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Crowns or Veneers for Tetracycline Stains

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I have severe tetracycline stains that I am ready to get cosmetically treated. I’ve seen two dentists about this. The first suggested porcelain veneers, the second dentist suggested porcelain crowns. The price quoted to me for the veneers is almost double that for the crowns. Can I acheive the same beautiful result with either porcedure? I like the idea of saving money, but don’t want subpar results.

Avery

Dear Avery,

a porcelain veneer being placed on teeth

It is an exciting time when you are getting to plan your smile makeover. I am glad you wrote. The single biggest factor that detrmines the beauty of your case is not necessarily which procedure, but which dentist. Think of cosmetic dentistry as an art form. If I commissioned two painters to do the same portrait with the exact same materials, the portraits would not be exactly the same. This is because the skill and artistry varies from painter to painter. The same is true of cosmetic dentists.

Now factor in that you are dealing with severe tetracycline stains and the dentist becomes even more important. Tetracycline stains are one of the most advanced cases in cosmetic dentistry and quite difficult to do.

The standard treatment for this would be to have porcelain veneers placed. Usually, dentist who suggest porcealin crowns do so because they do not have the skill to cover the stains with the thin wafers of porcelain that make up veneers and think that using dental crowns will make that easier. This is not the case.

With dental crowns, you also want to consider that there is significantly more grinding of the teeth for preparation. This weakens the teeth and puts them at greater risk down the road. Plus, you can never backtrack from dental crowns. Once the tooth structure is gone, it’s gone. There is not a way to get it back.

Just because the first dentist suggested veneers instead of crowns, does not necessarily make him an expert cosmetic dentist. The easiest way for you to find an expert, artistic cosmetic dentist is to go to the AACD.com website. They have a find a cosmetic dentist link. However, it is important that you check that you want an accredited dentist. AACD accredited dentists are the top cosmetic dentists in the country. Any one of them can ensure you get a beautiful smile, even with severe tetracycline stains.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Are Same Day Crowns as Good as Traditional Ones?

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I need a crown on a front tooth and my dentist is suggesting that I use his new CEREC machine, which will allow me to get my dental crown the same day as my appointment. There is something appealing in that, but I want to make certain that they are just as good as the traditional crowns. This is a front tooth so I don’t want to have something that doesn’t fit right and makes my smile look weird.

Beverly

Dear Beverly,

CEREC crown block

 

The CEREC machine can produce a well fit crown. However, front teeth are a bit trickier. It’s not tricky to make them fit. The difficult part comes in getting them to look both natural and beautiful. It takes a great deal of artistry.

With CEREC, the crowns are produced from a single block of porcelain. If you look at your front teeth, you will notice that there are many variations to the opacity. Parts of your tooth are lighter and have more translucency than other parts of the teeth. Because CEREC uses a single block of porcelain the results will be uniform, which will make front teeth look rather flat. Your dentist would have to know how to use different types of stains and tints in order to produce the variations needed to look natural.

If your dentist is not a highly skilled cosmetic dentist, I would not use CEREC for a front tooth. In fact, even with tradtional crowns, you need to make certain the dentist uses a temporary try-in paste to make sure the crowns not only look natural and beautiful, but that they blend seamlessly with the remainder of your teeth, especially the adjacent front tooth. It will probably take a few tries to get it perfect.

This is above the skill level of most dentists. I would either look for a dentist who is recommended on the mynewsmile.com website or someone who has reached accreditation with the American Academy of Cosmetic Dentistry. These are the top cosmetic dentists in the country. If it were any other tooth than a front tooth, it would be an easy assignment.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

30K Cosmetic Dentistry Disaster

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Can you help me find a different dentist. I just had a total smile makeover that included both dental crowns and porcelain veneers. This was done to fix both the damage done from my teeth grinding as well as cover my tetracycline stains. They look really opaque, which does give them a fake appearance. However, the thing I’m worried about is my jaw has been hurting. It didn’t hurt like this before the crowns and veneers were placed. I did have some low level aching because of the teeth grinding. However, now my jaw really hurts all the time. So much so that it is distracting. My dentist insists not only does everything look great but that he has passed all the check marks for proper placement. I’m at my wits end and have already spent $30,000 on this.

