Get your dentist to redo those crowns that were adjusted through the porcelain, at no charge to you. It is bad enough you need to waste your time coming back 2 more times to redo it…

Keep smiling,

Dr. Chris

Dear Doc I had a root canal done 4 months ago and for 6 weeks I had a sore spot below the tooth in my gums that felt sore when I touched it plus the tooth felt sore to the touch when pressing down on one side. I went back to the dentist three times. The first time the dentist re-cleaned inside and there was no change. The second time the dentist said I might have a crack so the dentist put in two fillings and the temp cover back on. The third time the dentist flushed the tooth out again and the next day the tooth started to fell better and better for about 6 day’s then stopped and started going back to the sore tooth. I was sent to see another dentist who said I have a crack somewhere in the tooth but in Southern Thailand they have no way to tell were that I should just have the root canal finished (filled) and a filling placed over it and hopefully it will get better with time. That I should not consider a crown as the crack is more likely horizontal and it may just break the tooth. I know this is out of the box thinking but I have solved some pretty hard engineering problems out of the box from time to time. Does the problem sound like a crack to you? Can it be that not enough nerve was removed? Thinking outside the box if I am going to wing it as there is no equipment here to test for a crack could I have the dentist put studs in my tooth that would hopefully go down beyond the crack and then cover the top of the studs in a filling. I know this is way out of the box but like I said I have solved many problems in my life thinking out the box.

Dear Mike,
I like the “out of the box thinking” quote 🙂 I “live” outside the box! (I am an inventor and product design manager for a company as well).
With regards to your tooth. There are several scenarios that could be happening. A x-ray would really be helpful for me to narrow it down.
First of all, has it really been 6 months that the tooth has been “open” without a completed root canal filling? That is really long and not usual.
The tooth should be filled as soon as the infection is controlled.
Now, IF the tooth is cracked, which is possible, it usually is more of a vertical fracture. The only restoration that may help is a full coverage crown, but a fracture sometimes can not be treated even with the most aggressive dental restorations. I personally would extract the tooth and place a dental implant!
If you can send me an x-ray then I can be more specific.

Keep smiling,

Dr. Chris

I have crowns, and I’m sure its the one giving me bad breath. The first night I had my crowns, I already smelled it when I went to bed and cover myself with my blanket and smelled the bad breath. Then after 10 years dealing with it, I have it replaced and notice the smell while the dentist is putting the crowns. I told the dentist about it and I said that I think its the cement that is smelling bad. I think dental groups should try to give time in this kind of problem and dentists doesnt acknowledge that crowns causes bad breath. It’s a serious problem because I am so insecure talking to people with it.

Dear Mary,

I am sorry you had to deal with this problem for so long…
My best bet is that it is “bad fitting crowns” where the gums around the crown harbor bacteria that cause the bad breath. A good fitting crown makes a world of difference in more ways than just cost.
I hope you are able to get good fitting quality crowns soon so that you can address this issue. I would suggest also a evaluation for gum disease, probably related to the crowns.

Keep smiling,

Dr. Chris

I was at new dentist today. I have a crown on my front right molar. I also had a root canal about 7 years ago. Now the dentist wants to replace it because it does not contact the next tooth. I have no problems with this tooth and I don’t notice food sticking between it. Should I replace it. Or just leave it Thanks Rosalyn

Dear Rosalyn,

Food impaction between teeth is dangerous and can result in inflammation as well as bone loss. I would suggest first finding out “why” there is a open contact now! If your new dentist can explain to you exactly WHY the space opened up then you may want to find someone who understands the causes behind problems – otherwise you will be doing this again and again and again…Plus, the problem that caused the open contact would be getting worse.

Hope this helps.
Keep smiling,
Dr. Chris

Thank you so much for your helpful website! Last week, I got a crown (#30) and I have a few questions and concerns. Honestly speaking, the crown that is in my mouth does not even look like it belongs there (size-wise) rather it looks like the lab sent me someone else’s tooth. It’s a BruxZir crown (which I understood would not be AS translucent as my other teeth – but wow!). I guess I could get used to it, if it was all that was imperfect about the crown but, more importantly, the crown is unusually LARGE and it does not match the contour of its neighboring teeth. There is sensitivity only to one quadrant of the tooth (I don’t know if that could be normal, or if it could possibly mean that the occlusion is “off” and I’m hitting that quadrant harder than the other quadrants). My dentist does not seem to find anything wrong with the crown but has agreed to exchange it out for one whose shade is more compatible with my other teeth. I pointed out that the tooth is unusually large and does not match the contour of its neighboring teeth – he was indifferent but said that he would tell the lab to take some volume off the crown on the inside side of my mouth and add some to the outside. I thought that was a strange way of putting it and I said “can’t the lab simply make sure that it follows the natural contour of my teeth based on my impressions???” Needless to say our communication with one another is dreadful and I get the distinct impression that this dentist wants to make me feel like I am a hysterical female with both overcritical and hypochondriac tendencies. I also am a bit concerned that the impressions taken for the crown are not full mouth impressions but rather only of that small section of my mouth. This crown is seated with medium strength cement for now since, though it was intended to be my permanent crown – it will not be. I’d like for you to share your opinion with me and give me some guidance on how best to handle the situation. I do not live in Kentucky. If I did, I would come see you for a second opinion. I tried calling a few dentists today to schedule an appointment for a second opinion but I really don’t know how to proceed with this dentist. I know that I need to be clear about my expectations but could use guidance on keywords etc…. By the way, this dentist comes VERY highly rated! “Best of [insert city]” and his ego matches. He gives the impression that he can do no wrong. It’s a tough situation all around. Also, because the crown has technically been seated, my insurance has been charged. I’d like to simply go to another out of network dentist, but it is not an option for me at this time.
Thanks!
Adrienne

Dear Adrienne,

I am sorry to hear you all too common story. Let me try to answer your question in parts.

1. “Best Of…” This is a misleading advertisement as any dentist pretty much can buy the designation and plaque. No real qualifications are needed!
2. You are correct, crowns need to match adjacent teeth. The dentist should know this and the lab should deliver this. Anything short of a naturally shaped tooth simply is poor dentistry.
3. The dentist probably did not take enough tooth structure away, most likely, so the poorly shaped crown is not “just” the labs fault.
4. The type of crown you received is very “hard” and not something I prefer to use. The color is monochromatic and it is super hard to remove.
5. Insurance…Well, most insurance practices charge so little for a crown (under $800) that the dentist needs to make his/her money on volume and low lab costs. The “only” person that suffers from this is you, the patient. I write about this all the time…one of my pet peeves. Look into finding a out-of-network dentist that puts “you” first!

Lastly,I would follow recommendation #5 as soon as possible. Consider how important a good fitting and good looking crown is to you. Make a payment arrangement with the new dentist and get it done right. (quadrant impressions are a good indication that it is not top notch dentistry you received).

Keep smiling!
Dr. Chris

Dear Dr. Hahn,

I’m so glad to find your blog. I had my permanent crown cemented for an implant on #30 two months ago. The doctor had a hard time adjusting my bite during the the crown appointment. She ended up shaving a significant portion of the crown because she said the adjacent tooth was hanging down too much. Consequently, the crown cracked in two weeks at the location where it was shaved down. I went in and she smoothed and polished the cracked area and said it should be fine. However, today very very tiny pieces came out of the area again. I can feel the area is rough. Unfortunately, the dental place is closed until after the new year. I wonder if you have any suggestions for my situation. Should I go along with them polishing the shattered area again or ask for a replacement crown?

Thanks in advance. Have a happy new year!

Anton

Dear Anton,

I am disappointed to hear dentists continuously make excuses for bad decisions…it seems to happen daily. Where has the planning phase of dentistry gone? So many patients complain that the dentists grind their new crowns down forever, blaming issues that they, the dentists, should have been aware of before they even touched the tooth.

In your case, the adjacent and opposing teeth to your crown were where they are long before the dentist made the crown. The dentist should have had the foresight to 1. either adjust the opposing teeth first, or 2. remove more tooth structure from the crowned tooth to allow for proper thickness of porcelain.

Secondly, dentists are now forced to work with cheap dental labs due to the low insurance reimbursements. This means that laboratories that make the crowns are not highly trained and produce a mass product more comparable to Chinese quality vs. American or German quality. This means that while a good lab would have called the dentists and explained the issues with the crown and given some options to correct, the bad lab simply makes a glob of porcelain and sends it knowing it won’t fit.

Lastly, a thin porcelain crown will break, and it is the dentists responsibility to fix it, right. Get a new crown. Unfortunately you will be stuck using the same office and lab most likely that could not get it right the first time. This is unfortunately the reality most patients face these days…not all dental offices are created equal, and as far as dentistry goes, you really do get what you pay for, and good dentistry is expensive.

I suggest all patients find the best dentist they can find and get their mouth fixed correctly. Take your time doing it right. Get a plan from a dental doctor, not a dental mechanic. Make payments, or spread treatment over time, but don’t compromise quality. Avoid, like the pest, dental offices that advertise that they take all insurances. Insurances tie the dentists hands behind their back and force them to cut quality dramatically!

I hope this helps.

Keep smiling,

Dr. Chris

Thanks for your response, Dr. Hahn. I’m very disappointed with the results as well after this last fracture. The worst is that the dental place is a nationwide chain that didn’t accept insurance. I paid over $1,800 out of pocket just for the crown.

I wish I live in KY so I can come in to see you in the future! Finding a good dentist that will take their time with me is so hard nowadays.

Have a happy new year!

Anton

Wow, that is not a cheap crown. I really hope you find the right dentist! Kentucky is a great place to visit 🙂

Dr. Chris

Thank you so much for taking the time to respond and Happy New Year!
I have a couple of follow up questions (hope you don’t mind…I feel guilty for monopolizing your time).
First, I guess that I neglected to point out that this tooth (#30) was formerly crowned, it had an older crown that was cracked so this dentist took it off, used the existing post and put on the new crown (the BruxZir) so I can’t figure out why this crown is so “malformed” for my mouth . Might it have something to do with the lab (?) or the partial impressions (?)
As you know, the crown was seated temporarily since it was immediately obvious (at least to me and my husband) that it would have to be redone because of color and size issues. I am so dissatisfied with this BruxZir (it feels like a malformed foreign object in my mouth!), I would like to have the dentist replace it with an Emax rather than with another BruxZir (Emax is the other type of crown that he offers) May I ask you :
1. If you had to choose between an Emax and a BruxZir which would you choose and why?
2. I would like to request that this dentist do full mouth impressions for the lab (rather than the quadrant impression that he made for the BruxZir). My Dentists (before this one) have always done full mouth impressions stating said that full mouth impressions are better. Instinctively, I know this just makes sense but can you please tell me exactly why?
3. Should this dentist do full mouth impressions and get me an Emax crown made for me if I request it?
4. Do you feel like it will be an uphill battle? And lastly.
5. Do you have any suggestions on how best to go about making these requests?
Your advice is VERY VERY much appreciated! This has been an awful experience for me.
Adrienne

Good Morning Adrienne,

Don’t ever worry about using my time up, this is what I like to do!

1. Emax vs BruxZir: A BruxZir crown crown is made out of zirconium and is very strong. Most labs make this out af of a solid block of Zirconium giving it a monochromatic, saturated look. They sometimes then are “painted” with color to make them look better. I am not a fan of what is called the “staining” technique of crowns. A Emax crown is made out od lithium disilicate and is a newer type of crown. It “can” be cemented according to the manufacturer, but I prefer to bond them on. They can be stained or “layered”, giving a more esthetic result. They also are pretty darn strong, but, not the most esthetic crowns either. I don’t use “BruxZir” crowns but rather crowns that have a zirconium core with porcelain baked over the core for esthetics. I use Emax in patients who have very strong bites (bruxism as well) but don’t really like to. So, here is the bottom line: A GOOD lab technician can make ANY crown look nice and work well! So, it is not the crown that is the issue, it is the lab. In general, I prefer cemented restorations over bonded restorations for many reasons.
2. Full mouth impressions capture the entire functional mechanism. The “other” side of the mouth has a “canine” as well that is responsible for anterior function, which is critical for design of the “angles” of the crown. Plus, the other side most likely has the “natural” tooth left that now is getting a crown, so, a beginner lab tech can simply copy the shape and size of the tooth. Every “quality” dentist will take a full mouth impression and bite registration.
3. I would do a full mouth impression and get either an Emax of a Zirconium core crown, not a pure zirconium crown. Say you want the “layered” technique, not the stained technique. Make sure the crown matches the shape and size of the opposing tooth in the same arch.
4. It most often is an uphill battle to get dentistry redone as dentists cut cost not because they don;t care but because the get paid too little to make any money 🙂 (this is an insurance issue)
5. Well, I would put your feelings in a nice letter, that takes the emotion and confrontation out of it. I also would consider a new dentist, out-of-network, who focuses on you, not the insurance company. You may end up paying to redo the crown with that type of dentist.

Keep smiling,

Dr. Chris

Thanks Dr. Chris,
It’s incredibly kind of you to go out of your way to give me, and all the others that seek your advice, so much of your time and consideration. Thank you so much 🙂 your information is invaluable. All dentists should be as great you! All I can say about my dentist (soon to be “not” my dentist) is that he has become a very wealthy man in his given profession – even though he accepts insurance. How he has managed to accumulate such wealth is not a hard equation. He gives everyone as little time as possible and works on volume. In his case – very HIGH volume. I believe that everyone deserves to make a good living at what they do and I understand the insurance “problem” however, even those dentists who do accept insurance need to do right by their patients. After all, this is a helping profession…a healthcare profession. It’s unethical to see your patients as simply a means to an end…or a way to buy another sports car. Insurance should not be putting dentists in the poor house but at the same time insurance-accepting dentists should not rely on cheating their patients to become wealthy. I believe that there can be a better balance. This has been an education for me. Maybe, if your insurance-accepting dentist drives a Bentley, walk away (ha ha)
I will follow all of the advice you gave me and will give you an update. Thanks again :)!!!!!!

Well said Adrienne 🙂 All the best to you.

Dr. Chris

Quick question: in your response to my inquiry on Jan 9th you said that an Emax can be bonded or cemented but that you prefer to bond it. Why?
Also later you said that you, I assume – generally speaking, that you prefer cemented restorations over bonded ones. Is that correct or a typo?
If you can clear that up for me, I’d be grateful. Just want to make sure that I completely understand. Thank you!

Dr. Chris,

Your comments/reply to Adrienne were actually quite helpful to me as well. If i may ask for some more detail, I would be forever in your debt!

I am actually in the process of having six anterior restorations completely redone by whom I’m confident is the best qualified in my area, after a horrible experience with my general dentist. I had three crowns placed on my 7, 8, and 9 as the result of fractures on the 7 and 8, and my previous dentist recommened I restore all six front teeth for the best result including veneers on my 6, 10, and 11 – HUGE mistake as I had nothing but problems with my canines veneers, and simply surprised of the outcome and wish I’d researched much more sooner.

I’m now in a better place after better temporaries have been put on, however, i’m now ofcourse concerned about the end result. My previous dentist’s lab tech used Empress, and they were bulky and grey. My new dentist’s lab tech may likely use EMax – if so, i prefer for a gradual transition of color toward the back….would that help these not look so obvious? Are Emax veneers less bulky than Empress? Thanks so much for your advice and feedback….very much appreciated. Kate

Dear Kate,

So, I am probably going to complicate things a bit more for you, sorry…
First, the material of the veneers is not nearly as important as the skill of the technician (singular, not technicians!). The better the dentist the closer the relationship between the dentist and the lab technician. Big labs have many technicians that vary greatly in skill level. To achieve consistent quality you need to know who will be making your restorations. I, for instance, use 4 different technicians to satisfy all my patients. One technician makes beautiful Hollywood white smiles (I call these my Knockout Veneers), another one makes beautiful restorations that challenge nature (these are what we call Natural Veneers), another technician works with matching shades on single teeth, and yet another “lab” makes restorations for those patients that want to save money (or have to), etc.

So, in your case, ask your dentist who will make the veneers. Go to their website, see if you like the work (yes, most good labs have good websites).
Now to the more detailed answer. I personally am not a fan of emax. I have done my fair share and tried to like the material because of its strength, but, I am just not a fan. It just does not have the translucency and realism I like. Empress on the other hand can look really beautiful, but, the most beautiful veneers are felspathic veneers (hand stacked porcelain). Why does everyone now recommend emax? Well, simple, it is easy for the lab to make!
Now, if a good technician works with emax then you will probably get a pretty good result, just make sure they “layer” the porcelain, not just make one big blob and stain the outside (this is how the vast majority is made).
Some of my preferred porcelains: Noritake, Creation, Authentic, Empress Esthetic. Empress is second, and emax is last. There are more, but I am used to the above.
So, to address the “six-pack”. Most good cosmetic dentists will avoid doing 6 teeth for many reasons, one being the fact that most mouths will have a back corridor down the side of the back teeth afterwards. There are some blog posts I wrote on this, so search for black corridor or six pack. I recommend 4, 8 or 10 usually. You can simply put composite facings on the back premolars (4,5,12,13) to help avoid the six-pack look.

I hope this helps! Make sure you love the temporaries and tell the dentist to match them in shape and form closely! That way there is no surprises.

Keep smiling,

Dr. Chris

What can I do if a dentist damages a tooth intentionally but for unknown reasons, then lie/deny when she was confronted about it? I want the behavior corrected but the office manager has been inaffective in handling the matter.

Dear Robert,

Sounds like there is an ethics issue in your office. Generally speaking I surround myself with people that I respect and enjoy working with. If I encountered what you have described I would remove myself from the situation (find another job) and possibly report the doctor to the dental ethics board. Tough road…sorry

Keep smiling,

Dr. Chris

Hi, I recently went to the dentist to have a filling replaced from old metal to composite. I have a crown (molar) #31 behind that tooth that when tapped by my dentist that day showed a sign of sensitivity in one spot. It doesn’t hurt now, it isn’t sensitive since he tapped it, but when I rub all around the tooth it feels like “its there”. Never noticed this before because nobody ever tapped it. He was going to replace it “now” anyway because it has a small pie shaped wedge that chipped out right after I got it in 2006 or 07. Now my dentist wants me to go to a (can’t remember name) DR that deals in root canals to check it out first before he does the crown replacement. I just want to get a new cap. BTW, it looks like a marshmallow not a tooth, and the color is horrible, bright white. I have to be diligent and floss all the time so it stays nice and clean. I’d do this anyway, but more with this capped tooth. Do I really need to go to the other DR? By your description, I’ve got a lousy cap! Thank you, Kathleen

Dear Kathleen,

Let me try to answer your question with the information I have 🙂
First, your dentist should have an “x-ray” of the tooth and be able to determine the need of an root canal treatment most of the time through several tests.
Second, it sounds like the crown is not “ideal” and that a “wedge” shaped part at the gumline is missing in the tooth. This is called an abfraction, if I am understanding you correctly. These lesions are due to a bad “bite” which means the crown is hitting the opposing teeth incorrectly. So, first I would have a simple bite adjustment done!!! Then, re-eval the tooth in a few days and again in 3 weeks. I bet it would feel better.

Let me know!

Keep smiling,

Dr. Chris

And one more thing, the cap feels like it could move if someone really tried to push it.

Dr Chris,
I would be so grateful if you could answer my question.
20 years ago (aged 11), I fell off my bike and broke my front right tooth in half..my dentist placed a temporary crown and for the last 13 years I have had a porcelain fused to metal crown. My teeth are very nice (if I do say so myself), they are straight and white, but recently I have become very self conscious of how my crown spoils my smile.
I have become very aware that the crown sits much lower down on the gum line than the front left tooth, and has a bluish appearance around the gum. It also looks a different round shape at the gumline whereas the natural tooth is more pointed.

Is it ever possible for a crown to sit as high up on the gumline as the natural tooth? So that they look the exact same length?

Dear Ella,

This question is very personal to me as I had the exact same experience myself at age 12. This accident is part of the reason why I now am a dentist!
So yes, you can absolutely have matching front teeth, and you should!
The most challenging thing in dentistry is a single front tooth restoration so I strongly urge you to see a AACD Accredited Cosmetic Dentist to help you with this challenge. You can find them through the aacd website.
The two front teeth must be as identical as possible.

Keep smiling,

Dr. Chris

Dear Dr. Chris,

I recently had the replacement crown however there is big silver stain in shape of a circle in middle of the crown. I saw it right after I got home. There is no way the doctor didn’t notice it. I wonder what that is and why the doctor didn’t do anything about it at the time. I’d like to know if it is normal before I call the office and question them. Thanks much for your advice again.

Anton

Hello,

I have had a crown placed on one of my upper molars 8 months ago, but I see that there is a gap between the edge of the crown and my gumline on one side of the tooth. The gap is very easily noticeable. Does the crown need to be replaced due to high risk of getting cavities?

