can crowns be made to match original tooth size?

[tumbleweed]

Hi All,

I haven't found Just out of curiosity, I'm wondering how difficult (or easy) it is for dental labs to replicate a crown (or bridge) to match the natural contours and size of what would have been the natural tooth.

I have a porcelain-bonded-to-metal bridge put in many years ago and a (allegedly) pure-porcelain crown put in very recently and both are thicker in body than my what my natural teeth would have been. Is this inevitable? Would making these crowns the same size as teeth compromise their strength considering that they have to fit around a post?

Personally, the bridge I didn't mind so much about the size because it was at the back but I would have thought the lab would have gained an idea of what it should be from comparing with the contralateral side of the mouth.

The crown is on one central upper front tooth and is considerably thicker than its natural equivalent next to it. It's also angled outwards at the end on side (medially). I'm not happy with it and was wondering if I get a replacement in the future, whether it'll likely be of the same dimensions. It does look out of place. Would it be reasonable to expect a correct match? I'm wondering if anyone else has the same experience.

If it's that tricky to make central upper front teeth small enough to match the natural ones, then how difficult would it be to make it small enough to match lower front teeth? (Now, I have seen people with missing lower front teeth but don't know whether it's from lack of interest or finances to acquire one or whether it's because they can't get one that fits.)

thanks for any answers.

 

[annie778]

Tumbleweed I'm sure when a dentist responds they will agree that it is possible, but that it probably means removing more tooth. Some dentists are conservative and prefer to retain more tooth because this may be healthier in the long term. It also depends on the type of material used for the crown as some types of crowns need thicker porcelain than others. Some of the newer materials are stronger and thinner, and therefore give more room for porcelain so you can reduce bulk. I know quite a bit about this because I had a similar problem.

 

[annie778]

Just realised you said bridge too. I don't have any experience of bridges. But it's probably a bit trickier with a bridge because of the load on the teeth etc.....

 

[Gordon]

Annie is about bang on with her answer, you need a fair thickness of porcelain for strength and most dentists don't like to reduce the natural tooth by that much, in fact in some cases it's not possible.

 

[tumbleweed]

Oh heck,
I wish I'd known that beforehand! I've never found dentists to talk through the pros and cons and risks of treatments.

I wish that I'd asked what result to expect. In my naivete, I just assumed that the private crown would be made with more care and effort to be an accurate shape and size (and colour).

I've just spoken to the dentist about the bad shape and she's told me that a size to match the original was impossible. But I still think they should have gotten the contours correct (it just out too much and makes closing my mouth uncomfortable). Oh the grief!

Does anyone know whether metal bonded to porcelain can be thinner and stronger than pure porcelain. I was given the option of an NHS crown or a pure porcelain one. I originally thought that an NHS crown would have black metal showing. I'm wondering if metal-porcelain would have made a better fit.

 

[Gordon]

Metal bonded to porcelain are thicker than all porcelain. You need a minimum of 1.5mm thickness for the former, 1.0mm for the latter.

 

[annie778]

Oh heck,

I wish that I'd asked what result to expect. In my naivete, I just assumed that the private crown would be made with more care and effort to be an accurate shape and size (and colour).

I've just spoken to the dentist about the bad shape and she's told me that a size to match the original was impossible. But I still think they should have gotten the contours correct (it just out too much and makes closing my mouth uncomfortable). Oh the grief!

.

Unfortunately the way the tooth feels against your lip and the way your face feels and looks after you have the tooth fitted are often the least of the average dentist's and technician's considerations. It's one of my biggest bugbear's with the dental profession that they see this as trivial.

I'm not sure I agree at all with your dentist. There are many labs who will take the skill and care to give you a crown that is a close match to your natural teeth. If it sticks out slightly a good technician can work on minimising that. A decent technician is like gold dust unfortunately. Even private labs have mediocre technicians and even the supposed best technicians can make mediocre crowns. The answer is to go to a dentist who understands your needs and who uses good technicians. Not necessarily one lab but several.

As Gordon says porcelain can be made thinner than gold and these days there are types of porcelain crowns which can be made very thin if necessary. Different types have different thickness needs due to the material inside. As I've said it depends on the underlying tooth....but as I've also said it's a case of how conservative your dentist has been and if you do want to have reduced bulk which means increased preparation, you need to be aware of the risk of potential future root canals. It's a trade off. At the end of the day it's not a real tooth but you can have the next best alternative in the right hands (and for the right fee).

