Getting crowns & Veneers to Match

Can you tell me how difficult it is to get a crown to match your porcelain veneers? I have several porcelain veneers but one tooth that needs a crown. I love my dentist but when he did this crown, it is whiter than my veneers. That actually surprised me because the stub underneath it is pretty dark. Before this, I was worried about the opposite problem. Is this a problem with the lab? Can it be fixed?

MaryEllen

Dear Mary Ellen,

It is possible to match a crown to porcelain veneers exactly; however, it takes an expert cosmetic dentist to do so. There is not much emphasis on cosmetic work in dental school. Truthfully, if a dentist wants to know how to do it well, they have to invest a lot of time and money in post-doctoral training. It takes years. Your dentist may be trying to do that, but it looks like he isn’t quite there yet.

This is a tricky thing to do, especially when the underlying tooth is darker than the rest of them, but it can be done. It sounds like he overcompensated knowing he would need to put some extra effort into that tooth. What he may not have factored in is the difference in thickness between a porcelain veneer and a porcelain crown.

You didn’t mention if you were given the opportunity to approve this crown before it was permanently bonded on. Typically, a dentist should put on dental work with a temporary try-in paste and allow you to look at it in several types of lighting to make sure you are happy with the results before bonding it on.

If your dentist did not do that, I would simply ask him to re-do the crown making it a bit lighter and then let you approve it first. If he can’t get the color to match, you could always go to a more advanced cosmetic dentist. You have a right to have your dental work match.

The best cosmetic dentists are AACD accredited. If you need to switch dentists for this procedure, that is who I would go to. They have proven skill and artistry and have trained for years to do this with excellence.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Sinus Perforation During Dental Implant Procedure

I need to ask about something that happened with my dental implant procedure. First, some minor backstory. When my dental implant was placed the oral surgeon perforated the sinus by a few millimeters. He said this is fairly common. The problems started six months later when the gum would not heal and he suspected there was some bone loss. He removed the implant which went pretty smoothly because there was no bone integration with the implant. He stitched the gums and asked me to wait a year to see if the area fills back up. Here’s one thing I am frustrated with. He did not give me any antibiotics, just Flonase and some instructions on things like not blowing my nose for a while, etc. Five days later I went in for a follow up. I’d had pressure and felt yucky since the procedure. While he thought everything looked great, I didn’t feel that way and insisted he give me an antibiotic. He did and I started feeling better. Did he put me in danger by not prescribing one to begin with?

Margie

Illustration of a dental implant

First, I will answer your question, but there is a much bigger concern here that I want to address after. As to your question, no, he did not put you in danger by not prescribing antibiotics as a preventative measure. It is better for your body’s health in the long run if there is not already an infection, to try and allow the body’s natural defences to keep one away. It helps to strengthen your system. Having some medication jump in and do your body’s job when it doesn’t need help ends up weakening its ability to fight infection over the long haul. Think of it like a parent who always steps in to help their child climb the monkey bars by lifting them when it is hard. Sure, they get up the monkey bars, but it did nothing to develop their muscles. Waiting until your body needed the boost was the right course of action.

Two Problems with your Dental Implant Procedure

I see two really big problems with your situation. First, is the sinus perforation itself. Yes, it does happen. I certainly would not call it normal. Plus, the amount of the perforation is a big deal. A few millimeters is HUGE in dentistry. I am really concerned that he blew this off. This could only happen if he did not do adequate diagnostics. He should have done quite a few x-rays and preferable a CT scan also. The dental implant procedure is a 3-dimensional procedure and does require a 3-dimensional map.

The second real concern I have is that your bone never integrated with the dental implant. This leads to dental implant failure. This also indicates to me (again) that he may not have done adequate pre-surgery diagnostics. It’s possible you would have needed a bone grafting procedure to make this work.

My opinion– get a different dentist or surgeon to do this when you’re ready.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.

Dental Bonding Won’t Stay On

I’m having some trouble with my dental bonding and need to know how to handle this. I have fluorosis stains and went to my dentist to have dental bonding done as a repair. I was not too thrilled with the results because you could still see the stains underneath and I paid for this so the stains wouldn’t show anymore. A few hours later the bonding fell off. I was rescheduled for a few days later and they re-did it. This time I asked them to cover the stains a little better. They made the bonding thicker, but again it fell off, this time a few days later. My dentist said I should not expect bonding to be permanent, but the way he talked about it at first it should last a few years, not a few days, especially for the cost. Is there a way I can get a refund? What is the best way for me to treat these stains?