Thanks,

Dear Kevin,

Generally speaking, if a crown does not fit perfectly on the tooth (meaning there is a gap between the crown and the tooth) then it will decay. So yes, if you have a gap, see your dentist and have it replaced!
Hope this helps.

Keep smiling,

Dr. Chris

Dr. Chris,

I have a concern with my new crown. It is on my very front tooth and the Dentist shaved a huge angle on the tooth, because of the way I move my jaw back and forth.. Asthetically, it doesn’t look uniform, and he wants to shave the ajoining front tooth similarily to make them match.. I feel this is really going to affect my esteem. SO, my question is, why didn’t he just leave the tooth straight (uniform with the adjoining tooth), and is the crown that fragile that it needed to be done?

Dear Will,

A single front tooth restoration is the pinnacle of cosmetic dentistry! Meaning, there really are not many things in dentistry that are more difficult. That being said, there are too many variables for me to give you an accurate response. Here are some guidelines:
First, all treatment options should be discussed prior to treatment. This would include the possible need to work on adjacent teeth.
Second, the shape and design of the new front tooth should have been determined in the prototype phase (the temporary). Once the temporary looks good and functions well you move on to the final restoration, never before.
It looks like there might have been some skipped steps in your case and that means an unpredictable result is likely. Being that a single front tooth truly requires an expert cosmetic dentist I would recommend you seek out a AACD ACCREDITED COSMETIC DENTIST to give you the best possible result.
You are right, it will affect hour confidence among many other things. This needs to be done right and I hope you seek a dental expert before proceeding with any other treatment.
Keep smiling,
Dr. Chris

I just got a crown on in it hurt bad. Plus it got a white ring around it. what does that mean?

Dear Charlise,

I am sorry for your poor dental experience. Dentistry these days should not be that uncomfortable.

It is difficult to diagnose a white ring around a crown without actually seeing it…my best guess would be the tissue is blanching for some reason – this usually is the case with tight fitting implants or bridges, but not so much with crowns. Can you give me some more information?

Thanks,

Dr. Chris

Can a porcelain dental bridge fixed permanently be removed? I had a dental bridge fixed to my lower jaw and I am very uncomfortable with it. It is been six months and even after adjusting my bite 5 times I am not still comfortable. The good tooth just above the bridge started aching days after the implant was placed and now I started getting horrible migraines because of tooth ache. The bridge covers three tooth and is exactly placed where there is a bend in the jaw. I did the dental work in India six months back when I was there. I visited a dentist in Florida where I moved recently and he is not willing to work on my bridge as he says the dental work done in India or Greece is messy. I even went to a neurologist to get my head scanned to get me cleared of any other issues which was causing the migrane. I very badly want to remove the dental bridge and I am not sure which dentist to approach and who will be able to cure my tooth ache and the resulting headache. Also I just want to know, has anyone got headache / migraine due to bad dental bridge ? or am I alone or is my speculation wrong ?

Dear Jayakumar,

It sounds like you do need to have that bridge worked on, possibly redone. The dentist in Florida called it “messy”, which I am not sure what he/she meant with. If the dental work is hurting the opposing tooth then it could be that the bridge is too high, or too low, both bad. I would recommend you ask a dentist here in the USA to evaluate and redo the dentistry as soon as possible! And yes, you can get headaches from bad dentistry…

Sincerely,
Dr. Chris

I just had two crowns put on my front teeth. The dentist filed them too thin in the back because of the bite and filed the length because the were a little long but now I feel they are to thin and when I called the dentist she said she maybe able to build them up with bonding? Does that sound right?

Dear Pauline,

There usually should only be minimal adjusting of your new front teeth. Since they were crowns you should have had the opportunity to have them adjust prior to permanently seating them! This would have given you the opportunity to see what they look like and the dentist the opportunity to see how they fit. That being said, sometimes all dentists need to adjust more than we anticipate after cementing the crowns.
Adding “composite” to porcelain crowns is not a good nor reliable fix. While it may work, the “thickness” of your teeth can’t really be changed if the dentist adjusted on the inside due to the bite being wrong. Adding to the outside surface negates the benefits of having porcelain in the first place.
I hope this helps.

Keep smiling,
Dr. Chris

I had a crown replaced and now I am continually biting the side of my mouth. My dentist says it is a ‘perfect’ fit. This dentist has the new machinery to build crowns in the office. The offer was made to do it again – but is if it ‘perfect’ why would I want another ‘perfect’ crown? I have had a lot of crowns but never had this problem before. Please advise. Thank you.

Dear Elaine,

It may be a “perfect fit”, but it obviously is not a perfect “shape” 🙂 If you are now biting your cheek then it needs to be redone to be perfect, or at least acceptable.
Hope this helps,

Dr. Chris

Hello Dr. Chris,
Maybe you can show me the way… I have had several crowns put in by my dentist, the most work i have ever had so i think part of my problem is I don’t know it this is normal… i had one crown (#3) put in 2.5 years ago,ove an implant. It just fell off last night as i was flossing (i may be too rough when i floss i think).. my dentist happily replaced it this morning. i also had #14 and #18 done. With #14, he noticed a gap in my x-rays after about a year so he recently re-did it at no charge, although pretty painful. #18 was recently done, about two months ago and then fell off about two weeks ago. I know for a fact that they are using permanent cement. My question is, is this normal? And if this is how the crowns are behaving after only a couple of years, what does that say about their longevity? Now I am so worried because I really like my dentist, i really appreciate his honesty and I am embarrassed to be rude or too demanding. I don’t know what I should do, if anything? I think he insures his work for 3 yrs. If I need to find another dentist, I have no idea where to begin! Your advice is much appreciated.

Dear Abby,

First, I am glad to hear your dentist is taking care of the issues, that is great.
Now, implant crowns are usually cemented with a more temporary cement and they can come loose. This is so for the reason that we may need to get to the implant below the crown in the future.
Secondly, I do not know the quality of dentistry that you are receiving, but good crowns can also fail, mostly due to acid from soda or other acidic drinks. How is your diet? Check my facebook post from today for another reason to not drink much soda!
Dentistry usually lasts longer than a few years, and a 3 year warranty is at the low end of the spectrum.
Hope this helps,

Dr. Chris

@Abby – this constantly was happening to me and it was because I used to drink soda all the time! I started dieting, exercising, and cut soda out of my diet and surprise surprise, I stopped having problems with my crowns falling out.

This can also happen if you drink a lot of coffee or acid fruit juice like orange or grapefruit.

I recently had a bridge (2 crowns) placed. When I went in to have the bridge placed, it was way too big and the dentist had to take another impression and have it remade. When I returned to have the new bridge placed, it still did not seat right. The dentist drilled/filed the crown down to fit and also drilled /filed the bottom tooth (original) tooth down to correct the bite. Is this a proper or appropriate procedure?

Dear Linda,

Adjustments sometimes have to be made on both the restoration (bridge) and the abutment teeth (teeth holding the bridge) or the opposing teeth. While this is not the case very often it does happen occasionally.
Now, that being said, minimal adjustments should be necessary only, not major drilling. The important thing is, does the bridge fit perfectly after it was adjusted? A fit-check x-ray may be necessary due to all the adjustments. Also, are the contacts around the bridge good? Does floss slide between the bridge and is there contact on top of it?
The fact that the dentist sent the original bridge back is a good sign that he/she cares. Now, did he/she take another impression or just ask for it to be remade?
How does the bridge feel?

I hope it is working out well for you now.

Sincerely,

Dr. Chris

I have a crown on a top molar and bottom molar- both have had to be replaced 4 times by the dentist because of fit. How many times is enough! I am tired of the pain.

Dear Gee,

4 times is just insane! I would recommend a second opinion/new dentist and focus on quality not cost. Pay more and get a good crown, preferably from a AACD accredited dentist.

Keep smiling,
Dr. Chris

I had my two front teeth prepared for crowns today. The temporary crowns are horrible looking. They appear to be longer and “bigger” than my natural teeth were. I am getting crowns because of a large gap between the two front teeth and a chip on one as well as some old discolored bonding that has been chipping off. Is the appearance of the temp crowns normal? Will the permenent ones look better?

Dear Elizabeth,

You are at an important junction in your life! Your front teeth are extremely important to you you speak, eat and feel about yourself. Do not, under any circumstance, compromise and let a dentist permanently cement crowns that you do not love!
So, that being said, here is the deal. Making front teeth look and fit good is an art. I sure hope your dentist is willing to work with you to achieve the look you want. This is what I do (and recommend):
There should be NO guessing on how the final teeth will be shaped. Your temporaries need to be adjusted until they look VERY similar to your expected final result. Do not allow the dentist to make final crowns until you have approved the length and shape of the front teeth in the temporary phase! Once you approve the length and shape the dentist needs to take molds of the front temporaries to communicate the shape and length to the lab technician. Then, when the final restorations are TRIED IN, not cemented, you need to see them in your mouth BEFORE they are cemented, and you need to approve them. Do not compromise – if you don’t like what you see, say no, it is you who has to live with these teeth, not the dentist.
Now, remember, the temporary crowns have to fit very good to allow the tissue to heal, especially between the two teeth. Often this space, the area where you had a gap, is over filled with crown material creating a way too long contact area which looks terrible. This is an art form and I hope your dentist has experience with cosmetic cases like this.

So, to summarize, the temporaries must look nice, how else can the dentist find out what you like and communicate that to the lab technician?

I wish you the best.

Keep smiling,
Dr. Chris

Hello there!

A tid bit about me…. I’ve had lots of dental work done. In fact, all my teeth are crowns except the front bottom 6. For the most part, I’ve always been happy with my crowns in the way they fit, feel and how long they last. I feel I’ve had good luck overall with dentists.

However, I just got a new crown and I’m concerned it may fall into the bad dentistry category. So in short:

New dentist that I went to. My upper right second from the back molar crown needed to be replaced due to a large chip. It was on my list of dental to do, so in trying to be responsible about my teeth I went to get it done. As it turned out there was a little decay, but still no root canal needed. My new dentist who I found online informed me that he only did CEREC crowns. I’ve always had crowns that were made in a lab. Long story short, after a good visit and deciding to give CEREC a try I started the process to get my crown replaced.

I get old crown taken off. New CEREC one placed same day in the office and off I went. But the next morning I called the office telling them the crown wasn’t going to work…. it wasn’t tight enough as I was getting huge chunks of food stuck and also the CEREC crown was shorter in height than my last crown. It didn’t line up with the tooth in front or behind. After the call… I make an appointment… I go back in and they redo the crown and replace it with another CEREC crown.

Again, I go home… this one is better. It’s not getting food in between. But it’s still a different height than the very last molar. It’s mostly in line with the tooth in front of it, but again it’s much shorter than the very last molar. My old crown was in line with both in front tooth and other molar.

Now, I’m not in pain… but when I chew it does feel pressure kind of sensitive. It’s not nerve pain like a root canal needed. It just feels like something is off.

My question- should my new crown match the height of adjacent teeth?

I’m really concerned. And as for CEREC I’ll never have another done.
Thanks so much for anything you can tell me.

Kim

Hello Kim,

Sorry you had such a challenge with that second molar…
Now, I don’t yet use Cerec for many reasons, one being that I like the hand-articulated fit and design. That being said, some Cerec crowns look beautiful, but just like a good lab tech can make a beautiful crown, it requires a great dentist to make a beautiful Cerec crown. So, for now, due to the ability of being able to get a better fit and esthetics with a real lab tech I avoid Cerec.
In your case yes, the teeth need to come together perfectly. Your dentist needs to make sure the top and bottom teeth “mesh” correctly, which is not easy with a Cerec. Regardless, it must be either redone or adjusted to fit. They “CAN” do regular crowns even if they use Cerec…have them send it to a good lab technician, or, you could go to a new dentist and have the old one credit you back part of the cost…either way it is a pain you need to deal with, sorry.

Keep smiling,
Dr. Chris

Thanks for finally writing about > Good dentistry
versus bad dentistry – What does a good crown look
like? | Ideal Dentistry – Dr. Christian W. Hahn < Liked it!

Dr, I just had 3 crowns put in, one just a replacement crown. I’ve been in pain since June 2nd #14, 18,19 14 is so sensitive & 18, can’t chew on my left side I’ve never in my life had a bad experience with a dentist been through crowns before root canals the dentist has always been a great experience even when I’ve had issues the bite is off I’m scared of the pain again, also dr, 18 was just a replacement crown would I still need a crown buildup on that tooth?

Dear Lill,

Dentists in general want to make people happy and be pain free :), so, if something is not working out right I strongly suggest you talk to you personal dentist about it, unless they have already given up on you. That is when I come in! So, nobody should be in pain for 2 months following a crown placement.

I hope this helps,
Dr. Chris

Hi,
Please would you be so kind as to tell me the name of a good Titanium crown? I have a estrogen fed cancer and do not want any plastic. Also the plastic is burning my mouth and throat very bad and I can not imagine this every day. I had it placed sometime ago. Would a titanium crown have to be placed on a metal thimble? Also, please could you give me the name of a good titanium inlay and onlay? I would be so grateful for your help as I am so lost. Thanks.
Ann

Dear Ann,

Why are you specifically looking for a titanium crown? I actually do not place titanium crowns – why not place a even more biocompatible zirconium crown?

Most good labs should be able to make a titanium crown if you really want one. One lab I recommend is World Lab USA – Ultimate Styles, in Irvine California. If you have questions you can ask for Naomi and tell her I sent you 🙂

Remember, the crown material is one thing…the cement is just as important!

Keep smiling,

Dr. Chris

I have several crowns on my teeth and some are not fitted well. My question is what material should be used to fill the gap between two crowns (one crown is made of porcelain and the other is made of a metal). My dentist said there was no material could be used to fill the gap. He had tried to use one material – I don’t know what it was – and it lasted only few months. Can anybody help me with my problem? These teeth really annoy me for they give me inflammation around the gum every time I eat.

Dear Beng,

Ideally, if the crown is not fitting well, you should have it redone! Alternatively, you can close a gap by bonding composite to the porcelain crown. A porcelain etch would be used first, then a silane agent, then a regular bonding agent and finally the composite.

Keep smiling,

Dr. Chris

Hello
I have a horrible bridge and two of the four teeth are way to thick and rounded, just awful!! They have metal on the underside of them. Is it possible to have those two teeth filed down without being totally removed so that I don’t have to pay for a whole new bridge? Thank You-

MY PROBLEM IS THAT I GOT MY TEETH SHAVED DOWN FOR CROWN PREP AND I HATE THE WAY THE CROWNS LOOK I WOULD LIKE TO GET A SECOND OPNION TO SEE IF THEY CAN COME OUT BETTER I JUST HATE IT SO MUCH I DONT WANNA RETURN TO THE DENTIST I FEEL THAT SOMETHING WENT WRONG SOME WHERE IT DOES NOT LOOK NATURAL AT ALL

Dear Marie,

Cosmetic Dentistry is a very personalized process…it can be very challenging to give a patient exactly what they want! But, that being said, a dentist needs to make every effort to do so. Once you have selected a dentist that prides themselves on delivery quality cosmetic dentistry it is simply a matter of communication. I will do whatever I can do for my patients to make them happy…this often involves tweaking porcelain after it has been seated to make it look more like the patient desires. If the dentistry you have on your front teeth is low quality care and the dentist is not a cosmetic dentist (a true cosmetic dentist) then maybe there was a mis-communication before starting the case on your expectations. Now that the case is cemented I would talk to you dentist about options and express your feelings. If he/she is not willing to work with you then you may need to seek a different dentist – and select this dentist on their cosmetic dental credentials such as accreditation with the AACD.

Keep smiling,

Dr. Chris

I have had my two front teeth crowned for the last 34 years. Six months ago one of my crowns split vertically in half. I sought the assistance of a private dentist for treatment and he advised replacing both crowns for the best cosmetically pleasing result. The process was long and I was promised knockout natural looking crowns. The first set had a nice appearance but although they had lovely translucency to the edges, there was a very yellow appearance to the top of the teeth at the gum line running down the centre of each tooth that made me feel self-conscious. I requested replacements and my dentist assured me he would improve next time to match my naturally whiter teeth. I went through another traumatic procedure and to cut a long story short, ended up with ill fitting, awful looking even yellower teeth that are such a disappointment! I feel cheated having spent almost £1500 on this treatment for two front teeth crowns. My dentist is supposedly the expert and should not have fitted these crowns with permanent cement when the colour was so obviously wrong. What should I do? Should I ask for a third attempt? Previously, my crowns had been admired; the crowns I have now are simply ugly. Please advise. Thank you! Best wishes, Ingrid

Dear Ingrid,

Cosmetic dentistry is an art that is very “subjective”. This means that I may love your front teeth while you hate them. The hardest lesson we need to learn as cosmetic dentists is that “your” opinion is really the only one that matters. It is for this reason that cosmetic dentists go through a lot of extra steps when making restorations on the front teeth – temporaries that need to be approved for shape and size.
Furthermore, we are able to “try-in” crowns before permanently cementing them. Were you able to see your crowns before they were cemented? This is a critical step as after they are cemented it is hard to make any changes.

That being said, if there is a yellow line that bothers you on the crowns, often the outside layer of the porcelain is “stained” or colored. Slight reshaping or polishing often makes the crowns more “white” as the underlying color usually is more opaque. This may be something you want to try first before asking the dentist to make a third set.
If you do decide to make a third set of porcelain crowns, make sure you approve the temporaries and try the final restorations in before cementing them.

Keep smiling,

Dr. Chris

I have 2 questions

How do you feel about partial crowns onlays? I had a large silver filling replaced with composite and it lasted a year. The bonding has failed and its sensitive to touch. (2 side filling)My dentists wants to crown it and I want to follow up with him and ask him to just do a partial if he will because I want to conserve the tooth structure. I am 41 so I hope I have a lot of years left on my teeth.

Also if I do crown a top back molar and I better to go with gold since it will last longer than a fused porcelain?

Dear Brian,

I am not sure why the white filling failed, but if it is due to size and a possible fracture related to the old amalgam then a crown or “onlay” most certainly would be a good choice.
Onlays are partial crowns, and a large onlay essentially is a crown.
Generally, speaking, gold will always outlast porcelain and is my first choice by a mile. If the esthetics don’t bother you (they don’t bother me) then I would suggest you look at a nice conservative gold onlay. Make sure your dentist and lab has experience with gold work – it requires burnishing, proper margin finishing and a very specific retentive design!
Also Brian, make sure you really figure out why the white filling failed…they should last a lot longer than a year!

I hope this helps.

Keep smiling,

Dr. Chris

Dr. Chris,

I have had horrible experiences with my crowns. I had two done at once (a top and bottom one that are opposing). The first dentist did a horrible job and the top one was shorter than my other top teeth and the bottom one taller than my other bottom teeth. There was also a lot of pain and sensitivity.

I had another dentist re-do them, and he assured me he would make sure they were right and would send them back to the lab if I was not happy with them. Well, he went back on his word. When the new crowns came and I tried them on, they still were not right (top one too short and bottom one too tall). I spoke up but I was immediately argued with, bullied, pressured, and criticized by the dentist. I tried repeatedly to say they were not right, but I got the same response. Under the pressure I made a horrible mistake and told him to cement them in (because I wanted out of there so badly).

So now I wasted thousands of dollars plus more in travel expenses to see this out-of-town dentist and I did not get better results. Is there any hope for me to ever get these redone correctly? I do not have the money, time, or emotional and physical resilience to go through it again at this time. It’s questionable whether I will ever trust a dentist again. If I were willing to try again, would you advise that? And is this something that you could correct for me?

Dear Maria,

I am sorry to hear about your problems with the dentists…Do the teeth still hurt or do the new crowns feel better?
First, let me say that most dentists will make sure the temporary restorations fit correctly, and, if those look good to you then you can have them take an impression of those temporaries so the lab can duplicate the height. I would assume a good lab should be able to follow them and give you what you want…
Now, I would do just that – make temporaries that you like and then duplicate this with porcelain. You could have a local dentist do this and send the crowns to a good lab (if you need one, ask me).

I could help you, but many dentists can do this for you 🙂

I hope this helps,

Dr. Chris

Oooo Dr. Chris,

I have horror stories..Im a disabled Veteran..and have 100% coverage at the VA Medical Center – Dental. Suffice it to say..they have fee’d me out to a Dentist. I was so happy after they have ruined my teeth. I finally got 5 crowns done. Three of them finally have permanent crowns. I looked at them and he asked me..”how do u like them” and I said…”What is this..Why do they look like bricks? What are they square and flat”…and are you ready for this…I guess I have STUPID written on my forehead..he said and I quote “That is the new style..they are flat to keep them more clean”..Im like …For an Italian woman..I have NEVER been so quiet…I told him “They are crowns..why do they need to be kept clean on the top of the crown”..and I told him that they need to be changed..To make this horror story cut short..I read ur article above..and realize the the “marshmellow” hit the nail on the head..and that him and the lab are taking short cuts on my teeth. I have a appt. to go back and they are replacing them BUT I’m sure they are sending them off to the same lab to do it again and im terrified. Do you have a name of a lab in the Colorado Springs, Co area that I can suggest they send them to and I spend a little bit more money so I know I can get them back looking like teeth and not BRICKS 🙁 Please help me…thank you in advance…:(

Dear Star,

Sorry to hear about your bad experience…
For the new teeth, make sure you like the “temporaries” before the dentist proceeds to the final restorations. The temporaries can be adjusted until you like them, then the dentist can take an impression of the temps to help the lab technician deliver the result you expect.

