Patient’s chief complaint- “My front tooth is ugly and holds my lip out. I don’t want to smile anymore.”
She had trauma to the tooth 20+ years ago resulting in a root canal treatment then. Root canaled teeth commonly turn dark and are difficult to disguise, even with a full coverage crown at times. A porcelain fused to metal crown was placed first by a previous dentist. The crown was longer than the contralateral tooth, and it was overbulked causing her lip position to be off and meaning the tooth reflected light much differently than her other teeth. The metal margin of the crown caused gum recession adding to her esthetic concerns as well. The tooth directly beside the crowned tooth had a large failing filling that was a result of the same trauma to the neighboring tooth.
We started with an in office whitening as you always want to make sure your teeth are their lightest shade prior to investing in any smile design to get an accurate match. We then replaced her crown with a custom shaded, all porcelain crown of low translucency and then used a custom mixture of cements and opaquers underneath to further disguise the black tooth. Again, sometimes the tooth is too dark to match the surrounding smile exactly (even with every little trick), so you especially want a dentist trained in cosmetics handling these cases as they can be challenging in the best of cases. In this case, the tooth had not been properly prepared before resulting in the overbulked crown so we had to re-prepare the tooth for the new crown to ensure the adequate space for good porcelain layering that could be thick enough to disguise the black tooth and thick enough that, even with the properly prepared countours (the patient’s main concern), there would still be adequate porcelain for strength of the crown.
We placed an all porcelain veneer on the tooth immediately beside the crown where the large, failing fillling was. A veneer is very similar to a crown except it only partially covers the tooth and is usually for looks, whereas a crown in full coverage and is typically to protect and strengthen a badly broken or heavily filled tooth.
The crown and veneer were made start to finish in our office where we can control every aspect from material selection, margins and bite to custom contouring and custom shading. This also cuts down on turn-around time in these cases where most of our crowns are completed in a single visit with no temporary crowns needed.
Our patient left happy and noticed immediately how much more comfortable her lip and gums were with her new crown in place.
XOXO, Dr. H 💋