Laurie

Dear Laurie,

Woman Holding her jaw in pain

Under normal circumstances, it would be very hard for you to get this repaired without paying for the whole thing all over again. If the only problem is the appearance it is nearly impossible for you to get a refund. You’d think that wouldn’t be the case when you are talking about cosmetic work, but that is currently where it stands. However, you seem to be dealing with some functional issues. I don’t know how he thinks the markers for proper placement would not include your patient not being in pain.

It sounds like your bite may be thrown off a bit, which could be leading to complicating issues such as TMJ Disorder. This can work in your favor because it means that the case isn’t truly functional. We’ll go over how to get this diagnosed in a moment. First, I want to go over the difference between a general dentist and a true cosmetic dentist. Even though there is not a recognized specialty in cosmetic dentistry, there are some distinct differences.

One of those differences is the amount of training they get. Smile makeovers are not taught in dental school. In order for a dentist to truly learn the techniques and artistry required, they would need post doctoral training. Another important difference is how they treat the patient. A true cosmetic dentist would not be satisfied with the work if you weren’t. They would first do a temporary try in and allow you to look at it in several different lights and make sure you are completely thrilled with the results. Even a little hesitation would cause them to ask, “What do you wish was different?” and it would go back to the lab to make the changes.

The easiest way for you to find one of these dentists would be to go to the American Academy of Cosmetic Dentistry’s (AACD) website. They have a “find a cosmetic dentist” link. Make sure you check the box that says you want an Accredited Cosmetic Dentist. These are among the top 1% of cosmetic dentist’s in the country. Have one of them examine your case. It will be helpful if they also have TMJ training. They can tell you if your current dentist’s work threw off your bite. If that is the case, then they can help you secure a refund so you can get this done properly by a qualified dentist.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Why Do I Need Root Canals after Porcealin Veneers?

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My dentist gave me a complete smile makeover with veneer crowns. When the permanent ones were placed in, two of them had sharp pains. The dentist adjusted them about 3 times and eventually the pain went away. However, not long after those same teeth developed abscesses on the top of them. He did some x-rays and said that the nerves died and those teeth need a root canal treatment. I was a bit shocked because he never mentioned nerve damage as a possibility. He said he didn’t know why it happened and I’m just unlucky when it comes to this. Since then, three more teeth have needed root canal treatments and two more teeth are starting to hurt. I feel like each of these teeth are going to “fail” at some time. I also feel like I’ve been taken advantage of. Is there anything I can do about this?

Miranda

Dear Miranda,

Comparison of tooth preparation between dental crowns and porcelain veneers

I am going to start by clarifying some terms because there is something that has me concerned you were misled. You mentioned you received a smile makeover with veneer crowns. That is not a thing. There are porcelain crowns and there are porcelain veneers. The two of these are very different procedures. You can see that even from the type of tooth preparation necessary.

Notice in the image above, on the left side there is a LOT of tooth preparation. This is what happens when your teeth are given dental crowns. On the right, is the preparation for porcelain veneers. I believe you were given crowns for a couple of reasons. First, it is pretty much unheard of for someone to need a root canal treatment as a result of porcelain veneers. Second, you said something about the permanent ones. It is dental crowns which start with temporaries and then go to permanent. However, there are times you’re given a mock up of your porcelain veneers and allowed to try them in to see if that is what you were wanting for your smile makeover.