When it comes to labs, us dentists send work to labs all around the country – it does not need to be a local lab 🙂
So, obviously a dentist that charges less than 1200 per unit will not be able to use the same labs I would use as they are too expensive (but incredibly good). For a good lab that charges dentist approved fees I would use World Lab USA in Irvine, CA. Make sure your dentist does not place full contour zirconium or emax on the front teeth, that never looks good! You should ask them to make Katana crowns 🙂

I hope this helps.

Keep smiling,

Dr. Chris

Hi Dr. Chris,

I’m 34 years old. My number 7 and 8 had root canals (with posts) and crowns in 1999. Last year I developed throbbing pain from them and I just had an endodontist perform an apico on both of them (he said 7 had a large apical infection and both canals had bacteria in them which he cleaned). He said neither teeth had fractures or anything and I should be great. That was 5 weeks ago. I’m still getting the throbbing and burning up my crowns into my nostril (like before the surgery). What are your thoughts on this? Dr. said it might be “phantom pain” but it really does hurt still (with no provocation really). I have xrays if interested. Thanks, t

Dear Anthony,

This is a complex issue…sending me x-rays may help a lot! I look at things a little different than most dentists…
First of all your body needs to be rid of infections in the mouth, that is critical. I would look at the quality of the root canals and the apico and then decide if I want to “keep” the teeth. Was the apico with MTA or amalgam?
No matter how good the root canal there will always be a certain amount of infection in those roots. Ideally you want to avoid root canals, but if you can’t then you must have a super healthy immune system and premium quality root canal treatments.
So, this leaves you with 2 options, basically. First, keep the teeth and second place an implant (never place 2 implants next to each other in the front of your mouth! It is an esthetic nightmare, so we place one and attach a cantilever tooth, #7, to #8). X-rays will help.
Phantom tooth pain? Phantom means that the tooth/teeth would be missing and they are still there. The feeling you have probably is from infection or your body simply not being happy that there are foreign bodies in it and it can’t get rid of them.

Keep Smiling,
Dr. Chris

I have had 3 crowns and a veneer replaced – the dentist decided to do the implant crown separately from the others – the first 3 are fine but he cannot get the implant crown right – it went back to the lab 3 times – after this it has had modifications made to it 5 times and is still not acceptable – in fact I cannot imagine there is any porcelain left to it – is it normal for a dentist to modify a procelain crown in their surgery and not send it back to the lab, he has used so many different materials on it trying to alter the shape and colour himself. thank you

Dear Jan,

5 times is a bit much…making modifications can involve a simple change in color or shape. You can adjust a porcelain crown a few times, but after too many adjustments the porcelain begins to look too “glassy”.
On the other hand, it is kinda good that the dentist is taking the time to make it right. I understand it can be frustrating, for both you and the dentist, but you want to end up with a good looking and fitting tooth. Just make sure neither one of you settles…these implant crowns last a long time!

Keep smiling,

Dr. Chris

Hello there, thanks for writing about this. Unfortunately you are missing another point. Shouldn’t the mating surface of the prepared tooth have no black stain on them? I am arguing about this with my current dentist. He says it’s ok and I dont say it’s ok. First off you want the prepared surface clean of any fungal matter, wouldnt that be common sense? My dentist says the black stain goes too far deep to get it all out. Even though i’ve already had the root canal, whatever this black stain is (caries or fungus) it is living there on the surface of my tooth and everything that i do won’t get rid of it. What if he does place the crown and adhesive over this black stain? Aren’t you giving the black stain a nice little house to grow downward? Eventually causing Advanced Perio which is something no one needs. I need answers. Thanx for ur time if you can help.

Dear SciResearcher,

The “black scuz” layer that you are talking about is often seen under temporaries and is easily removed by allowing hydrogen peroxide to sit on the tooth for a minute or so. Yes, if it is present it should be removed – it comes of very easily.

Keep Smiling,

Dr. Chris

hello Dr. chris
i went to a general dentist 7 months ago for a problem of bad smell between two of my teeth upper second premolar and first molar
my first molar had root canal treatment and it is restored with amalgam
i had not any problem with it before.
However, the dentist decided to place a crown on this tooth
and he put a pin in it to reinforce the tooth like he said
the crown was made of zirconium
after that it cause food impaction , the dentist replace the crown tow times but it still have the same problem.
One week ago i went to a another dentist and she removed the whole crown and made a new one but this time i chose metal fused to porcelain
but the problem is still and there is a food impaction

Dear Bedro,

Sorry to hear about the trouble you have had with your tooth. I can’t see your tooth so I will do my best to give you some advice. First, since you had the crown redone several times I will rule out poor fit…that would be truly rare. The next issue is probably related to the space between your teeth. If you had gum disease or bone loss the tissue between the teeth goes away and food traps arise. Redoing a single contact (crown) will not solve the tissue trap issue. That is what I would bet is the problem. Consider looking at this and let me know what the dentist says!

Cheers,

Dr. Chris

Hello dr. chris
I am very thankful to you for replying my post .
In fact i went to the dentist today and she decided to take off and send the current crown to the lab again to remodeling the contact point . I hope that she can solve this problem , and thank you again .

I had a front tooth crown put in. I have a two crowns in the back of my mouth and never thought to ask many questions because I never saw them, they feel right and look right. Now, my front crown was cemented in and during the appointment I noticed it was larger than my other front tooth. They said there is nothing they can doabout that because they ccouldn’t go any smaller because the croen needed more material around the tooth. They also wanted to fill in the between my two front teeth. Well, they said that is how the tooth had to be made and I was hesitant because of the size and they told me I was the only one who would really notice. Well, two weeks later, I hate my crown. It doesn’t match my teeth, it’s much bigger than my other tooth, and its a completely different shape. I’m really self conscious of it now and I’m embarrassed to smile. Is it true that they had to have material around the base? I can’t seem to believe that. What can I do to fix it? Do I need to get my other front tooth fixed to match? I have a dental plan and paid almost $750 for two visits, and I can’t really afford to pay for my other tooth to match. Please help.

Dear Stephanie,

I am sorry to hear you went through that. Let me give you my insight…
First, a dentist should never cement a crown that the patient does not like, period.
Secondly, we have great control over the shape of crowns for several reasons. Number one is that the dentist prepared the tooth below the crown to specifically give the laboratory enough room to make a properly shaped tooth. Secondly, the technician has to have the skill to match the adjacent tooth.

It is YOUR tooth and you get to make the decision if you want to close the space between the teeth, not the dentist. If you have a natural space between the front teeth and you close it by making only 1 of the two teeth then of course that tooth is going to be wider! Not a very smart idea.

I would not settle. You expressed your concerns at the seat appointment. The dentist needs to redo this correctly.

Cheers,

Dr. Chris

hello dr.chris
i wish you have a good times
thank god , my problem is solved
thank you for help … your diagnosis was right
it was a probles with crown fit ..

HELP Dr Chris: I am 69 years old and have burning metal taste in mouth. I had two front crowns replaced and they do not look like the other four crowns from 20 years ago and the same lab did the work. The new crowns show very little margin of porcelain and lots of gold. constant pain food shoots right up to the gums. The dentist insists it is my imagination the taste and has not offered to do anything with these. The other crowns show a lot of porcelain. Constant burning, mouth, lips and metal taste are driving me crazy. She polished the two crowns as my lip gets stuck to it when I talk, again, told me that was a muscle reaction in my lip. Do I have any recourse of recovering my expenses for these crowns and go to someone else or is this how crowns are made. I looked in a mirror and it is very visible the difference in thickness of porcelain on new ones is very thin ring. thanks I hope I can find someone soon.

Hello Peggy,

If you have had crowns on those teeth for 20 years that were fine and the new crowns have the issues you mentioned, then it would make sense that the new crowns are part of the cause!
When making new crowns, especially ones on the front teeth, we make them out of a composite material first as a temporary measure. This temporary crown tests the fit and look of the new crown as the new crown should be made similar to the shape and size of the temporary. If the temporary worked out fine for you then the final should as well. I hope they did it this way for you.
The metal taste can be related to many things, including base metal on a crown.
Your lip should not stick to your new teeth any more than it did with the old teeth – blaming your imagination is just ridiculous.
Long story short, those crowns should be redone from what you have told me, either using all porcelain or a high noble metal base (not simple base metal). That being said, if the dentists does not agree to do this for you, then you will need to contact your local dental society that will contact your dentist, possible initiating the peer-review process.

Keep smiling,
Dr. Chris

Dear Chris,
I have recently had work done on several teeth. a couple of root canals and some PVC crowns. (Is PVC good for crowns?) One of my crowns has been reattached four times in a year and 1 month. The last time it was replaced the dentist put a larger pin in it in the hope it would stay stuck this time. About three months and it would come off so I am hoping it does not come off again. Is this normal to have to replace it so often? The dentist has not charged me since it was within a year but if it comes off again he will have to charge me. I was wondering if the material/cement might be defective or mixed wrong or something like that. One of the times I went in for a replacement of it I told the dentist I was having trouble with the tooth below it and he checked it but did not find anything wrong. Six months later it is really bothering me so I go back for another replacement of the crown above and have the dentist to check the tooth below and he says wow that tooth has rely decayed and exrayed it, set me up an appt. for a crown. I was reluctant to let him do the work for another grand because of the trouble I have had with the other crown staying on and why he could not see the problem when he checked it six months prior. Does this sound like good dentistry to you or should I be looking for a new dentist? Thanks for your reply. My best regards to you for your comments on this site. Patsy

Dear Patsy,

You need a second opinion! There are many issues I see with your case. First, crowns should not come off that quickly. When a crown comes off so quickly then it usually is the design of the tooth below the crown that is bad. Secondly, changing the “post” under and existing crown alters the shape of the tooth where a new crown would be essential. Third, even insurance companies (and they have the lowest standard of all) expect a crown to last at least 5 years. So, don’t let them charge you again.
Now, a tooth usually does not go from no decay to major decay in 6 months. Another reason to seek another dentist.
PVC is not used in crowns, maybe you meant CVC or PFM (one is all porcelain the other is porcelain fused to metal).

This is far from quality dentistry so the best thing you can do is find a new dentist.

Keep smiling,

Dr. Chris

Dear Dr. Chris,
Thank you so much for your reply. I felt deep down that this was the info you would reply with. I just hated to think this dentist would cut corners etc. I did call his office after I requested a comment from you and I asked why the newest crown looked like it had a filling on it and why it was rough feeling? I was told they had to expose some steel on the crown when they were fitting it but it was good and if I needed to come in to get it smoothed out to come in and they would take care of it.
It is 50 miles from where I live so I am not going back for that and I will be looking for a new dentist for sure. Thanks again, Patsy

Hello
I have zirconia crown on my lower front tooth and it does not look very good. When my dentist showed it to me i was really surprised that it was a metal free crown. Top part of it really matches my teeth but near the gum line it is very yellow with a grey line. I was under the impression that zirconia crown can perfectly match your teeth. Is that right? Actually my metal-ceramic crown looks better than this one.
I have read that your used to work in LA. I live in LA. Would you mind referring me to some good cosmetic dentists in this area?
Thank you.
Ed

Hello Ed,

Sorry to hear you had a bad experience…Zirconium can be beautiful! What you describe sounds like poor lab work.
Go see Dr. Nick Davis in Newport Beach (smilesbydavis.com) if that is not too far.
You could also Dr. Bill Dorfman (celebrity dentist with his own show now) or Dr. Brian LeSage, both legends in cosmetic dentistry.

All the best,
Christian

I hated my temporaries. Hated. My dentist didn’t care. I have a crown that is giant and awkward compared to my other teeth. It doesn’t even sit well with my jaw at rest. It makes it hard to keep my mouth closed, and has increased my drooling at night. It is even so close to my other tooth that it is hard to floss. He refused to fix it, even after I came in to complain. He said there was nothing wrong.

It’s been years now, what should I do? Am I stuck with this?

Dear Amy,

Unfortunately it has been years and you have no recourse with that dentist. I am sorry he/she did not listen to you.

Life is too short to have such a big issue right in front of you all day, every day. Go find a good dentist and get a nice, comfortable crown for that tooth! 🙂

Keep smiling,

D.r Chris

My new dentist said he needs to replace my crown on my dental implant because he thinks its trapping food. The dentist who inserted this implant and crown did it 8 years ago and its porcelain. My new dentist is saying that I have a cavity next to the tooth near the crown so he suggests replacing the crown and filing the cavity better to see it clearly and replacing the crown altogether as it traps food. What do you think? I think he is trying to score big on billing me for something. Also suggests I have some glue on teeth that he feels I have destroyed enamel

Dear Sonia,
It does not sound like you have a trusting relationship with your dentist…which is critical for proper care.
The 8 year old implant might very well have some tissue recession over time. This tissue recession traps food and trapped food harbors bacteria. Bacteria release acid that dissolves tooth structure-this is what we call decay.
So, if the implant crown has to be removed it would be wise to take a look at the adjacent tooth for decay. Once the implant crown is off the adjacent surfaces can be checked. If there is no decay then you won’t need a filling 🙂
This approach sound very honest to me.
I am not certain what is meant with ” I have some glue on teeth that he feels I have destroyed enamel”, sorry.

Keep smiling,

Dr. Chris

Hi dr. Chris,

I had my numbers 7 and 10 feel filed down for porcelain veneers after I got my braces off as a teen. A few weeks ago one of them broke off, but with the tooth inside, at the gum lines. I was told the tooth was very calcified and needed a root canal and post put in before they could fit me for a crown. Now th crown has come back from the lab (after being wrong twice) and as the dentist showed me what it would look like I was horrified! Not with the color or shape, but with the fact that I could see the color of the post at my gum line! This is visible when I smile and makes it look like the top of my tooth at the gums is dark grey…is there anything that can be done about this? My dentist mentioned the option of going to see a specialist (I don’t remember the title) to have my gums “pulled down” over it…but that seems severe. I’m extremely worried about the fact that I will look like this for the rest of my life when I smile. Do you have any advice? Is there another route?

Thanks,
Lindsey

Dear Lindsey,

There is no reason why you should not be able to get a beautiful crown that does not show black at the gumline. That being said, this requires both a great dentist and a great dental technician. The most important thing is that you don’t settle with a crown that you do not like!
A specialist (periodontist probably) can place a gum graft, but without seeing the actual situation I do not know if this will be successful. There is more to this than a simple yes or no.
So, I would seek a second opinion prior to accepting a bad looking crown. Go to http://www.aacd.com and go find a AACD Accredited Cosmetic Dentist! This is your best bet to get an honest opinion of what is possible.

Keep smiling,

Dr. Chris

Hi.
Just a quick question but I got root canal done on one of my molars and it was fine for about a month or two but suddenly, it started hurting a lot. Every time I bite or even touch it it hurts and like now, it’s radiating pain. Could this be the effect of an ill-fitting crown?

Hello Steph,

If your root canal treated tooth is now hurting you need it looked at! It could be fractured or the root canal could be failing. The crown has very little to do with it other than not being adjusted correctly…this situation certainly warrants a visit to your dentist and a new x-ray!

Keep smiling,

Dr. Chris

I am so frustrated. I had a three bridge crown covering six teeth for 25+ years. It had high margins and a chip and I finally found a nice dentist and reasonable price. Well, we have had THREE bridges made from a lab and they all look bad. The last one I had mounted because it was looking good but after a week I feel the teeth are too small. They are definitely shorter than my last bridge and the temporary. They took impressions of my original bridge, sent my original bridge in, took my temporary impression, took an impression with no teeth. What more can I do? I have to have this one torn back out and try for a fourth time, but I have lost hope.

Dear Cin,

It is frustrating, I agree. Finding a “good price” and a “good lab” is nearly impossible. I would have to guess that the lab is a large conglomeration of technicians, not a single technician. When you had that old bridge made 25 years ago you certainly had a single lab technician, and artist, make the bridge. Today many dentists need to save money by using large, less qualified and not very artistic dental labs, patients demand lower prices and the only way to offer that is to cut quality.
So, if you want a really nice bridge, you need to use a very nice lab. I would, for instance, recommend Naoki Hayashi from Ultimate Styles in Irvine, CA as one good technician, but, I am also certain your dentist will refuse to pay for him. This is a problem I see many dentists run into. So, if a good bridge, or any dentistry for that matter, needs to last 25 years and look good, why not invest in the best? Even if the bridge costs twice as much it would be done right the first time, look good and you would not have your quality of life affected….food for thought 🙂

Keep smiling,

Dr. Chris

Dear Dr. Cin,
7 years ago I had two porcelain crowns put in on my two front teeth(distal)
Since then they came out more than 5 times, and I have had them cemented in again. the last time I asked the dentist if some type of reinforcement could be put in so they stay in my mouth, but she said that they( the dental industry) does not use pins anymore because it erodes the tooth. Dr Cin, is it true, and if so; is there an alternative.

kind regards,

Anthony

Dear Anthony,

Many dentists still use pins 🙂 I don’t use them because bonding is so strong and predictable.
Crowns should not fall off! Crowns are either cemented or bonded on. If they are cemented then the underlying tooth structure needs to be prepared ideally at at a 6 degree taper. That being said most teeth are over prepared like a teepee which allows for no retention, and then crowns fall out 🙂
If there is too little tooth structure left then the crown needs to be bonded on. A correctly bonded on crown lasts a long time as well.

For your case it would help to know why your dentists feels your crown keeps falling off. Is is preparation design? Is it a functional issue?

Hope this helps.

Keep smiling,

Dr. Chris

I am disappointed with the result of one of my new e-max crowns which were replaced after 17 years. I had both front teeth done and the dentist explained how great e-max crown material is. However, I was not prepared for one of the crowns appearing to be a lot darker in colour than the other a few hours after being cemented in. I returned to the dentist and she said that it was as a result of my tooth being root filled and black underneath. I am puzzled as to why she did not see this coming. She knew the colour and position of the original tooth to be crowned and she also knew the material of the crown. I was advised to return in one months time when we could discuss options. In the meantime I will have to put up with it…….

Dear Lynn,

Emax is a new and very strong material, but in my opinion not very esthetic. Every dentist and every lab like to use it because it is easy to use for them. I do not like the way it looks – it always looks gray-blue to me.
Anyhow, your problem is different. When we work on teeth we always take preparation shades (the color of the underlying tooth structure). When there is a root canal treated tooth then it is critical to note that it is always darker and this needs to be addressed in the restoration.
As I said, emax is blue gray and when cemented allows the underlying color to affect the final shade dramatically. When trying in the crowns this is not as easy to see as it changes with cement. Most experienced cosmetic dentist know this and would either use a premium lab or avoid this material in this case entirely.
The old crowns you had probably had metal underneath that blocked out the color.
So, it is very obvious what needs to be done in your case. The crowns will never match, they need to be redone. Cutting off emax is extremely hard as the material is so rock solid. The dentist certainly is hoping you will choose to live with it – don’t.

When the two (both must be redone at same time) crowns are removed, make sure the dentist as enough experience to place bonded restorations with one tooth being so much darker. A better bet would be do place a layered (not just stained) zirconium crown. This would ensure much better esthetics in your case. The dentist could also use such material as authentic which are beautiful.

Long story short, you are right and do not settle, Your case is tough, requires experience and a good lab.

Keep smiling,

Dr. Chris

I am 81 years of age, so haven’t had cavities for a number of years. My main problem is having crowns come unglued, and a bridge that was glued in several times that finally ended in a tooth implant. Right now, I have a back lower molar that has been reglued three times and the dentist said in order to build up the tooth to hold the crown I would need a root canal. He also said since it’s not hurting, and I don’t want a root canal, I can leave the tooth uncovered and that won’t be a problem. I would like to just leave it uncovered, but want to be reassured bacteria won’t get in.

Dea Patricia,

If there is not enough too structure to hold a crown correctly and your dentists says it would need a root canal treatment to hold the crown, then I would think deeply about doing that first…
I have several patients where it was nearly impossible to place a crown on a tooth on the back and we left it “uncovered”. All I did was make sure it was smooth, comfortable and that should work well for a long time. The tooth will move over time but that was ok with the situation I was faced. In your case if the dentists believes it is ok then you probably are ok 🙂 Leave it, brush it, follow it!

