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Advanced cosmetic and general dentistry

Archives for February 2020

Should Your Cosmetic Dentist Use a Crown or Veneer After Root Canal?

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When I received a root canal from my cosmetic dentist in 2018, she wanted to place a porcelain veneer over the toot, but I declined. The tooth is dark now, and I’ve relocated to Burlington, which is 400 miles from my former dentist. My new dentist recommended a crown for the tooth because he said a veneer wouldn’t work anymore. I didn’t realize that he would have to file down the tooth for a crown. I know it’s probably too late, but was my dentist too aggressive in recommending a crown? Elyssa from Burlington, VA

Elyssa,

Dental schools train dentists to restore a tooth with a crown after root canal treatment. Your dentist was likely doing as he was taught. Crowns require shaving your tooth to ensure it fits without negatively affecting your bite.

When Do Cosmetic Dentists Use Crowns After Root Canal?

  • Extensive damage – If a tooth has a lot of its structure missing, dentists place a crown. After root canal treatment, a tooth can become brittle, and the risk of fracture increases. A crown protects the tooth.
  • Back teeth – Daily, back teeth are subject to the pressure of biting, chewing, and grinding food. If a back tooth is severely damaged, broken, or split, a crown will prevent further damage and withstand the forces of biting and chewing. Less pressure is exerted on the front teeth.

Do Front Teeth Need a Crown?

An impact on your front teeth is usually lateral. So front teeth are most likely to snap off at the gumline. A dental crown removes about a millimeter of structure around the entire tooth and can weaken it.

Although most dentists prepare teeth more aggressively, the photo below shows very conservative preparation for a dental crown. The tooth will be stronger and less likely to break.

What About a Porcelain Veneer After Root Canal Treatment?

After root canal treatment, some cosmetic dentists choose to restore a front tooth with a porcelain veneer whenever possible. Only 0.5 mm of the enamel is removed.

Most general dentists don’t place veneers on front teeth after root canal treatment because it requires more skill. The dentist and the laboratory technician must understand how to conceal the darkness of the tooth and make the veneer look natural. Most general dentists like the skill and artistic ability to provide aesthetic results.

The photos below are an example of the amount of tooth structure that dentists with conservative porcelain crown preparation vs. conservative porcelain veneer preparation.

Photo of prepared tooth that was shaved for a dental crown

Dental crown preparation

Photo of a tooth that was conservatively prepared for a porcelain veneer

Porcelain veneer preparation

What Causes Discoloration After Root Canal Treatment?

Rather than darkness from the tooth drying out, root canal filling materials inside the tooth can darken it. Advanced cosmetic dentists prevent premature darkening with the following steps:

  • Clean out the filling materials
  • Place a white fiberglass post into the root
  • Seal the opening with tooth-colored composite

The technique delays discoloration for five or ten years and prevents the need for a veneer until then.

 

Michael Szarek, DMD of Lowell, MA sponsors this post.

3 Possible Causes of Yellow Dental Crowns and What You Can Do About It

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In September 2019, I received six crowns on my upper front teeth, and they are turning yellow. I’m not a smoker, soda or coffee drinker, or a sugar addict. Although the crowns were beautiful when I received them, they now look like I forgot to brush my teeth this morning. I’m afraid to return to the dentist who placed my crowns. Before I make an appointment with anyone, will you please give me some ideas about what’s causing the problem and how it can be fixed? Am I correct that this isn’t something that teeth bleaching gel won’t help? Thanks – Tana from Bear, DE

Tana,

Photo of teeth whitening trays in a case, for information on DIY teeth whitening from Lowell, MA dentist Dr. Michael Szarek.

Teeth whitening won’t brighten yellow porcelain crowns

As you realize, your crowns should not be turning yellow. Porcelain is stain-resistant, so if even you were a smoker or coffee drinker, your crowns wouldn’t attract stains. And porcelain is colorfast so the issue cannot be resolved with teeth bleaching—whether it’s take-home or in-office treatment.

What Causes Porcelain Crowns to Turn Yellow?

Three possible causes include:

1. Damage during dental cleaning – If you’ve had a dental cleaning since you received your crowns, the hygienist who cleaned your teeth could have damaged the service with a power cleaning instrument, such as a Prophy Jet. This tool cleans your teeth with blasts of sodium bicarbonate, but this power cleaning damages the glaze on porcelain veneers and crowns. Acidulated fluoride treatment is another possible culprit that chemically etches away the glaze on porcelain.

2. Damaged glaze when crowns were placed – If your dentist adjusted the front surfaces of your crowns while setting them, he or she might have damaged with glaze. Or maybe the laboratory that made the crowns didn’t glaze them properly.

3. Crowns are not porcelain – It sounds outrageous, but sometimes patients think they received porcelain crowns but received composite instead. If a dentist misrepresents treatment to make you believe you have porcelain crowns when you don’t, you have the leverage to get the dentist to pay for the correction. If your dentist falsely advertised your cosmetic work as one treatment—but you received another—you can threaten to notify the state dental board about the issue.

What’s Next?

We recommend that you schedule an appointment with an accredited cosmetic dentist for a second opinion. The dentist will examine your dental crowns, identify what’s causing the discoloration, and explain your options for regaining a white smile.

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.