A smile makeover does not require the aggressive grinding down of the teeth. That is why porcelain veneers are the standard. With dental crowns, if there is too aggressive a tooth preparation the dentist risks exposing the pulp. This is what I think your dentist did. Many dentists who did not invest in post-doctoral training will do porcelain crowns instead of veneers because it is what they are more familiar with. If your dentist lied to you and hinted you were getting veneers, then you need to demand a refund as well as for him to cover the cost of the root canal treatments. If he didn’t say you were getting porcelain veneers and you just assumed that, you can still ask him to cover the root canal treatments because he is the one who ground down your teeth too aggressively.

I’m sorry you are dealing with this. For those reading this considering a smile makeover, it is always better to have a smile makeover done by someone with the right training. I would recommend you use a dentist who is AACD accredited.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Did I REALLY Get daVinci Crowns?

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I wanted to get a smile makeover, but have never been happy with the dental work that gets done in my area. I was very upfront with my dentist about this. He suggested that I get dental crowns and we have the work done by the da Vinci lab in California. He said they have a reputation for being the best of the dental labs. I thought this sounded okay and we went forward. When the crowns finally came in, my dentist called me for a try in, but when I got there he said they weren’t happy with the crowns and were going to have them readjusted to meet with what he asked for. I was a bit confused by this because he told me they were the best. Then, before I left, some man came to pick them up and work on them. I don’t think they noticed I saw that. Now, how would a guy from a California lab get all the way to Mississippi the same day? I mean, yes, he could fly, but would they really fly someone out for this or just have the dentist send them back? I’m worried I’m being taken.

Evie

Dear Evie,

a porcelain veneer being placed on teeth

I’m afraid you are being taken as well. My best guess is, if he sent them to daVinci to begin with, that he’s having a local guy make the changes. That is not what you agreed to so he is being dishonest there. I will say there are some other red flags here as well.

When someone wants a smile makeover, the standard for that is porcelain veneers, not porcelain crowns. Now it is possible that you already had dental crowns there and that is why your dentist suggested them. If you didn’t, then that is a sign your dentist is not a skilled cosmetic dentist. They will often suggest crowns because that is a basic procedure they were taught in dental school and porcelain veneers require post-doctoral learning.

What Matters Most – the Dentist or the Lab?

The truth is even though the daVinci lab has branded itself as one of the top ceramist labs in the country, they are a large lab. Not all of their ceramists are what is known as master ceramists. These are the ones who would create the most beautiful work. daVinci will save their master ceramists for some of the top cosmetic dentists in the country and then give the unskilled dentist’s work to one of their lower level ceramists. Why is this?

The reason behind that is no matter how good a ceramist is, it will not make up for the deficiencies of the dentist. When it comes to smile makeovers it is the skill of the dentist that makes all the difference. They design the smile. All the lab can do is follow directions. Granted some follow directions better than others, but even the best ceramist cannot make up for a poorly designed smile makeover.

I am going to suggest you not allow your dentist to bond on these porcelain crowns until you approve them. He should use a temporory try in paste and you should get to see them in several different lightings. If you don’t love them, have him send them back to the lab. If he tells you that you are being too picky, remind him that it is a smile makeover and you are supposed to be picky. If he can’t get it right then maybe he should refund you and let you see a dentist that can do it the way you want.

If it comes to that, you will want to see a dentist who is AACD accredited. These are the top cosmetic dentists in the country.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

My Smile Makeover Is Turning Yellow

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I spent a good amount of money hoping to get my dream smile makeover. It’s been a disaster from the beginning. I selected a very white color because my natural teeth were very white. I just didn’t like their shape. My dentist gave me six porcelain crowns. However, when the came in they didn’t look as white as I expected. He assured me it is the color I asked for. Now, to make matters worse, the crowns seem to stain every time I even drink something. I am going in for a consultation with another dentist and I have no idea what to even ask him. Do you have any recommendations?