Keep smiling,

Dr. Chris

Dear Dr. Chris,

Hello Dr. Happy Holidays. My 69 yr. old mother is having her old crown & bridge work redone. She paid half the total up front & was going to make monthly payments for remainder. When they did the fitting she was very unhappy with the entire thing & did not except it. It has been 6 mos. & my mom still has no teeth. They tried to fit her 2 more times when the framework is not going to work. They want her to sign a contract that states no refunds after 90 days. They are telling her she thinks she’s a Know-it-all because my mom happens to be a highly skilled dental tech & owned a successful crown & bridge dental lab, Their excuses for stalling her are things like someone had a baby or they were held up at the airport. My mom is finally to to point she wants a total refund but they want her to pay for very shotty work with a 16 % discount. This is $11,000 of dental work. Shes using her old crown as her temporary. What should we do about this situation? I would appreciate any advice you can give me. Please.

Thank you & Happy New Year
Sincerely, Kendra

Can you give me a good cosmetic & general denistry dentist in the West La area. Preferably close to Beverly Hills.

Dear Susan…..

You are in the prime location for cosmetics 🙂 There are a lot of good choices.

I like Brian LeSage, he is a great dentist and a nice guy.

http://www.cosmetic-dentistry.com

Keep smiling,

Dr. Chris

Thank you for your reply. When I read these posts I have had all these problems with my crowns. Too big, redone too small, Foul smell coming from the gum line of my two front teeth. I am not going back to the denist that has created these problems.
I went back to my old denist. Dr. Masliash on Wilshire. He sent me to Dr. Bustomonte he just finished doing gum surgery to clean underneath one of my crowns because I had a bad infection. I don’t understand how some dentist just don’t think long term. They just don’t care. I am debating to have my two front crowns done (odor under gum line) for a 3 rd time with Dr. Masliah whom I trust. He just fitted me with a night guard to help with the stress I have been feeling because of bad dentistry. Then we are going to figure out what to do. My insurance said that if Masliah can make a case for bad workmanship they will cover them being redone. I will also research the dentist you recommended. Thank you so much for your website to help all of us.

Your welcome 🙂

I have recently started having a foul smell from the gum above a crown. I had a root canal and a crown put on less then a year ago. Ever since the crown has been on I have had swelling in gums and irritation when eating. I went back to the dentist who put the crown on and he said there was nothing wrong. After a few month the swelling went away and I thought everything was ok. Now I am getting this foul smell and it is terrible!! I bought a water flosser but it only helps for a couple hours then the smell is back. I started going to a new dentist office b/c I didn’t trust the last one that put my crown on. The new dentist has told me that I have a cavity on each side of the crown. I am going to get them filled but my appointment is not for a month and half away (The dentist is booked). I am wondering if the foul smell is from cavities beside the crown or the crown itself. It seems to me that the smell is actually coming from the gum right above the crown. Please help me this is so ridiculous and the smell is terrible!!!!!

Dear Rachel,

The smell probably is from the crown – if it does not fit right then stuff gets under it and causes a rot smell…Anyhow, I would see a quality dentist (ideally someone that does not take insurance) and get a second opinion. Most top dentists will do that for you for a nominal fee.

Keep smiling,

Dr. Chris

Hi, I’d like to send you a picture of what to me looks like a bad crown according to your website. If this is true what can I do about it. This is a temporary crown…not permanent but if the temp looks this bad, what should I expect from the permanent?
PS
This dentist was on my insurance provider list

Sorry I just got this email Ann Li, there are literally hundreds of questions 🙂

You can send me a picture to chahn {@} idealdentistry.com (wrote it like that to avoid spam bots).

Keep smiling,

Dr. Chris

My two front teeth are both endodontically treated teeth. According to my dentist, they are both structurally fragile. One has a post in it (which I now know makes the tooth even more structurally unsound). I have had crowns over these front teeth changed at least five different times for different reasons: (1st time)crowns were removed because you could see black line at top of gums; (2nd time) gum line was higher over one tooth than the other; (3rd time) crowns were made much smaller than my natural teeth and I didn’t look like myself; (4th time) crowns were still too small for my mouth; and this last time…the crowns were made too thick and bulky and the dentist has fused them together (made me sign a form releasing him from any liability if the natural teeth broke IF I didn’t let him fuse the crowns together). He also warned me that if I tried to remove these crowns I could lose my natural teeth…which would mean I would need implants and he said “we know how that went.” (I lost an implant in the back of lower jaw – due to infection – which I seriously think he caused after cementing the crown over the abutment…another story). Anyway, these teeth are big and unnatural looking and I find it even difficult to talk without “spitting” on the person next to me. In your opinion, would you just leave them as they are and be uncomfortable or risk the chance of them breaking off and having them cut off and recrowned?

Dear Carol,

Sounds like you had a dental crown nigthmare! Sorry. It is difficult to give an exact answer as I really would need to see a good x-ray for this one…but, I am not a huge fan of bonding teeth together for many reasons, especially on the front two teeth.
So, if they look bad and you can’t speak correctly I would remove them and fix it. Implants are a good solution but you would never want to place 2 implants next to each other on the front teeth either…
Look up a AACD Accredited dentist http://www.aacd.com and they can help you 🙂

Keep smiling,

Dr. Chris

Dr. Chris:.

My son had to have a veneer done on his front tooth. He had it done by a dentist in AZ and then went to CA for school. This veneer kept coming off and when he contacted the dentist in AZ he referred my son to his sister in CA to do his ‘follow-up”. Well sister apparently is a better dentist and as soon as he comes home from school and this tooth as been on for over a year it comes off again. Son is on his 3rd trip since last Sept going back to the AZ dentist and he even called his sis and asked her what she used to keep the veneer on as long as she did. What could possibly be happening to cause this veneer to keep coming off? He is so careful and it is affecting his ‘professional appearance’ and career he is a DC out of college. Any recommendations? Thank you for your thoughts. Mom from AZ

Dear Mom,

A veneer should not come off! Is it a porcelain veneer? Once a veneer is bonded on it should break before coming off. If you send me more information about the procedure I will be happy to give you more advice. Some questions to ask: What material is the veneer made of? Why was it placed? What was used to cement it?

Keep smiling,

Dr. Chris

Greetings,

I recently had a root canal and crown done. The entire procedure went down well but a bit irked that the top of the crown is a bit flat. The bite and fit is perfect but when my tongue rolls around the tooth it doesn’t feel like my other teeth. Does the crown’s contour and shape gradually change? Perhaps i’m picky, but i like how my old tooth felt when my tongue rolled on it.

I have two other crowns one also is a bit flat but has no contact with my tongue so there isn’t much of an effect. Another crown appears to be more similar to my other teeth.

Maybe I just need to get use to it as when you get a new cavity which also makes for a “flat” feeling. At first i loved the crown, but not sure now.

Dear AJR,

You will get used to the new contour of your crown 🙂 It should ideally feel like your other teeth but most crowns these days come back pretty flat from the lab…Unless the crown is not touching the opposing side correctly it should be fine!

Keep Smiling,
Dr. Chris

Dr. Chris – thank you for your response. Perhaps, I didn’t indicate in my previous question that I will do anything to avoid dental implants – particularly, in the front. I had a failed dental implant (lower back tooth) that left me with partial numbness on my bottom lip. As I mentioned in my earlier comment, both teeth in front are endodontically treated with one having had a pin/post inserted – so it is even more fragile. Since dental implants are my absolute last choice, could these fused crowns be removed safely without breaking natural teeth – then affix new “layered” zirconium crowns to my teeth by bonding them on? (I believe you mentioned herein that “if little tooth structure was left then the crown needs to be bonded on.” ) But, you went on to say that a correctly bonded crown will last a long time but “make sure the dentist has enough experience to place bonded restorations.” Since my treated teeth are much darker, your suggestions to one commenter regarding placing a layered (not just stained) zirconium crown might offer better esthetics – sounds like the route I’d like to take. Not only do these two crowns look totally unnatural, but, after two years, they are still terribly uncomfortable (tight), stick out from the rest of my teeth and cause increased saliva (feels like I’m always about to drool) . In addition, because of the bulkiness of these teeth, my overbite has created additional problems: bruxism and TMJ problems. With that being said, can you suggest an accredited cosmetic dentist (I tried searching on http://www.accd.com, to no avail) who has vast experience in bonding crowns (as opposed to cementing) who is interested foremost in saving natural teeth and who has a good lab? Although I live in Alabama, I am willing to travel to obtain the best treatment. Thank you so much.

Dear Carol,

Ok, implants would work but are a last resort and you certainly don’t have to use them 🙂 For your front teeth…having a post and a buildup in the tooth does not equal weak or broken tooth. I would remove the crowns, see what I have to work with and go from there. Sometimes I replace the post and core, sometimes I leave it.

Depending on what I find I would go with “cemented” zirconium (you cannot bond zirconium) or “bonded emax”. Either way, if you layer the porcelain (both can be layered or stained) then you will receive a better esthetic result. Layered zirconium is slightly weaker than stained zirconium though…there are benefits and drawbacks for each combination and a good dentist will be able to decide one the one for you.

Please give me your ZIP code so I can recommend the closest dentist I feel could help you!

Keep smiling,

Dr. Chris

Thank you, Dr. Chris…at least you have given me hope! My ZIP code is 35763 BUT I will travel either to Nashville, TN (about 2 hr. drive) or Atlanta, GA (3 1/2 hrs) (my daughter lives there). In other words, I want this done right and am willing to travel. I certainly wish you weren’t so far away.

Thank you so much!
Carol

Hello Carol,

Dr. Mark Sayeg in Atlanta is wonderful. Contact him and you will be well received.

I just had a cerec crown placed, and I get this “pulling”sensation around the tooth/gum area whenever I sip through a glass or a straw. I don’t notice it every time, only occasionally. I’ve noticed this type of sensation with another crown I had years ago, but other crowns I had done in the past, nothing at all. I know it sounds strange, but has anyone else ever experience this type of feeling with crowns? Could it be a sign of poor fit or the crown just being too big? Thank you.

Dear Gail,

That is a new one for me 🙂 But, as I tell all my patients, it is not your imagination. If something feels “off” it mostly likely is. It could be a fit problem – open margins, too close to the bone level, or too big around the gums. Certainly worth talking to your dentist about!

Keep smiling,

Dr. Chris

Hi, I’m considering going to a prosthedontist for a second opinion
due to a space issue I have between two crowns
that were placed over anterior teeth, using temporary cement, a month ago. I am unhappy with the look and placement. My dentist seems satisfied with
the whole thing and has discouraged me from having new ones made. She told me that I would need to go to the lab myself for this fix, and I’m not sure why. From everything that I’ve read, a space like I have between the crowns could lead to food impaction issues and possibly further decay. Sorry if this is an unmentionable, but I can also blow tiny saliva bubbles through the opening which annoys me. Only rarely is my speech strangely affected with the very occasional word sounding a bit slurred, I’m told. I would like to send you two pictures if I may? One taken by my dentist post crown application; three in the front altogether, problem with the two front – and the second taken today, so that you can see how my gums have responded to the crown placement. My dentist told me that my gums will never “grow” to fill the hole. Thank you. 🙂

Dear Susan,

When I have a patient that is unhappy and I feel I did the best I can then I recommend a second opinion. You could do that as well just to settle your nerves 🙂

Keep smiling,

Dr. Chris

My temporary crown does not allow any of my teeth (except the one right above) touch at all. I could pass a credit card thru my teeth when jaw closed. The dental assistant said it can’t be filled down anymore, this is how it will have to be. I wish I could ask the dentist but he’s not accessible. Is it okay for this temp crown to remain like this for a few weeks? Thanks

Hello Amy,

In short, no, not acceptable. Your dentist needs to always address your concerns.
I hope it worked out…

Keep smiling,

Dr. Chris

Hi Dr. Chris,

My dentist recommended I get a crown for a cracked tooth that did not hurt. He said it could break and/ or cause worse damage by leaving as is. I did approve my dentist’s recommendation since he is a doctor, etc. After six months of the new crown, my tooth aches throughout the day especially when I drink something cold. Do you recommend I go back to the same dentist to repair? If so, is dentist liable to correct for free since I already paid but not done correctly the first time? Thanks for your help.

Dear Quentin,

Pain is not always a good indicator of when dentistry is needed. Actually, pain means it is almost too late. A crack is unpredictable and even a crown is not 100% able to fix that. There is a chance that a root canal treatment is necessary or that the tooth is even fractured beyond hope. I would give you dentist a chance to review the tooth and it is highly unlikely that he/she is liable unless the crown is absolutely terrible.

Keep smiling,

Dr. Chris

Hello,
I realize you’re exceptionally busy but I hope you can answer these questions for me 🙂
I had two Porcelain-on-Metal crowns started yesterday, Near Walnut Creek, CA. of my Two Front Upper Teeth. They seemed to do some sort of ‘mold’ BEHIND my teeth first, then did a couple large full upper molds that took 5 minutes to set. I can’t remember when in the process they did this, before or after drilling… I mentioned that the mold would make a good custom bleaching tray and she said I can keep it if I want. (I didn’t bother). So, my question is, How Will The Laboratory know what they are supposed to look like if I was going to be allowed to keep the mold? Will they use the first ‘behind the teeth mold’? (Maybe she meant I could keep the full one AFTER the crowns were fabricated at a Lab…)
The Temporaries look Reasonably Good, They had asked if I wanted to keep my ‘Madonna gap’ I said yes, so the temps look ALMOST exactly like my old teeth except for a bit of a larger bulky non-symmetrical area on the upper-left of the left tooth from my POV. My second question, Will the CROWNS look as good as the TEMPS? or will they be Very Different coming from some Lab tech who knows where? (Probably China. I don’t want to know LOL) If the Non-Symmetric Bulky area near the gums is still there, can they shave and shape the Porcelain the day of fitting or is that impossible? I am so afraid I will not like the crowns and they will NOT redo one of them right? It was only yesterday, should I ask them to ‘stop the presses’? Or assume a Lab Tech who makes teeth will know that a tooth should be symetrric and not have unusual mounds of additional bulk near the gumline? Here is a Before / After pic (I am a cancer survivor and was in hospital for 3 years and in intensive care for 10 months, during which my teeth were allowed to rot (no one expected me to survive and told me so often as during a completely unnecessary open lung biopsy, they nicked my ‘Aortic Arch’) They also told me there were no ‘showers or bathtubs’ so I was unable to wash for 3 years, one day while wandering the halls with my IV I opened a door and there was a beautiful Jacuzzi Bathtub (WITH AN ORDERLY ASLEEP IN IT). So if they were too lazy to help me have a much beloved bath during this nightmare they surely were not going to help me maintain Dental health! (and this was a RELIGIOUS HOSPITAL in Los Angeles (the same one the Killed JOHN RITTER!) I can’t imagine what the non-religious ones are like LOL! Anyways that’s to describe why my teeth ended up in such bad shape, Simply and Only, because I was SUBJECTED to the BARBARIC Medical Practices of HOSPITALS IN MODERN America! Here is Before After photo from yesterday:
http://s3.postimg.org/67dunxn9v/crowns.jpg
I hope hope hope the Lab tech will know to shave off that bulky part that is shown with the green arrows. I wish I could send the LAB this photo LOL 🙂 THANK YOU!

Dear Robert,

It is important that all the questions you posed to me be directed to your dentist as he/she is only able to help you if you communicate this with them.
Only your dentist knows what lab is making the crowns, what guide they are using to make them, and what to expect.
The one thing I can tell you is that you do not need to accept anything during the try-in day if you do not like it. Once you approve the crowns and they cement them then it is a done deal.

Keep smiling,

Dr. Chris

Hi,
I had 2 root canals performed a week apart ftom each other last month. Tooth #30 was crowned the day after the root canal with a zirconia crown. The dentist told me to give it sometime to adjust, but after two weeks of unbearrable pain due to being too tight and putting pressure to nearby teeth and not allowing my mouth for full closure, I had him file the crown. This dentist was so upset and told me after this adjustment if there was more pain, I needed to address it with the root canal specislist who performed my procedure. I knew my pain was not from the root canal, but more from pressure at contact points and the side where the crown met the upper tooth. I decided to seek a second opinion and saw a new dentist who has helped me tremendously addresing my concern. He filed this unconfortable crown and relieved much of my pain. There is still some mild pain when i make certain head movements or when I lay down as if the contact points need to be filed. Is there a way to file the contact points without altering the structure on tooth 29 and 31? I had no idea zirconia was being used on this tooth. I thought I was getting porcelain and was just explained this is what I had by my new dentist. Can the crown, which is not even covering the margin near my gums, be removed if this continues to be unconfortable? Thank you, I will see my new dentist next week and would like to have some idea of all this.

Thank you Karen for your question. Please visit my new podcast on Drill The Dentist http://www.drillthedentist.com to see your answer! I am trying to answer most if not all questions once a week. I hope I will be able to help you.

Keep Smiling,

Dr. Chris

Hi Chris,
I had a crown fitted on one of my upper molars a few years ago due to there being an abnormality on my enamel causing delay. I had it fitted and within a few hours I realised there was a problem. I returned to the dentist and they shaved the crown down drastically because when I bit there was a huge gap between my other teeth. I also complained that the crown was not anywhere near the shape of my original tooth or the rest of my teeth. Whilst it is perfect on one side the inside comes out towards my tongue at least 1/2 cm more than I know it should. It’s like it’s been squished. I also have a substantial gap between my crown and gum which I have gotten floss caught in before. As well as this, as a result of the shaving there is no reall shape to the underside of my tooth and it has an uncomfortable matte feeling. Furthermore, I have awful sensitivity from cold. My dentist told me that this was normal for a crown and that the matte feeling and sensitivity would decrease over time. My tooth is still matte and my sensitivity has gotten worse. I have complained about this everytime I have been for my 6 month checkup and everytime I have been refused treatment. I wish I had made a bigger fuss when Crown was fitted but I was 16 and very misinformed by my dentist. It is past the first year where I had a guarantee but even during that time they refused to do anything. What can I do in this situation? I’m a student with very little money and my parents paid loads for this porcelain crown. Is there anyway I can demand my dentist refit my crown? Thank you.

Thank you Katherine for your question. Please visit my new podcast on Drill The Dentist http://www.drillthedentist.com to see your answer! I am trying to answer most if not all questions once a week. I hope I will be able to help you.

Keep Smiling,

Dr. Chris

Great read! I would add one more step to a great fitting crown. The dentist must provide the patient with a great fitting temporary to hold the place while the crown is being made. As a technician, I can create a beautiful crown that fits the model work perfectly. But if the temporary is a bad fit- the crown may not go in perfectly when its time to seat it. 🙂

Dear Jen,

You are exactly right! The dentist needs to provide the technician with a beautiful prep, perfect impression and place a great fitting temporary to hold the space till the final restoration is delivered! Thank you for mentioning this 🙂

Keep smiling,

Dr. Chris

This may not be the best place to ask this, but, I’m looking for Atlanta dentists and I have no idea who is good and who is not… do you know anyting about this Atlanta dentist? They’reIt’s located Atlanta, only 15 minutes from my house. I am not able to find reviews on them – Exceptional Smile LLC, 4420 Bankers Cir, Atlanta, GA 30360 – (678) 841-8800

Dear Izetta,

I am not familiar with this dentist but the “smile gallery” that I viewed online makes me worry…personal opinion. Bulky teeth are a warning, especially if they are put on a smile gallery showing you what you can expect!

Keep smiling,

Dr. Chris

My 5 year old daughter got crowns on two of her front top teeth. When we got home and I had her take the gauze out of her mouth I was in shock of what her teeth looked like. The crowns are huge in comparison to her other teeth and are placed higher than her other front teeth. She just started school and I feel horrible sending her to school being embarrassed. Is it normal for it to look this different or should I say something?

Dear Cassie,

I am a firm believer that we need to make sure kids have a great experience in their childhood. That being said I would make a significant effort myself to make those teeth look great, not big and unusual. I would speak to your dentist but this is an art and maybe this is as good as they can get it. This means you would need to seek out a cosmetic dentist.

Keep smiling,
Dr. Chris

Dear Dr. Chris,

I had root canal done on my four front teeth 8 years ago. They were capped with fused-to-metal crowns. Two months ago I decided to change them to all porcelain crowns. The dentist installed posts in all four teeth in order to make them stronger.
Three weeks ago one of the teeth began throbbing. It is not painful. It comes and goes, but I am very concerned. He wants me to see an endodontist and have the root canal redone, which would require a surgery because I now have a post in that tooth. I am very scared; dentist did an x-ray, which showed neither infection nor a crack in the tooth, as far as he could tell.
Do you think the surgery will help? what could cause this throbbing?

Dear Julia,

A couple of things…
A post does not “strengthen” teeth. Not sure why that was stated that way. A post is used when there is not enough too structure to attach the crown to.
Posts do add an extra expense/charge……….
Now, a post is only used with a root canal treated tooth. So, in my experience a bad “bite” or how the teeth come together can really affect the tooth and cause just what you mentioned…redoing the root canal that has been fine for years and suddenly is acting up seems suspicious. I would get a second opinion quickly. I hope this helps.

