Dentistry is a unique profession. We don’t just deliver a service, but we also deliver a product. Porcelain crowns, or caps, among many other type of restorations are delivered on a daily basis in a dental practice. So, what makes one dentist different from another? Why does one dentist charge more? What could the big difference be?
Here is a quick example of the difference between a good crown and a bad crown.
The sole purpose of a porcelain crown is to repair and preserve the tooth, mimicking its original shape and function. The color should match the existing teeth, so it blends in.
This is what we expect from a GOOD crown:
- Perfect Fit
- Matching contour to the neighboring teeth
- Straight emergence profile from the gum tissue
- Good contact between the teeth and the opposing biting surface
- Good color and stain match to neighboring teeth
Common errors seen in a BAD crown:
- Poor fit of crown – Results in recurrent decay, sensitivity, quick failure of crown.
- Over contoured crown – Results in inflammation around tooth, gum disease, recurrent decay and quick failure of crown.
- Crown fits on tooth like hat on a hat rack – Result is same as #2
- Crown is either too tight between teeth, too light or no contact at all – Results in food impaction, and consequent recurrent decay.
- Crown looks like a marshmallow or corn kernal rather than a tooth.
So now you know what a good crown should look and fit like. Now why are not all crowns made like this? Simply put, making a good crown is an art and requires a high level of skill. It takes time, and time is money.
The dentist needs to deliver a perfectly prepared tooth, a perfect mold of that tooth, and a perfect prescription to what he/she wants from the technician.
The technician needs to perfectly trim the model, perfectly build the crown on the model, and perfectly adjust that crown on the model. Then the dentist needs to try this crown on the tooth first, make any necessary adjustments, and then cement the crown perfectly. There is no room for error!
Preparing the tooth takes time and skill. Taking a perfect mold takes time and skill. The less a dentist gets paid for a procedure the less time he/she can spend on it. It is a simple matter of economics. It is a business. Running a dental practice is very expensive and there is significant cost involved.
Now, once a perfect mold exists the crown needs to be made by a highly skilled technician. The more skill the technician has the higher the cost. It is a very simple formula. You get what you pay for!
All these steps and requirements put together are what it takes to make a good crown. A bad crown is not much better, and sometimes worse, than no crown at all.
Look at the photos and see if you can identify the differences between the good and bad crowns. Then, decide which type of crown you want in your mouth.
Good Crown
Good Crown
Good Crown
Good Crown
Bad crown
Bad Crowns
Bad Crown
Bad Crowns
Bad Crown
I could literally post thousands of photos of bad dentistry.
The difference between a good and a bad crown is immense – the aesthetics are better, the fit is better, the longevity is better. Would you expect to pay the same for a good and a bad crown? Of course not. A crown should last a very long time – decades. So, if the cost difference is less than a few pennies per day over the lifespan of the crown, why not get the good crown?
At Ideal Dentistry we only place good crowns because that is the right thing to do.
Keep smiling,
Christian
{ 22 comments… read them below or add one }
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
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
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.
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.
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
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
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
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