Dinah

Dear Dinah,

a porcelain veneer being placed on a tooth

Porcelain Veneers

I am sorry this happened to you. The first thing I’d like to ask is why dental crowns? Typically, a smile makeover is done with porcelain veneers. Was there some decay on the teeth that required crowns or were there already crowns there? Either way, it is water under the bridge. Those teeth will always need dental crowns from now on because the structure of the tooth has been ground down to fit the crowns over them.

One other thing that bothers me is why the crowns are picking up stains. If he truly gave you porcelain crowns, they would be very stain resistant. In fact, they’d be even more stain resistant than your natural teeth. I’m prone to wonder if he just said they were porcelain but used some other type of material. That is the first thing I’d have the dentist you are going to for a consultation look at.

However, let’s back up a bit. What makes you think this dentist you are going to get the consultation from is any better than the one who provided your disappointing results to begin with? I would make sure you are going to an expert cosmetic dentist. Look for someone who is AACD accredited. Then you’ll be certain to have an expert with both technical and artistic skill to work on your smile.

By the way, if it turns out your dentist gave you something other than porcelain crowns, you can get your money back because of misrepresentation.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Teeth Whitening Before a Dental Crown

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I am getting a dental crown on a white tooth and I want to do a touch-up on my teeth whitening before I get it. I asked my dentist how long I would have to whiten my teeth each day and for how many days to get them back to their original color when I first whitened them three years ago. He couldn’t tell me so I am wondering if there are some tips you have.

Bethany

Dear Bethany,

teeth whitening trays

 

I am going to help you with this, but before I do I want to let you know that I am concerned that your dentist was unable to answer these type of questions. Teeth whitening is a fairly straightforward procedure. If he can’t deal with that I would not trust him to place a dental crown on your front teeth. We’ll go over how to find a dentist who can in a moment.

The Basic Principles of Teeth Whitening

The main idea behind whitening your teeth is the longer you wear the whitening gel, the faster your teeth will whiten. You can wear them one hour a day, but they whiten faster than if you wear them several hours a day or overnight. Because each person’s teeth are different in the amount of staining and how white they want them, there is no way to quantify a number of days/hours. The one constant is you want to leave a week between when you stop your teeth whitening and when you begin the procedure for your dental crown. This is because the teeth will continue to whiten during that time period.

Getting a Crown on a Front Tooth

Crowns on back teeth are no big deal. The color doesn’t have to match exactly. However, matching a single crown to a front tooth is a completely different story. All the light hits your front teeth making all the differences much more visible. Even the best cosmetic dentists will do a couple of try-ins before settling on it being just so.

Ideally, you would want an expert cosmetic dentist to do this. Look for a dentist who is AACD accredited. Then you can be certain they will get it right. If your dentist cannot tell you about teeth whitening, I would not let him near this crown.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

 

Smile Makeover Disaster with Tetracycline Stains

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I have tetracycline-stained teeth. I went to my dentist who is very reputable and has done a great job for me over the years. I was considering porcelain veneers, but my dentist talked me into porcelain crowns saying that they would help cover the stains better. This did not turn out to be the case. The gray is visible with each of the crowned teeth AND the crowns look fake, so it’s obvious I have fake teeth. But, not even pretty fake teeth. He said he can send them back to the lab. I’m so confused. I looked online and there is a woman from a different dentist who has beautiful teeth after getting her tetracycline teeth made over and she used porcelain veneers! What has gone wrong with my teeth? Will doing them again with crowns make a difference? I don’t think I can get porcelain veneers after I have crowns, right?

Leslie

Dear Leslie,

a porcelain veneer being placed on a tooth

You are correct that you will always have to have crowns now that you have them. This is because the teeth have been ground down to little nubs. That tooth structure is gone. In a way you have answered your other question already. You said, “…a woman from a different dentist.” The key to any smile makeover is the dentist who does it. One warning sign is when a dentist suggests porcelain crowns over porcelain veneers when the tooth is healthy and does not need a crown. These dentists are either not comfortable doing porcelain veneers to begin with or do not have enough skill in them and think that the added structure of dental crowns will make it easier to cover the stains.