Cheers,
Dr. Chris

Hi Dr Chris,
I was unhappy with 4 dental crowns on my front lower teeth, and after two attempts by the dentist/lab to adjust the color while I waited in the dentist chair I was still unhappy. So I left the dentist with my new crowns temporarily cemented in the hopes that I would grow to like them. I have not, so I got a second opinion from another dentist who informed me the crowns are too opaque and not enough translucency, and need more lucency in order to match the rest of my teeth. This second dentist recommended a color using their Vita Mastershade Guide. My question for Dr Chris is what is the best and most diplomatic way to handle this with the original dentist: should I be upfront and tell them I have been for a second opinion and discuss the suggested color, or should I simply tell them I don’t like the color and ask them what they can do about it?

Dear Lilly,

So it sounds like you need to tell your dentist that you don’t like the look and that another dentist said they were too opaque. It is normal for people to seek out second opinions, we all would. Now, the problem is with the lab, not necessarily the dentist. A good lab would help but they are expensive…I am not sure what lab your teeth were sent to (in house?) but the lab technician should be able to understand “translucency” and opaque and make the necessary adjustments.
One thing is for sure, do not allow the teeth to be cemented until you are happy!!!!

Cheers,

Dr. Chris

I had a root canal and a crown 5 years ago. It failed and had to be extracted. I kept the tooth and It has a split right down into the root. ..what is the cause of that?
If it is an error of the dentist why would they not be obliged to pay for the reparation costs?

Thanks

Dear Susan,

Dentists repair teeth and help you prevent teeth from breaking. A root fracture has sooooo many reasons behind it, very few of which are due to dentists. Teeth live in a very harsh environment and will fracture like a windshield over time. Dentists then try to put restorations on the tooth to prevent these fractures to spread from the chewing forces of the mouth. This does not always work and the tooth continues to break. So, dentists are not responsible for decay, fractured teeth or oral hygiene. We help you try to prevent it 🙂

Keep smiling,

Dr. Chris

Dear Dr. Chris,

Thank you very much for responding to my question. I had an appointment with a root canal specialist and he does not know why I have this on-and-off throbbing sensation. He said: I can redo the root canal but there is no guarantee that the throbbing will go away. “It is up to you.” – not a very helpful advice for a patient.

I now have a different problem and would much appreciate your feedback. The dentist who is working on my crowns is getting increasingly frustrated. His technician has already made three (!) sets of crowns and they were so bad that the dentists did not even let me have a look at the mirror the first two times. Last time, I insisted and what I saw was completely unsatisfactory. The teeth look grey(ish), (which he also recognizes) and the shape is very good either (which he does not seem to care much).

He keeps telling me that my case is “special”. When he took off my old crowns (installed 8 years ago), he found that the teeth became very grey, so when he tried translucent crowns made of emax material, the grey color showed off, he says. But it also looks like the technician did a bad job each time and the crowns look grey/unnatural even when I don;t wear them. they are nothing like the shade that we picked (B1)

Now he says that we should try zirconium crowns instead, which will mask the grey color of my teeth. He mentioned that they are more opaque which makes me very apprehensive. I do not want opaque crowns, that’s what i had with my first fused-to-metal crowns. (and he promised a much better result but now tries to lower my expectations).
My question is: are zirconia crowns more opaque/less natural looking? it is true that for discolored teeth, zirconium is the only suitable material?

I am so frustrated and anxious. It has been 5 months since we started and we are nowhere near the end.

Thank you very much for your time.

Julia

Hello Julia,

Emax has a tendency to be gray and is not my favorite esthetic material. It takes a master technician to make it look good!
With a gray tooth you need to block out the gray and create color in the porcelain. This also requires a master technician. Zirconium will be much better than Emax in that respect. Now, zirconium is cemented, not bonded so the tooth preparation needs to be correct or it will not stay on as well. I prefer cemented over bonded myself most of the time but make sure the prep design is correct.
If the technician is not able to get this done send the case to my friend, Naoki Hayashi from Ultimate Styles, he is awesome and does lots of my work. A google search for his lab in Irvine California should be quick and easy.
NEVER settle for a bad looking crown 🙂

Keep smiling,

Dr. Chris

Thank you very much for your reply, Dr. Chris. Unfortunately I am too far away from California. I live in Canada. After three unsuccessful attempts to get the color right, I have no faith in this technician. I should have kept my old crowns which were made years ago in Ukraine. They were not so bad but I thought that technology in Canada would be more advanced and I would get my dream ‘holliwood smile’
I am not sure why the dentist made new impressions last time (he did not bother to explain), but as a result, the temporary crowns no longer fit very well; I have a gap at the gumline between two teeth, which looks terrible.

Sorry to hear that Julia. You know that you do not need to travel to California to see the technician right? They work with photos and your models 🙂 I would strongly consider it…

Cheers,

Dr. Chris

Sorry Julia, I hope you find a good dentist in Canada. I would check with the Canadian Academy of Cosmetic Dentistry.
Keep smiling,
Dr Chris

Dear Julia. Looks like I missed your question, sorry. Zirconium would mask better and can look great but requires a more retentive crown preparation design! I hope at this point you found something you like. I am thinking of creating a recommended lab list on my site to help patients pick good labs 🙂

Keep smiling,
Dr. Chris

Hello,

I lost my bottom retainer and although i have a permanent retainer, i didn’t want my teeth to move so rang my othrodenist and booked an appointment for a new retainer to be fixed. I went to get a mould for my bottom teeth two days later and i teeth didn’t appear to have moved much. However the mould was taken very quickly- i feel as though it was not in my mouth for long enough to harden. Since i have received my new retainer i have been wearing it properly yet my teeth have changed shape-they are all in line yet i feel like all have moved forward/backward together as my mouth has changed shape when closed. I am worried the mould was not taken correctly. is this possible? if the mould was not in my mouth for long enough could it have possible impacted the shape of it? Thank you in advance

Dear Noor,

Usually offices are pretty good at molds 🙂 At this point you should wait to see how the retainer fits rather than worry. If the teeth do move make sure you have mentioned it to your orthodontist so they can then correct it!

Don’t settle…

Cheers,

Dr. Chris

Hello Noor. Retainers come in many different designs and a good impression is always important. I would suggest you talk to your orthodontist about your shifting teeth so they can adjust the retainer or make a different one.

Keep smiling,
Dr Chris

I had 2 crowns replaced by a dentist that did the original 2. The first 2 crowns are not even 1 year old. The crowns were too deep into my gums and they were always bleeding. A periodontist spoke to the original dentist and it seemed like he was going to do the right thing. I had the temps taken off this morning and the new crowns put on, but my bite felt awful. I left the office and then returned 15 minutes later. The dentist seemed annoyed but he proceeded to try to fix. Everything started to feel better on that side, but now the other side of my mouth have the my teeth banging together. He seemed more again, so I just left. Also the spots that he “fixed” are rough now. Shouldn’t he have smoothed that out.

Dear R Nash,

It was a good thing that your dentist redid the crowns. Now, getting the bite correct is not “optional”, but required. Take all the time you need to get this done right, regardless of how “annoyed” the dentist may get.
Maybe you should have him put in writing that he/she would be paying for any problems arising from having a bad bite that was not there before the 2 crowns were placed. For some reason I don’t think he/she would sign that paper and go ahead and adjust your bite 🙂 Sorry, a bit passive aggressive but this type of problem should never happen…

Keep smiling,

Dr. Chris

Dear R Nash. A correct bite is critical and you want to make sure it is adjusted until it feels right. There are many reasons why he bite could be off but don’t settle for a bad bite. You also do need to have the teeth polished after each adjustment.
Keep smiling,
Dr chris

Dear Dr Chris,

I have an abscess at the apex of a molar that has a crown recently installed on it. It has not had a root canal treatment yet. I noticed that this crown trapped food since the first time I ate after it was installed. It was very painful because food wood pack in between the teeth every time I chewed. I had a filling on the other side that has fallen out twice so i can only chew on the side with the crown. There is a crown on the tooth right below the crowned tooth that I have the problem with. It apparently failed and therevis significant decay underneath it. No infection fut it is rotting away my dentist said and needs to be pulled. He didvroot canal treatment and installed that crown as well. Each crown costs $1,000 and the root canal another$1,000. He suggested an implant for the lower tooth and its becoming clear that is where the issue with the upper tooth us going. Am i crazy or do i need ro find a new dentist? Any information you can give me would help. Thank you, Jean

Dear Jean,

With all the decay issues you are having it could be a multi-faceted problem…meaning, both of you 🙂
Let me explain. Quality dentistry is only step one. Much more important is your ability to maintain a mouth that is clean and pH balanced. ACID is what causes decay. Acid can be release by bacteria that hide in your mouth under poor dentistry or simply in spots you cannot reach. Much more common is the acid that people ingest today on a regular basis. For example, each time someone drinks a soda, diet or not, the mouth is decaying for 20 minutes until the pH is brought back up normal. Looking at all the soda people drink all day long it is not hard to envision why there are so many dentists and so much dentistry.
My suggestion would be to find a dentist that works with you on your pH balance, nutrition, and places excellent restorations. If you have not heard about pH, soda, or periodontal disease from your dentist, run.

Keep smiling,

Dr. Chris

Dear Jean. You need a “plan” of where your mouth is at. You should be very aware of what shape each tooth is in and what your options are. A food trap is not acceptable so this makes me question the quality of dentistry you received… A new dentist that tells you exactly where you stand would work but you also need to prepare yourself to pay about double…
Keep smiling,
Dr Chris

Dear Dr Christian Hahn,

The information you’ve provided about good vs bad crowns is extremely informative. My question is, If a dentist charges me for an improply fitted crown and there are complications like a failure causing me to have more treatment an possibly the eventual loss of the tooth or teeth is it common practice to charge me for that too? Is it likely that a dentist will acknowledge his error and offer to repair it without charging me a staggering amount of money to fix his mistake. Is it rude to request that. ? Thank you for your time. Shirley

Dear Shirley. Establishing if dentistry was acceptable or not does require a second opinion. Only a dentist can make the call that a crown is a bad fit…So, you would need to find a dentist you trust and get that second opinion. Then, if it is determined the crown is not up to acceptable standards then you would approach your dentist. If this happened to me I would offer to redo it for free 🙂

Keep Smiling,

Dr. Chris

Dear Shirley. Most dentists do not pay for any treatment you may incur due to their dentistry. If you feel the work is inferior then you need to get his confirmed with a second opinion and often you will need to go through peer review to get a final answer. Best to just stick with a top dentist and do it right the first time!
Keep smiling,
Dr Chris

Hi Is it normal for my crown to have a silver ring all around the bottom? I don’t have it on the bottom of my upper crowns (all molars) . Also one of my crowns has silver (looks like a filling in it) do you know why they would have made it that way?

Dear Kim,

Sounds like it is a porcelain fused to metal crown. The dentists opted for this crown for their reasons and should have probably discussed with you the options first. I would ask your dentist why he/she used this type of crown as it is becoming less and less prevalent.

Cheers,
Dr. Chris

Hi Dr. Chris,

Thank you for getting back to me. I just had another crown put in and this one has it too. Is it cheaper for the dentist? Is it stronger? He only showed me the outside and he held it so I didn’t really see it inside. He did not show it to me in my mouth before he cemented it in, but the other ones he has done look good, except for that ring around the bottom of them which I really don’t like. I just want to make sure there is no amalgam in them as that is what I wanted to cover up. Such a shame I have been leaking mercury into my system for years, as that is really what is in amalgam fillings. I think it is very interesting that almost no one gets amalgam fillings anymore, yet no one ever really talked about the change. Makes me wonder why??

Dear Kim. The silver material is probably metal that the porcelain was built on. There are many types of crowns and this is one that most dentists use (not me). It is not very esthetic and if it is a porcelain junction margin then it tends to be rough as well. These type of crowns tend to be cheaper but I always recommend using the best materials possible. It will probably work for you but your dentist should have also informed you.
Keep smiling,
Dr Chris

Hi Dr Chris
I had a root canal done over a year ago and from day one have had a problem with it.. The best way to describe it is that it feels like the post and crown are way to tight. After reading this it confirms what I already knew and that is that I also have a bad crown. It looks like a blob of porcelain was just laid over my tooth. The tooth is really bothering me lately. When I went back right after I was told there was nothing wrong with the root canal.. I have two others that I don’t even think about. The only difference between this one and the others is the post. Is it possible a post could have been put in wrong and can this be fixed?

Dear Kerri,

There are so many variables here….I would need to see a picture of the root canal and post to give you an honest opinion. One thing I can say though, your feelings usually are right and you may need a second opinion to look at this situation.
You should not be able to feel the post or root canal for that matter. The crown may be too tight and have poor contours which would result in the situation you described.

Cheers,

Dr. Chris

I’ve been a patient of my dentist for 15 years and had extensive dental work. One of my more recent crowns has been cold sensitive ever since it was placed several years ago. It wasn’t cold sensitive before the crown. There is a very noticeable gap on the inside between the crown and my gums. Could that be the reason? I could tell he was not happy with it when he was placing it. When I complained about the sensitivity I was told it was temporary. When it didn’t subside he adjusted my bite and said if that didn’t help he would have to do a root canal.

Dear Patricia,

If there is a gap where the crown touches the tooth then it needs to be redone asap! If your dentist is not communicating with you on this then go get a second opinion on that tooth before you do need to kill the tooth with a root canal. Most dentists will work with you on getting it right 🙂

Cheers,

Dr. Chris

Hello,

I have just had 3 crowns fitted over very discoloured teeth, due to very old fillings from when I was a teenager (now 26), whilst they do look quite d=good, I can just see the black of my real tooth around the top of the crown where it meets the gum and also if i look inside my mouth the white crown doesnt go all the way up to the gum on the inside and therefore is showing black from my actual tooth. I am very self conscious with black teeth and I had these crowns hoping they would cover all the black. Question being, should I be able to see any black of my real tooth?

Many thanks,

Dear Katie,

The black from your underlying tooth is visible due to many reasons…if the dentist wanted to hide it completely he/she would need to put the edge/margin of the crown deep below the tissue. That being said, if this was one of your chief complaints then you need to discuss this with your dentist as the crown may be a functional success but esthetic failure. Most dentists will want you to be happy and possibly redo them with a margin that goes deeper below the tissue.
Now, margins that are above the tissue are actually healthier for you! Getting the tissue exactly right is the pinnacle of Cosmetic Dentistry and not easy for most to get perfect.

I hope this helps,

Dr. Chris

How long should a dentist replace a bad crown for free? Tooth # 15 was chipped so my dentist put a porcelain fused to metal crown on, problem was it didn’t fit so he sanded off the porcelain on the back side of the tooth, exposing the metal underneath. since this is a back molar you can’t see the exposed metal unless my mouth is wide open and you are really looking. I asked him to replace it a few months after it was placed, but he said the crown was fine and didn’t recommend replacing it. I have since changed dentists and my new dentist wants to replace the crown. The crown is only 2 years old, is my old dentist required to replace it for free? My insurance won’t cover it because it is less than 5 years old.

Thanks

Dear Cara,

If the crown was adjusted to the point were it was worn down to the metal it should have been replaced before it was cemented. Crowns should be adjust prior to being cemented of course for these reasons. The metal usually is super thin!
Now, 2 years later you will have a tough time proving that this was the case as the chart notes most likely will not reflect your story.
On a good note, as long as the metal is not worn away the crown is sealed and should be fine, meaning that it does not need to be replaced for that reason. Why does your new dentist want to replace it? The metal showing is not reason enough for a replacement unless you wear through the metal……
Insurance, which is not concerned about you one bit fyi, won’t pay for a replacement because the just picked the 5 year number out of a hat. I do not let insurance dictate treatment and would look at your health first – sometimes crowns placed a month ago by dentists should be replaced!

I hope this helps,

Dr. Chris

what about trimming good teeth to fit the crown/ I figured the crown was too big and they would trim the crown instead of my other teeth

Dear Eric,

Sometimes the bite is adjusted on the opposing tooth for various reasons. Regardless, the dentist should explain to you “why”. If the tooth that is receiving the new crown is already cut down to it’s minimum size and there is still not enough room for porcelain or gold then the opposing tooth will need to be adjusted.

If the new crown is just too big then you are right, the crown itself must be adjusted and not the opposing tooth.

Cheers,

Dr. Chris

Hi,
I recently had two front teeth crowns placed due to my natural teeth worn down. The first crowns that came in were wrong color and the second set seemed better, but I only really got to see them for a short time in the bathroom before they were cemented in. Now it’s been 2 months since I got them done and I’ve realized that they are so much more yellow than the surrounding teeth. I used to love my smile but now hate it due to the color of my crowns. They look really nice otherwise, but I just can’t get over the color difference. Is it too late for me to get them replaced without having to pay the full price for new ones since I did already approve them? I’m scared to ask my dentist about it.

Dear Jenny,

Never be afraid to speak to your dentist. He/she may charge you a bit for redoing them since you approved them but you need to be happy with your smile.

I hope you get the smile you desire,

Dr. Chris

I had a bad feeling about one of the five crowns my dentist pressured me into getting..I had to have a better dentist remake it because it was so poorly fit. I just had another one put on by the first dentist (he is the only one who participates with my dental plan) and it is totally flat, while the surrounding teeth are of normal contour for teeth. I am just now starting to think that he, not only was just doing crown to line his pockets, but is not doing a satisfactory job and on all of them, I eventually needed a root canal done. With this last one, I could feel that he was grinding the tooth really low down, and I think he even realized that it was too ground down and now the tooth is very sensitive to cold, hurts with pressure…so guess what, I am probably going to need endodontic work on this one too. I guess learning now is better than never. I think he has been unethical pushing these crowns on me, then they all eventually needed root canals. Btw, each crown costs me (out of pocket) $1,000. And each root canal costs me $800.

Sorry about your experience Jody but it has been my experience that most dentists try to do their best. The cost of dentistry is high not because us dentists want to line our pockets but because we had to spend at least 8 years of post High School education learning about Dentistry. Most dentists graduate today with $250,000.00 to $500,000.00 in loans and zero income. Then we have to build a business, pay staff, pay labs, and make a living 🙂 Yes, it is a business but why would anyone smart enough to become a Dentist or Doctor spend 8 years of their life during which they certainly could earn a great living doing many other things become a Dentist or Doctor only to continue to struggle?
Sorry for the rant, but I still am paying my student loans 🙂 I chose to put my patients first and do not subscribe to any dental insurance plans. This is for the patients benefit as I am here to serve my patients. $1000.00 for a crown is about half my fee so I do not know how a dentist can use a premium lab and deliver premium care and make a living at that cost, sorry. I also understand that not everyone can afford that cost so I do spend a lot of time helping my younger patients understand how to avoid crowns and root canals in the future – this is the key. There needs to be a dentist for everyone – some dentists are forced to charge $600 for a crown due to the insurance company owning them – I would rather do just about anything than work in that type of environment.
So, I hope you are able to prevent future problems with proper diet, function control (proper nightguard), proper oral hygiene and good dentistry.

Cheers,
Dr. chris

Hi,
I recently had a crown/cap placed on an implant for tooth #31. Since day one there has been a gap between the bottom of crown and top of my gum; extending about 5-7mm from back of tooth #30 to implant post. I continuously have food getting trapped in this area. I thought I could live with this, but I can’t. I went back to dentist and he told me this happens and it’s normal. There’s really nothing he can do and if he attempted to do something it could cause other problems. He did suggest making gap larger to allow better cleaning.

I believe this answer to be unacceptable. Am I correct?

I’m concerned to have him do any more work regarding crown/cap because if something goes wrong I think he’ll say he warned me of that.

I’ve only had crown since Jan 2016 is this something I can get my money back.. so I can get a new crown elsewhere?

I’d appreciate your opinion.

Thank you,
Francine

Dear Francine,
While I am not able to actually see the implant it is usually best to not have this gap. If the implant in the bone is not placed correctly then sometimes it is impossible to get a proper emergence profile (tooth contour). I would suggest you get a second opinion with someone that can actually see the implant and x-ray so that you can make an educated decision. I would not make the gap bigger!

Cheers,

Dr. Chris

Hello Dr. Chris,

What is your thoughts of a Composite Resin Crown over a Porcelain Crown on a Molar.

Thank-you,

Vince

Dear Vince,

What a great question! I am not sure what the circumstances are so it is hard to answer if this is the right course of action but you certainly can bond composite resin (like indirect Componeers) to porcelain if done correctly. This would prevent the need for more tooth removal and could be a great option to open the bite or change occlusal anatomy (as well as improve esthetics).

Cheers,
Dr. Chris

Hi there.

I recently had a crown put on a front tooth that I broke when I was a kid. I am getting a weird sensation from the tooth whenever it makes contact with my bottom teeth. I can only describe it as a pressure or pushing sensation. It is not pain at all. The temporary did not have this problem, only the permanent crown is doing it.

