Where to Find an Expert Cosmetic Dentist?

Dr. Hall has compiled a list of expert cosmetic dentists. Please visit the website www.mynewsmile.com. They are organized by state, and he has personally reviewed the work and credentials of each dentist listed there.

Porcelain Crowns

You have maybe seen someone with porcelain crowns on their front teeth, and it was obvious that they were crowns. On the other hand, I'm sure you've seen people who have also had porcelain crowns on their front teeth and you had no clue that they weren't their own teeth. Why is this? What is the difference between a realistic-looking crown and one that looks fake?

There are two basic ingredients in a beautiful porcelain crown.

All Porcelain Crowns vs. Porcelain Fused to Metal

The crown in the illustration above is pure porcelain. But an all-porcelain crown isn't very strong by itself. It could fracture under biting pressures. To give it strength it can be fused to a metal foundation. This makes it very resistant to fracture, but it also causes some esthetic problems. The metal, unlike natural tooth structure, is opaque. So it will be coated with an opaquer before the porcelain is bonded to it. And a porcelain fused to metal crown will develop a characteristic dark line where it meets the tooth. Dentists who use porcelain fused to metal crowns will try to hide this dark line under the gumline, but in time the gums will usually recede a little and the line will become visible.

To get around these limitations, new technology has been developed that allows dentists to bond porcelain directly to the underlying tooth structure. This gives the porcelain enough strength to be able to resist normal chewing forces in the front of the mouth, where the esthetics is most important. Not all dentists like using this bonding technology. Often it requires additional education beyond dental school. And the techniques are difficult, requiring meticulous attention to detail. The slightest contamination of the tooth with the gingival fluid that naturally oozes from everyone's gum tissue, for example, will ruin the procedure.

  Here is a photograph of a patient with two porcelain fused to metal crowns on the lateral incisors. Note that the dark line at the gumline is showing. Also notice the coloration. While the natural teeth get darker nearer the gumline, these crowns get brighter. This is because the crown material has to be thinner near the gumline, which makes the opaquer more noticeable here. Right next to the gum, where a little of the metal is showing, they are exceptionally bright.
Here is the same patient after the crowns were replaced with all-porcelain crowns. The dark line at the gumline is gone. The color gradient of the crowns is natural. In fact, if you hadn't seen the "before" photo above, it would be difficult to tell which teeth were crowns and which were natural.  

The Art of Working with Porcelain

Part of the reason for the natural result in this photograph is the porcelain material. It can be made with a luster, color, and translucency that perfectly mimics natural tooth structure. But there is another very important ingredient, and that is the artistry of the dentist/labortory technician team. There are some tricky elements to the case above. The patient's natural central incisors, to start with, don't perfectly match each other. The one on our left has more reddish-brown color in the upper half of the tooth. The one on our right has some vertical grooves that are slightly off-center that give the surface an unusual reflection pattern. To get the natural result pictured, the dentist had to correctly prepare the teeth to accommodate the needs of the laboratory technician. Then the dentist needed an exceptional eye for color and other aspects of the appearance, and the ability to communicate these to the laboratory. Some of this communication can be done with photographs, but no photograph records color with perfect accuracy. And there are often little touches that the dentist needs to apply chairside, such as tinting the bonding cement or applying underlying color masking techniques to teeth with certain structural problems. It is a team effort, and the dentist is ultimately responsible for the success of the case.

Finding a Cosmetic Dentist Who Can Create a Beautiful Result

Dentists are attracted to the profession because they like to fix things. And they are trained in dental school to be engineers who can produce solid, long-lasting results. Dentists with enough artistic ability to produce natural results like those shown are few and far between. Additionally, most dentists, because they are so focused on function, don't take the time to learn the skills required. My advice, if you are having crowns done on your front teeth, is to consult my list of expert cosmetic dentists. On a companion website, I have listed about two hundred dentists all over the country that I personally recommend for procedures such as this. Simply visit www.mynewsmile.com and you will find a dentist who can produce beautiful results.