I had a root canal and the tooth needed a dental crown. My dentist has had a very hard time getting it to look natural. The first one looked way too white. Then he redid it. The next one was a more realistic shade, but still doesn’t match my adjacent teeth. He bonded that one on. At first, I thought I could live with it but I’m really uncomfortable having mismatched front teeth. He’s willing to try again. Do you think I’m being too picky? I can tell he’s getting frustrated, even though he hasn’t said anything. Is this because it was a CEREC crown?
Louisa
Dear Louisa,
CEREC crowns can look natural
The tendency for most patients in your situation is to finally just settle for a crown that doesn’t look quite right. If this is a front tooth, however, even a slight variation in the color between the crown and adjacent teeth will be noticeable to others and will make the crown look fake.
Your dentist may have the best of intentions, but it is a highly developed skill to get a single crown on a front tooth to match perfectly, that is especially true with CEREC crowns where the crown is often milled from a single block of porcelain. With a traditional crown, it also requires a good relationship between the dentist and the laboratory technician, where they can communicate about color and understand one another.
Even with expert cosmetic dentists, there will often be several try-ins before the crown is matched perfectly. In your case, since your dentist bonded on a crown that didn’t really match, it doesn’t appear that you are in the hands of an expert cosmetic dentist.
Another way that is being used very effectively to match crowns on front teeth is photography. Using sophisticated camera equipment designed for taking dental photographs, the dentist will start by taking a photograph of a standard shade tab of a shade that is close to the shade of your natural teeth. The shade tab will be put up against your natural teeth and photographed, and this photograph will be sent to the ceramist as a guide in re-creating the natural color of the tooth. Then, if the crown provided by the ceramist doesn’t match perfectly, that crown is tried in on the tooth and a new photograph is taken. The ceramist then will be able to see, in the lab, exactly what color modifications need to be made to get it to match perfectly.
A typical family dentist will not likely have photography equipment like this. Furthermore, if he or she has only the training provided by dental school, they are going to be lacking in a lot of color training. Dental schools teach very little about color, and will ordinarily not get into the complex and subtle variations of color and translucency that make up a tooth.
So what do you do? If you are willing to settle for a crown that is just close to the color of your existing teeth, stick with this dentist and keep having him send it back to the lab (or in your case, re-do it on his CEREC machine) until it is right.
If you want to get a perfect match, then have a frank discussion with your dentist and transfer to another dentist who has more expertise in cosmetic dentistry. But know that only a small percentage of dentists have that level of expertise that you need to get a perfect match. For most of them, the way they get a perfect match between two front teeth is to do two crowns on them.
This blog is brought to you by Portage, MI Cosmetic Dentist Dr. Susan Dennis.