Any idea what this is? I am not sure how else to describe it and I am afraid my dentist will not know what I am talking about.

Hello Michael,

It sounds like you just need a simple bite adjustment. This is quick and easy so go ahead and talk to your dentist before it causes a problem 🙂

Keep smiling,

Dr. Chris

Hello,
I had a crown done on tooth #3, I cannot see but feels ok, my issue is when I floss it feels like floss gets under the crown and shreds the floss and if I pull it harder it breaks the floss. I talked to my dentist and he says that is good to floss around and get underneath…he said he could perhaps “buff it up” a little. This makes me doubt that the crown is done correctly, I thought everything has to be sealed so well. I do not feel there should be an edge where floss gets under. What should I request from the dentist?
Thank you,
Mona

Hello Mona,

Shredding floss is a bad sign…an x-ray (bitewing) might be able to show the actual fit of the crown but “buffing” it would not solve this issue as it is between the teeth and you cannot correct that location unless the tooth next to it is gone.

I hope this helps.

Cheers,

Dr. Chris

Dr. Chris, Thank you for your response. What would you suggest I do??? Can I require the dentist to re-do the crown??? Please advice how to act on this.Thank you again, Mona

Chris,

Have you ever educated your patients on the burden that insurance places on them? For some of us providers, we have no other choice than to offer 600 dollar crowns BECAUSE of insurance negotiations. And it’s sad, because there’s a FINE difference between the work I used to do as a fee for service practice associate vs. an office with over 20 PPOs associate. I hope the people who ask you for an opinion understand the limitations of what their insurance gets them. You don’t really get to be picky on the small things (shade matching, translucency of anterior restorations), Just the things in which would cause HARM to the patient, but minor issues are rarely ever addressed being reimbursed by insurance.

Shirley

Dr. Shirley,

You are completely correct, insurance places a tremendous burden on dentists! Patients cannot expect a Ferrari for the cost of a used Yugo, yet many of them do. This is one of the biggest challenges faced by dentists and I opted to see fewer patients, make a little less money but deliver only fee-for-service dentistry. Many dentists in my town do not have this option and they struggle to balance business and health care. I do believe you can provide a service for patients that don’t have the money for premium dentists but we need to be careful not to treat patients like a paycheck – check this x-ray below a patient sent to me today with his dentists saying he should get gum surgery to fix the swollen gum issue…
Bad Crown
This is why I write this blog! Patients needs to get “acceptable” dentistry regardless of how much they pay…
For all the dentists out there providing the insurance crowns at $600 per unit, I am not sure how you can do it, I sure could not…but someone has to.

Keep smiling,

Dr. Chris

Dr. Chris,

I had a crown done in 2009 & it has never bothered me, i recently went for a cleaning & my dentist informed me that the gums around the crown were inflamed & irritated. He used a explorer today & told me that the gums began bleeding when he used his explorer & that this was not normal, i asked what the option to correct this issue was & he explained that either replacing the crown or seeing a endourologist to get minor surgery & move the gum line up or down (cant remember) would fix my problem.

I have no pain or sensitivity in the tooth @ all.

The same dental office i went to today are the ones that did the crown initially, the dentist that seen me today did not do the crown, a doctor that is no longer there did. The Dentist from today informed me that it looked like the crown was not the best fit from the get go.

He also explained that I could try using a stimulator & water pick & try healing the gum around the tooth, before trying minor surgery or replacing the crown.

Here is a x-ray of the crowned tooth: http://imgur.com/P6eqIAv

Picture of tooth 1: http://imgur.com/wcghpG8
Picture of tooth 2: http://imgur.com/dGjajqR

What is your opinion on this, please let me know what you would recommend for one of your patients? Thanks!

Dear Rob,

The images were EXTREMELY helpful! Here is my adjusted image showing you what the problem is:
Poor Fitting Crown
The crown fits terribly bad and you need a “good” new crown. If this was produced by the current office and they watched this on x-rays for years then you NEED to find a new dentist. This is one of the worst fitting crowns I have seen.
So, do not get any “surgery” as the problem is entirely the bad crown – the fact that the dentist mentioned surgery as an option makes me shudder.

Keep smiling,

Dr. Chris

Dr. Chris,

I can not thank you enough for your insight on this problem of mine. So basically from what i understand the crown was way to big for the tooth from the get go? Would you say this is a typical case of poor lab manufacturing, or the dentist did not take a proper impression? Regardless of the crown being ill fitted, is it true the dentist should not have placed the crown & cemented it in knowing that it fit so poorly?

I had a ceramic/porcelain crown put on tooth #3 at a cost of $950. My dental plan doesn’t pay for that type of crown on that tooth-only pays for a high noble(gold) crown. My problem is I wore braces as a kid and before the work started I had 4 teeth pulled: #5 and 12 on the top and 21 and 28 on the bottom. So tooth #3 shows in my smile and I don’t want a gold crown showing. Shouldn’t they cover the tooth colored crown in this instance?

Dear Sue,

It sounds ridiculous that they would “not” cover a crown on that tooth. A High Noble crown could be a High Noble Gold Crown with porcelain fused to it….They certainly would not be able to limit it to gold only. I would call them or have your dentist call!

Keep smiling,

Dr. Chris

Dr. Chris,

If you had a previous dentist @ your practice that placed such a ill-fitted crown like mine & he was no longer @ your practice, even being it was 7 years ago would you replace it for free? Does it appear that malpractice is in play here as it took 7 years to pick up on this problem of mine? Also, for the sake of $$, would you say its safe that i now have the knowledge to make sure the crown is properly fitted to go back to the same practice that put my crown on & request some kind of discount for a replacement, or demand it replaced for free, one that properly fits?

I know you said i NEED to go elsewhere, but financially i may not be able to if i am offered a discount for a replacement or replaced for free. Would you say this is safe to do as long as its a different doctor & i ensure its properly fitted before i leave?

I had veneers done 25 years ago I got new crown and to veneers done. My bite is off my teeth don’t match. Hat to get root canal in one tooth a little bit oh the nerve was left, hen tooth get taped it hits the nerve. My gum line is sore all the time and the dentist says it will all settle down. Got it done 7 months ago

Sounds like your bite is off which means you are hitting the teeth too hard which can result in killing the tooth. Doing a root canal onyly takes away the pain from the tooth – if the bite is still off then the gums, bone and tooth will also continue to fail.
You need to have your bite looked at and adjusted by someone that understands function! Then you need a nightguard 🙂

Cheers,
Dr. Chris

Hello Dr. Chris,

Thank you again for all of your advice. I went back to the dentist, WELL EDUCATED being what you informed me of, thanks again! Anyway, i went in & they admitted that the crown was ill fitted from the get go, the dentist that installed the crown for me is since gone.

I went to my appointment, they cut off the permanent PMF Crown & discovered some decay, they got rid of that, then upon inspecting the root canal treatment found some moisture on one of the roots, i go in soon for a re-root canal treatment & they are doing all of this @ little to no charge.

I figured you would want an update, but since you informed me that i needed to go in to get it replaced it sounds like I seeked your guidance at the right time, because there are some problems under the crown now being rectified, thanks!

I have a problem going to the dentist, and was wondering if a re-root treatment is a fairly painless process, should i be just fine? I am scared & seeking guidance on what to expect.

Hello Rob,

Your welcome and you should be fine 🙂

Cheers,

Dr. Chris

Dear Dentist,

I recently had a lower first molar extracted because of a crack – followed by a bone graft, titanium implant and porcelain crown screwed into place. All expensive and seemingly well done EXCEPT the crown itself is quite ugly. It really does look a bit like a kernel, and the filled screwhole is grey/blue. It doesn’t look like the tooth it replaced. I complained immediately, and wrote to explain my dissatisfaction the next day. My dentist agrees that the aesthetic is disappointing but explains that a flatter tooth is necessary “to reduce stresses” and also because there is little room for vertical shape given the chimney and fixing system and my “short teeth”. He offers to redo a cemented crown but says not to expect a “higher” tooth, as there is no room for it. I do expect cusps and vertical shape within the height of my tooth, but have lost a bit of confidence now so feel nervous about having a bad crown cemented in!
How to know that the new crown is OK before its finally fixed in place? And should I “manage my expectations” as the dentist says? There are almost no pictures of good-looking molar crowns – in mouths – on the internet, but lots of fuzzy photoshopped and computer generated images. Is it really possible that a flat tooth is my only option?

Hello Sophia,

So, lots of good questions. First, yes, you can have a good looking implant crown but there are limitations that can affect the final result. The space between the teeth is one of those restrictions. I don’t have a photo so I cannot comment on that in your case. The “abutment” on the implant has a certain height but if there is a room/space issue I would ask your dentist to use a UCLA Abutment method (attaching the screw retained implant directly to the implant without the middle part).
Screw retained implant are better for many reasons. The screw access hole should be filled with an opaque white teflon material and then a matching composite color placed on top of that. This should result in a very esthetic (not gray or blue) result.
Lastly, implant crowns should be slightly out of occlusion only – it still should look the same. You should expect a nice looking implant crown!
I have many photos of good looking implant crowns but not here at home from where I am writing you 🙂

Cheers,

Dr. Chris

Hello,
I recently had crowns re-done for my top 6 front teeth (canine to canine).
The finished crowns came back with vertical ridges that I can feel with my tongue on all but the canines- my dentist claims this is intentional and done for a natural look, to avoid a ‘flat’ appearance when light hits.
The presence of this detail was not mentioned at the start of the process, nor was it present on previous crowns, so I am skeptical.
Is this considered a standard practice in production of crowns? I am not 100% sold on the appearance..
Thanks

Dear Sammi. Texture does usually help a lot with appearance and light reflection but you are the boss and your crowns need to look good to you. These ridges can often be polished down if needed so live with it for a while and then decide. Ideally this would have been discussed before the crowns were cemented.
Keep smiling,
Dr. Chris

Dear Dr.Chris..

I had two side by side implants and crowns put in my mouth 4 years ago. The edge broke on one and I tried to let it go, but food kept sticking on it. My current dentist, which I have been going to for 2 years, said he does crowns of this type and I agreed to replace it. He said he would stand behind it and do whatever to be sure I was satisfied. I was concerned because he only took a mold impression and no measurements. Right away the crown trapped food. I went in and he took it off and sent it back to be corrected. It is worse! He suggested pulling the molar behind it because I only bite on half of it. I was shocked and said no. He now suggests he can do some work to that same wisdom tooth to try to fill the gap. Is this normal?!
Should I allow him to try that? That tooth is fine and I think he should only work on the new crown he put in

I am wondering if this type of crown should not be done by a general dentist and only with a prosthodontist (which I had the original one done by). Should I even let him work on the wisdom tooth? Get a 2nd opinion? Ask for my money back?

Dear Barbara…
This type of dentistry is routine and a general dentist should handle handle just fine.
The dentist needs to get the crown right without trying to correct it by working on the tooth behind it. Don’t let them touch the tooth behind it and ask that the implant crown be redone until it is right. If they can’t deliver a correct crown then you should get your money back and see a more experienced dentist.
Keep smiling,
Dr. Chris

Hello Chris,
i just had done my zirconium-pocelan crowns-13 on the top jaw.They do look nice,but i have strange feeling that they dont fit properly-they feel sort of loose.
Specialy the four front teeths then i brush them,i think they moove.I told my dentist,but she said that is normal.

Dear Ingrid. It sounds like the bite is not adjusted correctly and you are hitting heavy on the front teeth. He dentist needs to get this correct or the teeth will move, break or fail with none loss. It is not “normal”. It annoys me when dentists try to avoid diagnosing the problem once they collected their portion by calling things “normal”. If it was normal then the dentist should have told you your teeth would be loose when you are done and how normal does that sound?
Get the bite fixed before it causes problems and get a night guard!
Keep smiling,
Dr. Chris

Dr Chris

I recently had 2 crowns done after 2 root canals. On teeth 36 and 37. On tooth 37 it was a perfect fit with no problems. On 36 however, I felt a space between the tooth and the crown. The dentist made several adjustments after which he decided to fill the edge of the crown which was not sitting well. Is this normal? Should I demand a new crown?

Many thanks

Dear Marcus. Often we need to adjust the fit until it is perfect. I send back about 1% of the crowns I want to cement to the lab to be redone as most often they are nearly perfect but even the best labs can make mistakes – or your impression could have been distorted. If the dentist was able to get the crown to fit correctly great, but if there was a gap then he/she should send it back to be redone. Sometimes we dentists don’t want to send the crown back to look like we did a poor job so we are tempted to just make it work but really we should tell the patient that it just is not perfect and we will redo it 😉
Ask you dentist and if you are concerned get a second opinion. An x-Ray should show how it fits if there was a gap.
Keep smiling,
Dr. Chris

Hello Dr. Chris,

Within the last 6 months I’ve had to get 2 root canals in the list two upper back teeth. The first was to fix a previous root canal that hadn’t been taken all the way through which caused an absess deep in the gums/bone. So that root canal was done and the absess is getting better. However, when my dentist put the crown on for that tooth (which took about 3 weeks) she said of your gums have receded being that when she fit it on my tooth it didn’t go under the gums. I found that to be a little unbelievable in 3 weeks but she assured me that it would be fine just cementing it to the tooth without being under the gums. There is a black line now along my gums and I can feel a gap between my gums and the tooth.

The issue is that I started having throbbing pain not in my tooth but in the gums and all the way into my cheek in that area that started about 2 months ago. She sent me back to the root canal doctor and the tooth behind the one I’ve mentioned now had sensitivity to cold and he said I needed a root canal for that one now too, so I did it. There was without question inflammation past the root area and in my gums in spite of the absess improving. It has now been 10 days since the 2nd root canal and the pain has not improved at all. They told me this was normal 🙁 but it doesn’t feel normal.

So my question is do you think that the gap in between the tooth and the gums could be causing the issue? Should a crown be placed underneath the gums? If it’s not can it lead to this inflammation, decay and gum.disease?

I told my dentist I want it fixed, and she’s saying it’s not necessary and it’s the wrong decision but I really didn’t have any pain before we did the first root canal and now my I feel irritation and uncomfortable constantly.

Sorry for the long note and thank you in advance!

Sorry for your trouble.
Let me address your issues one at a time:
1. The crown margin should not be placed deep below the tissue, that makes things worse. Keeping the margin 0.25 mm above the tissue margin would be ideal.
2. You should not be able to feel the edge of the crown, that indicates a poor margin.
3. There should not be a black line. We don’t use porcelain junction margins (I sure don’t) but that is what it sounds like. Most dentists use zirconium or emax, both all porcelain. What type of crown is it?
4. The bite or how the teeth touch needs to be perfect. It sounds like there is a problem with your bite and all my patients (85% plus) wear a night guard to protect their teeth and joint. Less than 1% of the crowns I place ever need a root canal treatment.

So, you need to get a second opinion in my opinion. Root canals are not only costly but unhealthy. The problem is still there (probably due to the bite).

Keep smiling,
Dr. Chris

I recently had 3 crowns placed on teeth that where filled and never gave me problems . Problem is that when removing my temp crown after 2 weeks the dental assistant broke the tooth that was left !! So I had absolutely no tooth left and the dentist said its ok and cemented the crown . Then his assistant cemented the second and third . The third tooth that had no root canal was very very sensitive so the dentist told her to cement with some medicine to take off sensitivity . After I left the clinic 3 hrs later the crown fell . Went the next morning to see what was going on the dentist put this gel that numbs the pain to give me an injection . The gel goes on the tooth and the pain was excruciating ! he said I might need a root canal and had to pay an extra $900 !! My tooth was fine before He touched it ,should I refuse to pay for the root canal since he hit the root when filing it down . Also I have a gap between the crown and gum . Please help !!

Dear Robbie,

Sounds like you need a second opinion. First and foremost you lost confidence in your dentist and that is a problem.
With regards to cementing crowns…. I am not sure what you paid for your crowns but my experience has been that cost is directly linked to quality, sorry. Time is expensive for a dentist and for that reason the cheaper the procedure the less dentist you get. The assistant will do more and more and the lab work will not go to a great technician/artist but rather something I would compare to a puppy mill. Sorry again, sore subject as I feel too many people are having these problems as quality gets worse, prices go down and the government tries to get its greedy hands into the insurance business.
In your case the tooth should not have come apart (maybe the poorly bonded core came out) before cementing and the temporarily cemented crown should not have fallen off (most likely poor preparation design). So, to me it looks like you need to see a quality fee-for-service dentist (AACD accredited I would suggest) before your mouth becomes a mess. When poor dentistry goes bad, as it always does, the dentists answer almost always is a root canal or extraction. Ridiculous.
I hope this helps,
Dr. Chris

Dear Robbie. I am sorry you had a bad dental experience. I can only attest to the type of dentistry I and other quality de toast provide and we would not have dental assistants cement crowns – not sure that is even legal. Anyhow, you unfortunately have little to gain by trying not to pay for the root canal and if you feel the work is really bad you would need to get a second opinion and then go through peer review. It may be just easier to find a dentist you have faith in!
Keep smiling,
Dr Chris

Hi Dr. Chris,

I recently had a root canal and a crown placed on one of my molars. Now when I push on the tooth or sometimes when I bite I feel pressure. It doesn’t hurt but doesn’t feel right. I have been in to have my bite adjusted and that didn’t help. Could it be too wide?

Thanks!

Hello Michelle,

My first check would be the bite but you said it was adjusted…maybe not quite enough or correctly?
Second, a fracture can feel like this…
Third, if the crown is too big or fits poorly then the periodontal tissue around the tooth will feel the same way…
Either way, it needs to feel better so talk to you dentist about these options. An x-ray would help to check the crown fit!
Cheers,

Dr. Chris

Hi dr. Chris
I had my upper molar cusps removed by a horrible dentist also the crown below it grounded on after I was experiencing teeth bumping into each other. My bite is slightly collapsed because of this shaving and TMD as well but the TMD is not painful like it was because when it first happens and I think it’s because I have been bracing my bite by putting cotton between my teeth. I feel this is a sign that if I get an onlay maybe on 14 to give back the cusp, and a new crown on #19 then my TMD will resolve, my bite will raise back up and I may recover, or maybe leave #14 alone since it’s still vital with no pain just missing cusps, get a new crown on 19 and maybe bonding on the right side to some back molars to build the bite! What do you think? It’s been almost 3 months since this happened, and I can only afford to get maybe the crowns not an ap Really need your detailed thoughts please??

Dear Lida. This is a complex issue and it would be impossible for me to give you a treatment plan with the limited information I have. But, here is the basic premise of what you need to do…
First, the TMJ is the dictating force in designing how the teeth come together since we cannot change the position of a joint. Your teeth obviously are not in harmony with that position. So, often we use a night guard to slightly open the bite, remove any interferences and then determine where the teeth should be. Once the night guard has found a comfortable position (centric relation) then we see what it will take to make the teeth fit into that position.
Over time our teeth wear down and shift, both of which can alter the TMJ position. When I rebuild smiles I often open the bite by working on all uppers or all lower, or both to re-establish that comfortable centric relation bite position.
So, you need a sophisticated dentist to at least look at you and guide you along this path – drilling in a tooth or doing an only may make everything that much worse and cost you lots of water money.
I hope this helps.
Keep smiling,
Dr. Chris

Correction…
I can afford to get maybe just the two crowns. I don’t want an appliance since my bite only needs slight rasing and I hear horrible stories about those orthotics permanently opening people bites or leaving them worse off then before. I also hear you can get restorations for bites without using them and by adding to the teeth via crowns bonding …your thoughts please!?

I need advice. Two years ago my dentist removed an amalgam filling that was 30 years old, put in a composite filling. I went home and looked at the tooth, thinking I would see a pearly white tooth, but I noticed a line of dark beneath part of the filling. So, I called the dentist office and told them I thought he left behind decay. They said they would get back to me. They did, oh no, that is staining from amalgam. Well, it is two years later and now there is decay in that spot and the dentist says I need a crown. I don’t trust him now…. I have a feeling he did cover over decay with the composite filling. Too much of a coincidence for my liking. Thoughts? I googled cover decay with filling and there are dentists who do this! But, if a dentist is going to do that I would want to be told. Stuff like that bothers me, it is like shingling over a rotted house!! I don’t like it at all. But, it got me thinking what if he covers decay with a crown? I do not want a crown that fails or needs to be replaced early. This is a dentist who has a good reputation, however, I am not feeling confident and he seems to like to do crowns on people and other expensive treatments. Thoughts?

Dear Steve,

If there was decay left under the filling you would probably be able to see this on an x-ray. Old amalgam does stain and we as dentists need to differentiate between “affected” and “infected” dentin. Dark color does not always mean it is bad in a tooth.
The question is why after 2 years you have decay there…that is a problem. Your dentist should be able to tell you if this was from a new lesion or leakage under the filling – there always is a reason and you need to know.