Marv

Dear Marv,

I think I can help you here. First, for the benefit of those reading who may not know what fluorosis stains are, I’ll go over that briefly. Fluorosis stains happen when a child consumes too much fluoride while their teeth are still developing.

Mild Fluorosis Stains

Mild fluorosis stains manifest as white spots (pictured above). Sometimes there are just a few white spots and those patients may not feel there is any need for treatment. Though, if they are numerous it can give the teeth a mottled look which may make a patient want some form of treatment for them.

Heavier Fluorosis Stains

With the more severe fluorosis staining, you will see brown spots and patches develop (pictured directly above). I have yet to meet a patient who did not want this treated.

Treating Fluorosis Stains

You have a couple of options to improve the appearance of these teeth. The first is dental bonding. It can work when a dentist knows what they are doing. In general, fluorosis stains are superficial so the staining can be gently ground away and that structure replaced with the dental bonding. However, your dentist is in over his head. We’ll talk about how to get a refund and find the right dentist in just a moment. First, I want to talk about a second option you have.

Dental bonding does last for several years (again, when done right), but you may want sometime a bit more permanent. In that case, I would look at porcelain veneers. These are tiny wafers of porcelain that can fit over the front of your teeth. When well cared for they can last a lifetime.

Getting This Done Right

Often, when you want a refund for cosmetic work it is difficult to get simply because you don’t like the way it looks. It may seem crazy, but it works to your benefit that the bonding keeps falling off. A basic standard of dental care, whether it is cosmetic or not is that it actually stays on your teeth.

I would simply ask for a refund. If he says no, let him know you will be going to both the dental board and your insurance company. That should sober him up.

Once you secure your money, I want you to do a search for an AACD accredited dentist in your area. These are the top cosmetic dentists in the country and will give you a stunning smile you will be proud to share.

This blog is brought to you by Salem, MA Cosmetic Dentist Dr. Randall Burba.

Should My Dentist Refund My Money after Not Providing on Time?

I told my dentist I was moving to another state, but needed to replace my snap-on denture. In deciding whether or not to replace them now or wait until I move, I asked him how long it would take if I did it through him. He told me three weeks. That was do-able so I went forward with it. On week NINE it finally came in! But, it didn’t fit with the snap fixutres. He sort of forced it on. By the next day, I was in agony. I couldn’t even eat bread without pain. I was able to take it off, but it was not easy. I called to schedule to come in they told me my dentist was on vacation but I can see another one. I agreed. He told me the ‘holes’ were not properly done and the whole thing would need to be re-done. At this point, I am out of time. Is it unreasonable to just ask for a refund and do it at the new office? I can’t really drive back and forth for this?

Lance

Dear Lance,

Snap on Dentures

Your dentist entered into a contractual agreement with you when he said the denture would be ready in three weeks. When they weren’t, he broke that agreement. He did not just barely miss the deadline, either. He was a full six weeks late and even then it was not a usuable denture. So, yes, he should definitely return your money without any fuss. I would not let them “fix” it. You will be better served moving onto the other dentist.

Now, I say he should return your money without any fuss, but we all know that humans are sometimes unreasonable. I would start by just asking politely. If he doesn’t respond as he should, you have a few options.

First, tell him you will have to leave a review letting others know about the poor service and result you received from his care. Marketing research shows that a majority of patients check online reviews before deciding whether or not to see a specific care giver. In that same vein, you could offer to let patients know how accomodating he was when it didn’t work out the way you both hoped as a means of making him look better if he does cooperate.

Second, threaten to go to the dental board. I don’t know any dentist who is excited about the prospect of their name and practice being brought before the board.

Thirdly, if you paid through any dental insurance, you can contact the insurance company and see if they’ll help resolve it.

I am sorry this happened to you. Most people get Snap-on Dentures as a means of having more affordable dental implant options. When this is the result, it can be very discouraging. Make sure after you move, the dentist you choose to re-do these has advanced (post-doctoral) training in dental implants. These procedures are not adequately taught in dental school.

This blog is brought to you by Salem, MA Dentist Dr. Randall Burba.