Smiles Makeover

There are various reasons we do crowns as well as various processes involved.  Most of the time, after a tooth is prepared and an impression taken, we can have the crown ready to cement in two weeks.  Crowns on implants will often require an additional week to make as implant components must be ordered by the lab and custom parts fabricated.  Those additional steps require more time at the lab. 

There are other times that the time frame may differ for various reasons.  Sometimes we like to keep a temporary crown on, or even the permanent crown, using temporary cement for an extended period. We will do this when we have concerns about the health of the nerve in the tooth and we want additional time to evaluate it.  If we need the lab to make a post for the tooth, this will also require additional time and appointments. Other times, we will send you to the lab so the lab technician can see you for custom shading and tinting so the best esthetic result can be obtained.  Timing of that appointment and availability of the patient and lab technician may delay the final finish date accordingly.

Like so many things, we want them done right, not just fast.  We understand that patients want things done right away, but we want them done right. We will always go the extra mile to make sure you get the result you want and deserve. 

When people have chipped or worn teeth, it can result in esthetic concerns as well as produce discomfort of the teeth or joints. While patients want things fixed quickly, our first challenge is to determine the cause of the problem.  We always want to know the cause because we want to prevent further breakdown of the teeth, as well as have long term success with any new restorations we may place.  Sometimes the fix can be as simple as a filling, a crown or a veneer,  while other times the optimal treatment may get more involved. We often see an underlying cause of tooth breakdown related to grinding or clenching teeth. When there is significant wear throughout, the restorative treatment to address this problem may involve a full rehabilitation of crowns on many, or even all teeth to re establish a normal alignment of the teeth.  Other times we see an underlying cause that is orthodontic in nature and we need to treat the patient with orthodontics such as braces or Invisalign prior to any restorations.  So, our “cosmetic” options will be determined by the problems we are presented with, and we will always show our patients X-rays, photos, and plaster models to explain our findings and recommendations prior to starting any treatment. If you have any concerns with chipping or wear, give us a call so we can see what options you may have to restore your optimal smile. 

When patients talk about “cosmetic dentistry” we are always interested to hear what people think that means.  To us, dentistry has evolved to the point that we feel most services could be considered “cosmetic” as we use tooth colored filling material for almost everything.  That said, many people consider cosmetic dentistry to include the use of porcelain crowns, porcelain veneers, bonded white fillings on front teeth, tooth whitening or bleaching, and white fillings on back teeth.  And yes, we routinely perform all of these procedures.  We also utilize Invisalign to help straighten your teeth,  and dental implant restorations to restore a single tooth, multiple teeth, or even all of your teeth.  In fact, we even feel the conventional dentures and removable partials we fabricate also fall into the cosmetic category as we not only use top labs and materials, but also take every extra step to ensure they look as realistic as possible.  So yes, we do perform all of these cosmetic dental services, and we will discuss them with you, as well as present options and risks of treatment before we start your treatment. Give us a call to set up a consultation so we can see what can be done.

We make every effort to select the best materials for your restorative needs. There are many options available for crowning teeth.  While gold teeth are often considered an older, not so esthetic option, they are still one of the best materials that can be used in dentistry. 

That said, most patients prefer the white crowns that look like real teeth.  The traditional Porcelain Fused to Metal (PFM) crowns have been widely used with great success in dentistry.  These PFM crowns can be made to look very realistic in most cases, but they are what we call “feldspathic porcelain” and this material’s biggest drawback is its low fracture toughness,  essentially, it can crack and chip easily. It also requires quite a bit of tooth to be cut away in order to use as directed. 

Lithium disilicate crowns are a newer option that is also highly esthetic.  This material has no metal substructure to hide and it also has a much higher fracture toughness than the PFM crowns.  This material also requires aggressive tooth prepping to use properly.

Zirconia is a newer material that is our strongest yet.  It is extremely strong and ther is no metal to hide.  Another benefit is the conservative tooth preparation that can be done to use this material.  The downside is that it is not as pretty of a material.  I looks good, but not great.  The manufacturers have developed even newer versions of this material that are starting to look much more like the other materials as far as esthetics, but the strength drops greatly with these options; however it is still much stronger than the traditional PFM crowns.

We choose the material we use based on needs.  Location plays a big role as back teeth do more work and would benefit from more strength, while front teeth don’t do as much of a chewing load, but are required to look good.  As fear as strength goes, the flexural strength (force to break the material) of a PFM is 90 MPa (MegaPascals), lithium disilicate is 400 MPa, and the strongest. Zirconia is 1465 MPa. You don’t have to understand the physics behind flexural strength or megapascals, but it is easy to understand that 1465 is more than 90. Since MPa is a unit of force needed to break the material,  zirconia is exponentially stronger for back teeth and is often used as we like the braun over the beauty. Lithium disilicate or PFM crowns are used more in front for beauty.  We also use labs that can custom tint crowns to get your shade as exact as possible.  We will make sure you are happy with the result you get.