Secondly, a good crown works well but it needs to be a good crown. The blog above that you read does describe what a good crown looks liek so study this and discuss with your dentist prior to getting it done.

I hope this helps.

Keep smiling,

Dr. Chris

Dear Steve,
So, stain under a filling is possible and can make a filling look a little darker if it is thin. Amalgam, nasty things they are, can leave a dis colored tooth that is pretty healthy so leaving the stain is ok.
That being said, the filling should be thick enough for strength and if a good “dentin” colored base is used you really should not see the color. Many dentists use “enamel” colored fillings all the time which results in translucent and consequent gray/dark teeth.
Now the decay is a different story. 2 years is a long time and many things can happen in hat timeframe. It is impossible for me to comment on decay on a 2 year old filling as there are too many variables but if the dentist is suggesting a crown now then the filling must have been pretty large. Also amalgams fracture teeth so it is likely that a fracture was present allow bacteria into the tooth and this results in decay.
A good crown is key and you are reading the right blog posts to understand what you need to look for there.

I hope this helps.

Keep smiling,
Dr. Chris

Thanks for the responses it all makes sense and I will make sure that I get a good result if I do get a crown.
thanks,
Steve

Hello,
About a month ago my dentist placed a PFM crown for my implant on my 2nd molar. After reading the disadvantages of PFM, and advantages of zirconia crown, I wanted to go back and replace my crown to the zirconia crown. Do you think it’s worth replacing my PFM or should I wait until it’s dead then replace it?

Thank you!

Hello Emily,
For implant crowns different rules apply in my opinion. A PFM for an implant crown is a good option as long as the dentist used quality gold. As a matter of fact, while I do use zirconium at times for implant crowns I am pretty sure a metal supported crown will be stronger and last longer since zirconium can fracture.
For my implant crowns I like to use the screw retained system whenever possible and I am using both zirconium and gold at times…my lab feels the zirconium will be just as strong but I feel the jury is still out.
In your case I would leave it 🙂

Keep smiling,
Dr. Chris

Hello Dr. Chris. I am hoping you will be able to help me. The back story to leading to current issue: I have been dealing with a crown issue (#14 molar). The original older crown had shifted a bit and a sharp edge was hitting my tongue. The Dental Director (aka Manager) of my group dental practice attemped to take the nib off with a drill (not a smothing bit) two times. After the second attempt it was obvious that he had overdone it, and a channel next to the molar behind it, where food and liquids freely flowed. He then said I would have to get a new crown (for which I had to pay a $200 co-payment). Another dentist in the practice removed the old crown, making the impression for the temporary (based on the impression of the old, now badly shaped crown) and I was very uncomfortable, still had an open channel/air pocket between the teeth, and I got an infection of the gums & was prescribed antibiotics. The new crown was placed, and I heard a “ping” when I was told to bite down. I mentioned this to the dentist, who said “oh, don’t tell me that”. He inspected things and removed excess adhesive and sent me on my way. I was numb at the time so I was clueless until later, when I realized something was very wrong. I had pain at the fracture site, and there still was a channel/air pocket between the teeth. After examination by the Dental Director, he determined that the crown had fractured, causing a gap on the exterior gumline. The dentist told me that the channel/air pocket issue would be fixed with the new crown. On to next appointment crown replacement. Different dentist did it this time and I was hoping for a great result, as he assured me of his years of experience. He took the fractured crown off made a temporary, and again, I got a gum infection shortly afterward. At urgent visit to have it looked at, was again given antibiotics. Again I was told that the issue between the molars of a channel/air pocket would be corrected with the new crown. I told the Dental Director that my cousin recently had a crown done, and the dentist used a temporary adhesive at first to be sure she was happy before permanently setting her crown. He said, “Sure, we can do that.” When I had my appointment to get the my current permanent crown, the dentist setting it refused use temporary adhesive. Said it could not be used with an all porcelain crown. So NOW, I have my current replacement crown I am STILL having an issue that is related to a channel/air pocket between the teeth. The air pocket is in the upper gums, and builds up pressure at times. It can be painful, and it is very distracting. It is not relieved by flossing. Brushing sometimes relieves it a little. Using a dental pick sometimes allows some of the trapped air to escape along the gumline of teeth in along the side and more forward. I have had 2 chunks of what I believe are old crown or tooth fragments as well as a skinny sliver of tooth come out of the channel as well. I went back for an urgent visit, was told I now needed to see the periodontist – first appointment, 2 weeks later. When date came, he had to reschedule. I went for urgent visit with Dental Director – he saw nothing. Refutes the possibility of having an air pocket. Finally saw periodontist yesterday, who said it was not perio-issue. (However, his own personal female dental assistant seemed to understand my explanation, and even mentioned what kind of perio-pocket issue she thought might be happening, but her idea was summarily dismissed.) The Dental Director then said to me, “Everything looks great, nothings amiss, there’s nothing more we can do for you.” Well I am still very uncomfortable, with a feeling of trapped air up in the gums and at times a stabbing sensation. Mind you, there is no pain in the actual teeth. Can you shed some light on what should be done to remedy this? Do you think I may have fragments still floating around in the upper gums? Should they remove the filling from the tooth behind the crown to see if there is a contributing issue there? Should I allow them to replace this crown AGAIN? And pray for a successful outcome? Thank you for your time. I know that this is long winded, but wanted to give you the details. PS- A friend works for a dentist who did a courtesy look and xray. He feels the boarders are probably bad at a minimum, and that the crown is a bit bulky. His feeling is a replacement.

This was quite a long explanation of a unique dental problem 🙂

First, I can’t really give you much of a diagnosis on an air pocket situation as this is not something I have seen. With all the trouble you have gone through I would make sense for you to simply get a refund and go to a top fee for service dentist that is highly experienced such as an AACD accredited cosmetic dentist. This would of course cost a lot more but the final result surely would be significantly better.

Sincerely,

Dr Chris

Thank you for that. I have filed a complaint with the management of my dental practice and am awaiting their response. I believe that a will designed and fitted crown should not have such an issue. (The air pocket is a constant distraction, affects my speech and my sleep!) Wish me luck and thanks again!

Good job :). And, good luck!

Hi Dr. Chris. Can I send you a photo through email?. Regarding the crowning skill of my dentist.

Sure. Anytime
Send it to info@idealdentistry.com – that should work 🙂

My zirconia crown teeth moves when I touch it with my fingers! Is it normal or should I go to the dentist because it may fall???

There are several reasons why your crown could be moving. One, the bite could be off and you are hitting it too hard. Secondly, you could have bone loss. Third, you could have an infection.
Either way you need to see your dentist!

Five years ago I had a root canal on #15 after part of it broke off around a failed amalgam filling, The tooth was then crowned. Unfortunately, the crown was too high, which eventually led to severe, almost blinding pain after two years. The dentist ground the crown down, but it never felt right. Yesterday, the tooth broke off at the gum line; the post was inside the crowned piece that broke off.

My question — is this failure to be expected or could the tooth have been weakened to the point of breaking as a result of the ill-fitting crown?

Dear Vince,

A root canal makes a tooth more fragile as it is “dry”. There could have been micro fracture in the root which would proliferate due to the tooth hitting too heavy. So, in my opinion a good fitting crown is paramount for the longevity of the tooth 🙂 I suppose that answers your question with a yes!

Keep smiling,

Dr. Chris

Hello

I have been through a dental implant in my lower jaws molar teeth, 3rd from the last.
Just 10 day earlier, my dentist fitted the crown. Although crown just fit well but it is about 6-7 mm smaller(in height) than ajacent teeth. Is is normal. (But it looks akward when I look in the mirror)

Please reply

An implant crown should only be a tiny bit lower, barely noticeable. So, no, 6-7mm would be really bad. When I restore an implant crown I usually would leave less than 0.5mm open clearance. This is checked by having the patient grind heavily and have the implant crown barely touch when clenching.
I hope this helps,
Dr. Chris

I am sorry, looks like my reply did not go through. Here it is again!
The implant crown should be very similar to the regular crown except there should be no contact until the teeth actually clench together. This is usually less than 0.5mm so 6-7mm would be huge! Send me a photo or get it looked at by another dentist soon…
Cheers,
Dr. Chris

Know of any good second opinions in Maryland Annapolis area

Sorry, I don’t. What are you looking for? While new patient second opinion or specific dental problem second opinion?

Just got a crown on one of the front tooth that’s next to an implant, and it’s clearly a bad crown. It’s too big, sticks out, the back is not aligned with my gum to where it’s cutting my tongue, and it’s a horrible looking tooth. The dentist didn’t even want to repair it. It is not the color I chose nor is it anything like I’ve ever seen before. It’s too thick and doesn’t feel real like the crown on the implant.

Dear Regina,

The dentist needs to ask you if you approve the esthetics before the crown is seated. If the crown also does not fit right then another issue arises. Get a second opinion and let your dentist know you need this done correctly. If this does not work contact the local dental board and ask for the peer review panel, they will take care of you.

Keep smiling,

Dr. Chris

Hello Regina. The dentist should have shown you the crown before it was permanently cemented and received your approval in color and shape. I would suggest you get a second opinion and get it redone if it is that bad. I would be surprised if the dentist who did the crown would not work with you to make you happy. We are in a service business…
Dr. Chris

Thanks awesome post. My problem is not the material the dentist used which is Porcelain but how he did it. I got 4 crowns on the bottom back done and here are the issues I have.
1) inflamed all the way in the back of the gum immidiately behind the crown, as if he pinched my gum when he put crown down.
2) Gums slightly inflamed around crowns and when I push gum around crown with my finger , a bad odor comes out and is on my finger as well from the gum.
3) Finally all crowns are sensitive to anything even slightly cold

Just don’t know what to do and if this is normal.

Dear John,

This is not normal and to me it sounds like the crowns are too big and over contoured – this is a common issue these days with labs. Unfortunately cost is always an issue and as crowns get cheaper and the insurance companies pay less and less dentists need to pay less for the dental technician to create the crown which in turn results in these type of issues. Sorry for the run on sentence. In short, quality dentistry is expensive but it really makes a huge difference and in many dental offices that take insurance this is what happens. I would recommend redoing them and using a different dentist that is out of network…sorry for your trouble.

Sincerely,

Dr. Chris

I had this same problem. Bad odor and my gums were inflamed. The crowns are pushed too far into the gum line. I had another dentist redo them and they problems are gone.

Exactly! Thanks for the comment Susan, quality dentistry really does matter.

Hello John. Sounds like the crowns are just not shaped correctly. This is often seen in “clinics” that try to deliver crowns at super cheap prices and use poor quality dental labs. Unfortunately the only solution usually is to quickly get them removed and new ones made by a quality lab with a quality dentist.
I hope this helps,
Dr. Chris

I just had 4 crowns on my 4 front teeth. When I first had them placed the colors matched and they were white. It is now 2 months later and a slight yellowish color is noticeable. I asked the dentist and he said it was normal and it is just due to saliva and that even porcelain stains a little. Is this true??

Hello Racheal! The color of the teeth/porcelain should be the same at first for a long time. Porcelain does not stain but the tooth underneath can darken, over time. Antibiotics and other medications can do this. If the dentist tried the crowns in “dry” they would look a lot different than if he/she used a cement which will allow the underlying tooth color to change the color of the porcelain. For this reason we use try-in paste that matches the cement color and verify that the patient likes it. The only concern is that maybe there is leakage under the crowns…the fit of the crowns needs to be good.
I can only recommend a second opinion to check the fit…
I hope this helps.
Dr. Chris

I am 52 years old. I am a life-long ice chewer, nail-biter, grinder, and worse. The result is that I knew at some point (in 10 years, i thought) I would have to have serious work done — either crowns, implants, or perhaps a combination. A year ago I had a bad car wreck, and a few of my front top teeth were chipped and broken, plus all of my lower front teeth also chipped wors than before. Since then the top teeth have had filing material added to them, but the bottoms were merely filed a bit to appear even, as there was not enough tooth left to allow filings.

My dentist told me that this accident would require me to have the major work much sooner because my teeth were getting too small to continue to use filling material — and each time the front top filling popped-off, the tooth needed to be filed down and made rough (and slightly smaller) for the next filling… more than 6 times in a few months on one tooth alone. My dentist suggested I see a Periodontist and Prostodontist for the work, and I selected a team who she thought would do a good job. Their recommendation was to have crown lengthening done to all 28 teeth, with the goal being to add about 3mm to my front teeth and 1-2 mm to the back teeth so I can get crowns on some or all of the teeth. They told me it would be a serious mistake to begin implants done at my age because, with my grinding, I also have plenty (too much) jaw bone, so I will likely remain a good candidate for implants in 20+ years if some of the crowns eventually fail. (They removed some of the excess jaw bone during the crown lengthening, BTW.)

The crown lengthening has been done, and my teeth look a bit better, especially the lowers… though the top edges of the lower teeth remain broken off, worn down, and rather ugly…at least they are longer than before. My dilemma is whether I should now have all 28 teeth crowned or merely crown the front 8 or 12 teeth, and perhaps also to one molar on each side to reduce the risk of biting down and cracking the front teeth. (Okay, I admit it, I am getting chicken! LOL) Will doing all 28 teeth cause me a lifetime of ongoing repairs? Or might only crowning half of the teeth cause even more problems? Thank you!

Very good synopsis and question!
You really do need an excellent dentist to guide you as you don’t want to do this again. To summarize, I would usually crown the second molars in high noble gold to maintain vertical dimension (not porcelain as it would break) and then make sure you have proper canine guidance in front. I routinely rebuild the entire mouth with 28 crowns but it has to be done right! The constant breaking of the front teeth concerns me… regardless, you must wear a properly made nightguard. Getting a full mouth reconstruction is a great solution as if it is done properly it should last a long time and if something breaks most dentists have a warranty if you follow the rules (cleanings, nightguard, nutrition). So, if you stage this process make sure you always maintain posterior vertical support and anterior guidance with a nightguard along the way. Feel free to contact me if you have any more questions!

I went to Dentist, for three tooth bridge, and six front crowns. My front teeth had been bonded 20 years ago, and needed whitening. So I decided to go to my daughters dentist who was very reasonable with his prices. So I had everything done. Well when I went back to have them put on, there was a different dentist there and with the room somewhat dark, he seemed to be in a hurry. I tried looking the small mirror and tried cleaning it with the blouse I had on so I could see what they looked like. Well, some were bleeding and falling off and it was awful. After he glued them and I was at home, I was so upset. The six teeth in front were not straight, they seemed to be (pidgeon toed) . The eye teeth are slanted and makes the other as well not straight. The bridge which were three teeth are so much shorter than the others!!! I am so upset. I live in Florida and I had this done in New Jersey. The Dentist who took the impression said give it a few months. It was a huge decision and expensive for something to look tis way. I am not able to bite a thread when sewing, bite a piece of wrapping off a cookie,etc. How could this happen?? Who decided to make my teeth so different then what they were?? They had nine teeth to do all open for them!!!!! They were just done in Jan. 2017 so I worry how painful it will be to try and remove them all!!!!! Please give my some advice

I am sorry you had a bad dental experience. It is really not acceptable that a dentist cements front teeth without getting your esthetic approval first. It sounds like the dentist was a bit in over his head. In my opinion it should be redone asap at no cost. That is where I would start.

When a crown is placed, how tight is too tight? Floss should fit between the crown and the adjacent tooth, correct?

When a crown is seated it should feel “normal”. Meaning, it should not feel tight and floss should snap trough. An open contact or a too tight contact are both bad.
Most often contacts these days are too tight because labs make these block emax crowns and adjust them to fit on the tooth before glazing them. Once the contacts are perfect they bake a glaze on the outside which makes it easier for them with polishing. This of course adds some thickness to the crown and they forget to adjust the contacts again and voila you have a too tight crown. If the dentist does not adjust the contact properly you end up with a poor fitting crown that is either too tight or did not seat all the way down and leaves an open edge where decay and fluids enter. This causes sensitivity and often the dentist has to grind a bunch off the top. I hope this helps!

My crown doesn’t have contact with the next crown that my dentist did. Is my dentist legally obligated to fix the crown? It’s been about. 1 year since receiving the crown.

Dear Connie,
Since it has been so long I cannot comment on that very well. The crown, when seated, needs to have contacts and fit correctly. Any issues should have been resolved at that visit. If you contacted your dentist right afterwards with issues and he/she did not resolve then the dentist should redo.

Since it has been 1 year no. These issues must be addressed at the seat appointment.

Dr. Chris, On the last appointment my dentist prepared me for crowns and sent the order. When I came home I noticed something really black (it was not there at first) on my gum and on my lip right above my front teeth I am waiting my crowns for. Then my skin mostly died and fell off. However, the tooth I am trying to match my crowns to also got darker: right now it is the same as the one on the other side of my future crowns (which is a dead tooth, but the tooth I am worrying about is very much alive). It looks like a film, but I cannot get it off with brushing. It is very frustrating, since I did not ask for darkening my teeth. I don’t know what that is. The only thing that I know that I paid for the “Cosmetic enhancement” (which I did not even agree to and don’t know what that “cosmetic enhancement” really means… – maybe that was something else, I don’t know…) I am confused and frustrated. Do you know (any idea) what has been done and if this treatment will eventually go away? Thank you very much!

Dear Mag, the black you are seeing could be many things including the chemical we use to stop bleeding. It should be temporary. I hope you receive the esthetics you desire. Be sure to APPROVE the new crowns BEFORE they cement them, that is the most common problem patients have.

I have been having trouble with a crown on tooth #10 since it was placed three years ago. It has never felt like it fits correctly which is likely the reason why it has fallen out once and broke twice. This crown replaces one that I previously had for 15 years and never gave me a problem until I bit down on something hard one day and it broke. This new crown has never felt the same or looked the same as my old one. My tongue constantly goes to it because it feels so foreign. My dentist has attempted to fix it each time it has broken but now is asking me to have a crown lengthening procedure before she fixes it a fourth time. I had the initial consultation with the periodontal surgeon and that went okay except for the $2400.00 quote for the procedure. My dentist will also charge me $1300.00 to do the crown again. I am not happy about the amount of money it will cost to fix this of course, especially since I have already paid for a crown twice plus a root canal. However, I am most concerned about allowing my dentist to have a fourth attempt at this considering the three previous failed attempts and this time having a surgical procedure on top of it that could alter the appearance of my gum line, resulting in the need for another oral surgery. Simply said, I have lost confidence in my dentist. I am wondering if I should get a second opinion from another dentist? I do not want to have this oral surgery only to have an ill-fitted crown placed once again. I am feeling very conflicted about this and need to make a decision soon as my current crown is loose and I do not wish to cause any further damage. I would appreciate any advice you may be willing to give.

Dear Karen, it is very clear to me that you need a dental expert. This is your smile zone and confidence in your dentist is not optional, it is a must.
I know that most AACD Accredited cosmetic dentists would be able to serve you well. Find the closest one and get a second opinion.
Cheers,
Dr. Chris

Dr. Chris:

I have had 6 emax crowns placed in front (my dentist chose emax because of how dark my endodontically treated are). I will not go into all the details here but would would like your advice. What other material – in front – would you suggest using that would be more aestically pleasing than the bluish-gray emax and yet strong enough to protect my fragile teeth? I have been told not to use zirconia because they can be very opaque. But, then, so are the ones I have.

Dear Carol. I find emax to be the least esthetic material out there yet all dentists like to use it. Strength is overrated. Most porcelains, including feldspathic porcelain, will last very long when used correctly. Zirconium can be made to look very nice but for better esthetics I use either authentic or empress (or narotaki). It also depends if it is a cemented restoration or a bonded restoration that the dentists wants. Strength is the least important characteristic of porcelain.
Just because a tooth has had a root canal does not mean it needs a stronger porcelain.
That being said I prefer a cemented crown so I can try it in better and reduce the margin error that bonding can have. Bonded restorations will need the margins polished which is very difficult and if your dentist picked emax for “strength” on the front teeth because they were root canaled then I would really doubt that he/she has polished the margins.
Cutting of emax crowns is very very difficult as the material is so hard.
I would use a high quality lab technician (note I said technician, not lab) to make zirconium LAYERED porcelain crowns. This would result in predictable esthetics with much healthier margins (make sure they hand polish the crowns with no glaze).
If you need me to recommend a few good technicians, let me now. They are not cheap but who wants to save some money and get ugly front teeth?

Dr. Chris thank you for all you do for others. Well, I’m still in the process of choosing the right material for front crowns. As I stated, my endodonticalkt treated teeth are very dark (think almost black) and my dentist believes feldspathic porcelain may be too thin and the black from my natural tooth will show through. He assures me his technician can make emax crowns that are not bluish/gray. But, then, that’s what the last dentist said and here I sit – new dentist, another decision. In your earlier response you suggested zirconia ‘layered.’ But when I parroted this info to my dentist he continued to say his technician has been with him for years. So my question: Since I would love feldspathic porcelain is it true they would be too thin to mask the black underneath? Should I insist NO emax regardless of my dentist’s technician’s unique skills? Should I still ask for layered zirconia?