Sending it back to the lab will only help if he can give them good directions. A lab is more like a pharmacy who fills the prescription of the doctor. It is the doctor that has to come up with the right diagnosis and the appropriate medicine for it. I am not convinced he can write the correct directions. However, there is no harm in allowing him to try. If you do that, do it on the condition that he uses a temporary try-in paste and if you don’t love them the second time then you get a refund. You should get to see them in several lights before making a decision.

If you end up needing a refund, you will want to look for an expert cosmetic dentist. The easiest way for you to do this is to look for a dentist who is accredited with the American Academy of Cosmetic Dentistry. AACD accredited dentists have proven skill and artistry. They can give you a beautiful smile whether using porcelain veneers or porcelain crowns.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Implant Teeth Don’t Match

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I had to get two dental implants on teeth that you can see when I smile. One is a front tooth and one is a canine. The implants themselves seem okay, but the teeth parts don’t match my other teeth. I’m guessing if they were beside one another they’d match each other, but they look weird and matte compared to the rest of my teeth. Is there anything that can fix this?

Ruth

Dear Ruth,

Diagram of a dental implant

There is always a way to get a dental crown to match your other teeth. However, your dentist may not have the cosmetic skills to do it. I would start by asking him to redo them. But, this second time, tell him you want them placed with a temporary try in paste, so you can make certain they match before they are permanently bonded on.

If he’s unwilling to re-do them, and the dental implants themselves are in good condition, you won’t have much recourse. You may have to bite the bullet and pay for new porcelain crowns by a dentist who has more cosmetic skills than your current dentist.

If it does come down to that, look for a dentist who is accredited with the American Academy of Cosmetic Dentistry or one recommended on the mynewsmile.com website. Dentists from either group will be able to create beautiful crowns that blend in perfectly with your natural teeth. Just make certain they have dental implant training as well so they understand how the crown will fit with the implant.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.

Crowns Versus Veneers for Tetracycline Stains

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I have tetracycline stains on my teeth and really want a pretty smile. I spoke to one dentist who has a good reputation in cosmetic dentistry, name Dr. —–[name withheld].  He wants to charge me $42, 000 for upper and lower full mouth veneers. Another dentist is suggesting porcelain crowns and is only $28,000. I really only have $30,000 to budget for this, so I should probably go with the crowns. However, I wanted to double check with someone not invested in getting my business as to crowns versus veneers for tetracycline stains. Is one better than the other for this? Plus, you should know I have a tooth grinding problem, which may impact your answer.

Carla

Dear Carla,

a porcelain veneer being placed on a tooth

 

The first dentist you mentioned, who is suggesting porcelain veneers is one of the top cosmetic dentists in the country. If you decide to go with him, he will provide you with a stunning smile. You didn’t give the name of the second dentist, but I am cautious about recommending him either way because he is suggesting dental crowns.

Tetracycline stains are some of the trickiest to deal with when it comes to a smile makeover. You have to get the teeth opaque enough to cover the stains, while still creating a natural looking translucency to the teeth. To compensate for the difficulty, some dentists will suggest dental crowns instead of porcelain veneers thinking the added thickness will make it easier for them. It doesn’t. I find porcelain veneers to be the superior treatment. As for your bruxism (teeth grinding), if you get a nightguard to wear while you sleep it will protect you from the grinding damage. So that will not be an issue.

If your budget is the main reason for going to the cheaper dentist, I am going to suggest a different approach. I know the quality you will get with the first dentist. Why don’t you have him just do your upper arch and use a strong teeth whitening, such as Kor Whitening to do on your lower teeth. It will take a bit to get the lower teeth to match, but if you are persistent they will. Then, you are only paying $21,000, which is below budget and will have a stunning smile.

This blog is brought to you by Philadelphia Cosmetic Dentist Dr. Michael Weiss.