Dear Carol, feldspathic porcelain is the most beautiful but will not mask black very well. To mask a dark tooth you need to block out the darkness and build porcelain out from there. This can be done with zirconium, PFM, and some other materials but the material will be thicker. I am just not a fan of emax on the anterior teeth, sorry. It looks “dead” to me. That being said, I have one technician I use (friend) that can make emax look amazing, but he is the best in the world – Naoki Hayashi. Maybe your dentist can ask my friend to make your teeth – his lab is in Irvine, California – Ultimate Styles. Unless Naoki does the work I cannot say I would endorse Emax.

Thank you, Dr. Chris. This may sound like a childish question but are dentists accustomed to patients requesting their specific/chosen lab technicians? I don’t want to appear to be one those ‘vampire’ patients but at the same time I AM paying top dollar and want my teeth to show it. My dentist assures me his lab technician, who has been with him for over 30 years, can make emax crowns pretty – not gray. Do I just let his technician do his/her thing and if I don’t like it, keep sending it back; or do I insist up-front he send it off to a master ceramist (the one you mentioned)?

Hi, I recently received a crown on my rearmost molar bottom jaw left side. As the dentist was applying it they ended up remodeling the grinding surface of the tooth above is this normal?

Ideally we tell patients if there will be a need to adjust the opposing tooth surface prior to cementing the new crown. This is occasionally done when the crown is thin, there is not enough clearance or the opposing cusp is too pointed. Usually we only take a small minor amount off and polish it up afterwards. I hope that helps!

hello, my dentist have modified the emergence profile on my crown and it’s so life changing because before a very bad odor was coming from this area now it’s better but there is still an odor and i have always my tongue between the 2 teeth i ask him to make the contact point less tight but he say it’s perfect and don’ t want to do anything more. any advise?

Once a crown is cemented you really cannot make the contact any lighter. This has to be done before it is permanently cemented, sorry.
The emergence profile has to be correct so it does not look like a big mushroom and traps food. This unfortunately is very common and requires a high quality lab and Dentist. An x-ray can often make the situation more clear if you want to send me one.

I have front tooth with dental crown cemented to it. Once I was eating it got detached and fell off. I am a bit worried as I fear it will detach again while I am out with my friends for dinner or during business trips as it is a front tooth. Is there any method method or cement out there which would make sure my tooth never falls off? please help me…I am always nervous while eating or going out with my friends…I feel everyone will laugh at me if something like that happens…please help!!

A crown should not fall off! You need to see your dentist to figure out what is happening before the problem gets worse…if you need more advice, let me know what happens after you saw your dentist.

Dr. Chris,

I have two crowns done about two months ago. After the crowns, I have massive pain on my crowned teeth. I went back to the dentist, she adjusted both crowns for me; however, it didn’t help. I still have massive pain with my two crowned teeth.

My teeth didn’t feel any pain before the crown. Now I cannot use the two crowned teeth because whenever I use them to eat, they give me massive pain. They are so sensitive to hot and cold drink and food. I try to just use them for warm and very soft food, they still cause massive pain.

Did the dentist do a bad job? I feel like she may cut too much of my teeth away and damaged my nerves.

Please advise why is that? I feel so sad. I don’t want to have root canal.

Your reply and help would be highly appreciated.
Celin

Dear Celin,

Clearly you are not supposed to have massive pain. I cannot give you a clear answer as I have too little information at this point. First you need to discuss this with your dentist and they need to give you options. A dentist must be able to come up with a differential diagnosis of the problem, or in other words, some ideas of what is going on. If you want to provide more information to me, that is good as well but don’t leave your dental office without either options or a solution. Cheers

Hello Celin. Not sure if I already replied, sorry for the delay.
You should not have that much pain. It is very difficult to diagnose anything like this without x-rays but regardless there is something going on that needs to be repaired. I would ask your dentist to figure it out or get a second opinion. If you like you can send me some x-rays to review. Cheers

Dr. Chris,

I had a crown put in about 2 months ago. Recently I bit into a small bone and possibly cracked my crown?

Feeling increased cold air/water sensitivity, and also started to get bad tasting saliva in my mouth.

Does it sound like a cracked crown?

Thank you!
Chris

A crack usually is diagnosed by having the patient bite on a piece of wood or plastic, isolating different parts of the tooth where the plastic/wood touches. Biting down usually is not as painful as when the bite is released. This is because the periodontal ligament around the tooth is pinched by the crack.
An x-ray can help if it has been as while as often a lesion will form down to the crack as well.
Lastly, checking the depth of the pockets around the tooth works well. Often the area where the crack is present will have a deep isolated pocket.

I would assume it is more likely the tooth is bruised and I would see my dentist to check the bite asap. If the tooth is bruised it can be pushed slightly out of the socket and make it hit the top of the other teeth first which can crack or kill the tooth.

I hope that helps!

Dear Chris. You need to see a dentist to have some crack tests done. A crack hurts when you bite down and release the bite. That is the best test. It can be sensitive to many things so get it checked out – cracks can become fatal real quick!

I had braces before my crowns. The two teeth that I had covered are/were peg laterals. One of them was positioned behind the bottom teeth and the braces brought it forward. It has been about three months since I had this done, and my bite feels very uncomfortable on that one tooth, so uncomfortable that I feel like it is waking me up from my sleep and my teeth are bumping it. I’m not sure if it has shifted or I just noticed it. My two front teeth have veneers and are cemented together to prevent my teeth from moving. Should my dentist be able to correct this by sanding the back of the tooth down (I’m not sure of the technical term)? I’m not sure what to do, but this is very uncomfortable.

It is critical that the tooth is not hit too hard all the time or will die! Your dentist needs to adjust or open your bite with an appliance until the tooth has moved out of the point where it gets hit. Peg laterals are easy to work with so this should not be too challenging. Make sure that the orthodontist leaves space around the peg laterals so when you restore them they are the correct width. Also often orthodontists do not make the spaces where the two laterals will be the same size. Insist on them being identical so your cosmetic dentist can do an awesome job!

Dear Dr. Chris

Hi there. I recently had three teeth prepped for crowns. Two teeth were broken and one needed a root canal. The teeth are prepped flat. Is this normal??? How will the crown adhere if there’s no anchor??
Sincerely,
Dona.

Dear Dona,
We do not prepare teeth “flat”, there has to be something to hold onto. If you have a photo of the prep then I can comment more accurately. There is a “table top” design that was used by Jimmy Eubanks, a great dentist and technician. This design was flat but used is specific locations where porcelain would be only under compression force. A full crown would never be prepared flat.

Hi Dr. Chris. I got a gum infection from a crown I got and I have no idea if it’s been placed correctly or not. Is there anyway I could send you an X-ray? I’d be happy to help consult you with SEO on you site, im currently the highest rated expert in the world.

Chase Reiner

Dear Chase,

Absolutely. Send me your x-rays and anything else you may have. I am happy to help 🙂 And wow, that is a very generous offer. I could use all the SEO help possible 😉

Send info to info AT idealdentistry DOT COM.
Cheers,

Dr. Chris

Hi there
I had my first crown fitted and I am really disappointed. I can see a black line of cement around the top of the tooth and the inside edge is smooth rounded and much wider than my other teeth.
Is this normal?

Dear Clare,

Just like anything in life there are many different types of restorations, in respect of quality. It is a challenge for patients to know what level of care they are getting as most dentists seem to be experts at everything (so they say and advertise). This is very unfortunate. Still, each level of dentistry serves a purpose. How do you most easily determine which level of care you are getting and desire? Compare it to a car. If you are looking for a Ferrari then you know you will be spending a lot of money but you also expect Ferrari level performance, esthetics etc. If you are looking for a Toyota Camry then you are looking for safe transportation and know you will compromise a bit on performance and quality.

In dentistry the only real guide the patient has is cost and insurance coverage. This means that if a crown is cheap then you will most likely receive a Camry and if a crown is expensive then you will receive a Ferrari. Not always of course, but often. Insurance in dentistry is a benefit – contrary to most patients belief it does not work like medical insurance. It pays a portion towards the dental procedure and has low yearly limits (less than 1 crown cost usually). The problem with dental insurance is that when a dentist signs up with an insurance company this dentist now cannot charge his/her regular fees but must charge what the insurance allows, which of course is a lot less so that insurances have to pay less. This cut in cost is a direct cut in quality. Sorry, but it is the truth. You get what you pay for in dentistry.

So, when you mention a “line” around the edge of the crown and a crown that does not look right, it sounds like a cheaper, less artistic crown made by a lab that charges very little. I would assume that this crown was mostly covered by insurance and the dentist did not spend too much time on it. Now, you can of course have it redone with a Ferrari dentist but it will cost more. The dentist, regardless of cost or quality, should have shown you the crown first and received your approval of the esthetics prior to cementing it, especially if it it in the front.

I have written many posts on this problem. Dental Insurance. I am here to help patients as much as I can, remotely, receive Ferrari care without having to see a Ferrari dentist.

I hope this helps,

Dr. Chris

Hi Dr Chris,
I’m hoping you can help me. After having some periodontal work, my dentist replaced some older veneers with porcelain crowns. Six, total. I brush twice a day, floss & take a daily oral probiotic. I have cleanings every three months. The last cleaning was 4 weeks ago. Since then, I have noticed my crowns have become yellow. This is very disappointing as it has not even been 3 years since I had them done! I have been so careful not to stain them! I don’t smoke, don’t take medications, don’t drink soda & never have coffee without a straw. Any idea what could be causing this? I feel terrible!
Thank you,
Lou

Dear Lou, the porcelain won’t stain, at least not permanently. This leaves only one clear option which is that the teeth are becoming darker from the inside, which is not unusual. The color from teeth comes from the entire tooth, not just the outside layer. The porcelain crowns take into consideration the color of the underlying tooth. As the underlying tooth gets darker, or more chromatic, the teeth become darker and often a bit more yellow. The extend of this depends on the thickness of the porcelain. The thicker the porcelain the more it will block out the color below it. On a side note, I am not a fan of thick Emax porcelain as it turn gray/blue and looks bad. Not the most esthetic material in my opinion but it is used all the time!

So, you are not doing anything wrong, per say, but even supplements such as colloidal silver can alter the tooth color.

I hope this helps,

Dr. Chris

I got 11 teeth prepped for crowns. All on top. The model has half teeth big other half smaller. Said they didn’t want to send it back to lab, would critic it when temp was out on. Never did. My head hurts, my jaw hurts, it’s leaving, my bites off, and dentist said it won’t be perfect? I paid 8000.00, now I got anxiety crying and scared to have the rest finished and my daughters wedding in one month!!! Please help! I was told by dental assistant that she didn’t want to send model back twice and said we can’t b that picky! It’s a mess, I can’t sleep or eat and it’s a nightmare! What do I do now? It’s onky been 5 days. They want me to gone in tommow. But I’m afraid by what the assistant told me is I feel I’m just in a bad situation with this whole thing?

Dear Darla, remember this, YOU are the boss. YOU hired the dentist to provide a service for you, not the other way around. A dentist is not allowed to bully you into accepting anything. So, do not accept something that does not look good or fit good. A few guidelines:
1. ALWAYS approve the fit and look of the restoration PRIOR to allowing the dentist to permanently cement it. Have them try it in. Look at it. If you don’t feel right or they are pushing you into it, say no. It must be right regardless of how many times it takes (within reason of course).
2. Do not allow them to do ANYTHING else until what they have already done is correct.

I am happy to help in any way I can. Send me photos, x-rays, whatever you need. I will give you an honest opinion.
That being said, 11 teeth/crowns for 8k is quite cheap and while you need to be happy it would be impossible for me to do 11 crowns for that.
Why did you need 11 crowns in the first place?

I had 11 teeth prepped for crowns (all on top). First model came back bad, they sent it in again, second set- half teeth on right small half teeth on left big. The assistant said they didn’t want to redo it she said we r being too picky. There’s a huge difference. They put me in temps and said they would critic it, they didn’t cause the dentist and assistant didn’t agree on what needed done and wasn’t talking now. My bite was off, it wasn’t grinded down, teeth ugly, and I’m with 11 grinded down teeth with jaw pain, head pain, leaking temp and anxiety cause I have no idea what to do. They want me to come back in tommow and I’m freaking out u did all this cause I have a overbite and teeth r breaking off. They charged me 8000.00 and I only make 15000.00 a year and I will have to pay on this forever. Now I don’t know what to do. Please help me! I’m a disaster and have my daughters wedding in one and half month, and they know this. I’m in a panic. I can’t sleep or eat right my bite is a mess.

I am also concerned that you would spend half your income on teeth…please feel free to email me more details.

I have a dental implant in the very front bottom row of my mouth. I’m so very insecure about it as I smoked for awhile after getting it done and I feel like the color has changed. When I ask people straight up, the response is always, “I can’t see it” but when at work, where I speak to people in very close proximity I notice they always touch the area of their mouth where my tooth is. As a means of expressing that they see an imperfection. At least that’s the thought I have. People always tell me it’s in my head but I’m not making up the fact people always touch their mouths when I speak. Blows my confidence level. Is there any home remedies for cleaning an implant? I went back to the place I got it done, Clear Choice, might have been the wrong choice, and they too said it looked good. I am not crazy the tooth has a darker color tint than the rest of my teeth. Please help!!!

Dear D., generally speaking your own opinion and feelings are all that matter. That being said, could you send me a photo of the area so I know what I am dealing with? There are always things you can do and if this tooth is having this much of an impact on your confidence then it should be fixed :).

Once a crown is glued in is it permanent or can it be removed to adjust when not fitted properly?

Dear Linda. Once a crown is permanently cemented it is not removable. This is the point so you do not need to worry about it coming off 🙂

Few months ago, when flossing I pulled my crown on the top left away somewhat. It isn’t completely loose, from what I can tell. But the tooth/crown shifted, and I have an extremely noticeable bluish grey line by my gum. I have a small mouth, and some crowding on the bottom. I am concerned this will only cause my teeth to shift more.
The other issue I’m having, I went in to have a bunch of dental work. They were doing 2 crown fittings in the left side- one top and one on bottom. I mentioned multiple times I did not like the color of the crowns. When they put them in, before cementing them, I was able to see them up next to my other teeth. Again, I commented that I did not like the color of the crowns and if I ever decide to whiten my teeth – then It will be even more noticeable as they are an off white and about 2-3 shades darker than the rest of my teeth. I asked why they were not matched closer to my teeth. I understand that my teeth aren’t extremely white, however, this is noticeable. The tech cemented them in. The dentist came in, and was supposed to do 3 fillings on the right side but only did one since the crown fitting took so long. And then another technician came in to readjust the temporary bridge on the bottom right. They then brought in papers for me to sign, and I was reading about th me color and stains, and they are not responsible for this. I again expressed how I was unhappy with the color. He said at least they are in the back, so they shouldn’t be too noticeable. Then he had me smile and said, They are a little noticeable but not much from a distance. He reported my unhappiness To the dentist. She came to speak to me, saying that is why they have me look at them prior to cementing. At which point I said I did say something multiple times, and again right before they were cemented in. Nothing was offered, so I didn’t think it mattered. She informed me that she can cut them out, but then I will have to go through this entire process again which the temporaries, then the impressions, and refitting the crowns. I’m exhausted. I go back in tomorrow to have the other 2 fillings that were supposed to be done today. Which will put me in a dentist office my only 3 days I don’t work. (My two younger kids had to go to the dentist yesterday, then myself today and tomorrow.). Then, I have to take my youngest back next week, and then he will have to go back again. I am supposed to follow up with a specialist to have crown lengthening. We were planning on me needing 3 root canals, which I don’t necessarily need but could get if I feel best so the don’t have to drill through my crowns at a later date. My mouth hurts. my gums are tender. I want this all to be over. Especially when prior to cementing the crowns, she blew cold air on my actual tooth to dry it and then placed the cold cement- and I was ready to jump out of the chair at this point from the discomfort. I just don’t know what to do. These crowns are noticeable, and I do not want to smile anymore b/c the color. I feel as though my smile has been taken away, and I’ve always been complemented on my smile. I can barely eat b/c I’m sore and I have sporadic sensitivity that is not triggered by temperature. And I don’t know if I can go back through this all.

Wow, you have been through the ringer. This is what is called a dental “mill”. A dental practice that works on volume and essentially puts business ahead of people. I cannot tell you how much I dislike this practice model. This type of practice is driven by insurance payments and counts on continuous treatment to make a profit. Run.
Now, if you told the dentist you did not like the color they should never have cemented them. Bad mistake. Get them redone until you like them. They will be with you for a long time.
The crown that moved – that is not normal. Have it looked at and fixed.
The comment that they want you to have root canals so they don’t have to drill through their crowns – insane. Again, run.
Find a dental practice that works with you, explains everything and does not tear you like a number.

Dear Dr Chris,
I had a crown placed on #15 following a root canal on feb 2nd that has felt wrong since. It pops when introduced to cold and I have bad bite sensitivity. I told my dentist I was in pain and the tooth felt hollow, like there was a bubble of air under the crown. She took x-rays and examined the crown. She says the seal and placement of the crown is perfect, bite is perfect, the root canal (done by a separate specialist) also looks perfect, but there is in fact a hollow “negative space” between the crown and the root canal. She told me to just let it settle for two weeks and then come back.
It feels wrong to me that the filling does not reach the root canal, and I’ve been in pain since. The pain is getting progressively worse, reminding me of the inflamed periodontal ligament I just took two steroid packs to calm down.
I want to demand that they remove the crown and fill the cavity FULLY. This dental practice was not at all inexpensive and had great reviews, while also being one of the only 3 practices (all related) in my insurance network. I don’t know what to do, but I don’t trust this practice anymore. I feel they should make this right.

Dear Mallory, when a root canal is done there is a hollow space in the tooth above the roots. The root canal specialist leaves this space empty (places a temporary filling, cotton or some other material) that the dentist then needs to fill with what we call a “core”. Sounds like your dentist either forgot or did not place it correctly. If this happened to me as a dentist I would remove the crown, place a core and redo the crown, after apologizing. So, that is what I would expect your dentist to do as well.

Hi I just had two crowns on both my two front teeth my question is should I feel the back of them on the roof of my mouth? Idk I had diff ones before this and I’m not really sure if my other ones felt like this.

Dear Alexandria. The new crowns should feel normal but may be a slight bit different in feel from your previous ones. They should be smooth and comfortable. You should not be hitting those teeth when you bite together first. Discuss this with your dentist as I cannot give too much feedback without actually seeing the area…

Do you have any good crown of top pre molar of pictures on people?

Dear Kelly,

I have thousands of good photos. Why would you like a premolar photo? There should be several in my “smile gallery”.

Cheers,
Dr. Chris

Do you think I will need a root canal done before getting a crown?

Dear Maylin,

I cannot answer this question without more information…

On a good crown will the seam be under the gumline?

Dear Heather,

The “margin” of a crown and its placement is VERY important! Great question. There are several reasons why we place margins in different places, but the general rule of thumb is you can place a margin slightly above the gumline or slightly below, just never “at” the gumline. The reason for this is that plaque/bacteria and food accumulate easiest at the gumline, and if your margin is finished at the same level you are looking at getting recurrent decay there. Many dentists will place the margin WAY to far below the gumline causing major issues. They do this in hopes of making it look better, but at what cost?
I usually place my margins in non-esthetic areas about 0.5mm – 1mm above the gumline. This allows me properly clean and finish the margin and for you to keep it clean. On esthetic cases I place the margin 0.25mm below the tissue line. When the margin is a contact lens margin, or it blends into the tooth with the same color, then I also place it slightly above the gumline.
I hope this helps!

Dr. Chris

I got a couple of crowns within the last seven years. After completion my gums were red and sore and they have never returned back to normal and I can see a thick line of Grey I guess it’s the cement along the gumline which part of the purpose for the crown would be to me to look like it’s a normal tooth. It’s obvious it’s a crown because I can see this and I hate it when I smile. It’s in my two back molars. The dentist says this is normal. I can’t imagine having this done in front of my mouth to see the dark grey all along the gum line. Is this normal and what can be done to hide it. The crown cost 1200 $1,400 in a small town thought it would be better than that. The dentist had a horrible time trying to get the bite right on one of them and it’s always been uncomfortable like something’s not right. Thank you.

Dear Stephanie. I am sorry you are experiencing this with your crowns…
The crowns now are quite a few years old…but, when they were initially placed you should have been informed of the “metal” at the gumline that most likely is causing this visual. It is not cement – if it was then this would have been a major issue this many years later. It could also be inflammation from having placed the margin of the crown too close to the bone. Regardless, it would require replacement to fix! Yes, you paid quite a bit and this should have been explained to you when the crowns were tried in.
Lastly, the more adjustments are required the more worried I would get about the quality of the lab…I hope you have a better experience in the future when you get those crowns replaced.

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