I expected exactly the same as you when I first had cosmetic work done, but I was in for a shock and a half when I realise the reality of the private cosmetic dental lottery. These days the market is a bit more developed and there is more emphasis on good service because of competition. However, there still seem to be surgeries who do both nhs and private, but don't do quality private work. It's certainly how I ended up on a dental merry go round years ago. I went to see an nhs dentist who talked me into having private veneers without even mentioning he was going down a private route. I think that general dentists should not do cosmetic work unless they are up to speed on their continuing professional development and can prove this to the patient. The patient is a consumer and at the end of the day this is a case of caveat emptor (buyer beware)...it's up to you to check what you pay for and do the research. Easier said than done I know....

Unless patients in the UK start being a bit more demanding nothing will change. Most people will go home unhappy and not want to complain because they don't want to make a fuss. They will get used to their unsatisfactory appearance and have a lower quality of life as a result. They will be unhappy smiling and maybe a little less confident. I see these people every day, you see them on tv. You don't notice that their appearance is not quite right because of their teeth, you just notice they don't look their best. You subconscious registers the irregularity and puts them in a mental box. A lot of people don't even think about it, but bad dental work is also very ageing. There is a whole new market in america for dental facelifts and still people in the UK are being fitted with cosmetic work that doesn't even remotely resemble their natural teeth or fit into their mouth properly. I despair....

How many dentists think of all this when they fit a crown? How many think...oh it's just another crown the patient isn't happy with ::yawn::

No offence to the dentists on here who are obviously much more in touch with patient needs than the average "painting by numbers" smash your teeth and grab your cash brigade....

ok rant about my pet subject over... yes doctor, I will take my medication now

 

[tumbleweed]

Dear Annie,

That was a reassuring post. I feel exhausted from expending time and energy stressing about my teeth. (I'd rather spend my time and mental energy on more important things but this underlying anxiety is very strong. I don't even think tranquilizers will help here.)

I wished that I'd observed the caveat emptor rule but when you're sitting in the dentist's chair and they demand a decision straight away, you don't feel you can ask for a few days to research the internet and then ring back with a decision. As she was sending the mold off that same day I didn't want to slow things down. I also had to pay a deposit for the crown and had a treatment plan to sign straight away (I'm assuming that if you did do research and change your mind, you'll lose your deposit). It turned out that I had to wait a month for the next appointment anyway.

I've written a letter of complaint and requested the crown be remade for a better fit - and not to pay extra. The dentist, predictably, tried to tell me that it takes 6 months to years to get used to. I am still convinced that my teeth did not have such an a large overbite to begin with. She told me to bring in photographic evidence of myself showing teeth before my accident. (I used to avoid being in pictures so am trying to contact friends to see if they've got any - usually taken surreptitiously.)

I have actually retained the broken tooth - all 3/4 of it except for where it had attached to the root. Found it on the road after my accident. It is about 1mm narrower compared to the crown (and the repaired chipped tooth). I'd never had a visible gap between my upper front teeth and if this original tooth is narrower, then surely this means that my teeth weren't naturally angled out as much. (Both original front tooth looked symmetrical, I would have noticed if one was 2mm wider than the other.) Anyway, I digress....

My dentist didn't want to redo her work (exactly what I'd expected) so as a compromise, she said she's referred me to a hospital-based NHS dentist for a second opinion. I don't know how impartial he'll be. 2mm to 3mm extra overbite may not look like much to the eye but it feels awful in the mouth. My lips don't feel comfortable staying closed together and the lower lip feels irritated when in contact with the edges of those teeth. And that's even before considering how it looks! (Don't get me started on that! The filling for the chipped tooth can be a colour that matches the rest of the teeth but a crown can't be made that same colour!)

So I'll have to wait potentially months for this second opinion (unless I go private and pay c.£60 for a consultation fee and possibly more for a letter?).

From a dentist's view, it's probably a lot of hassle to re-do one's work but from a patient's view, to live with something that looks and feels so unnatural for the rest of one's life is self-esteem destroying. Yes, to make it more awkward, I am a fairly young female and I'm studying for a career which involves face-to-face contact with people, so it's not as if I can hide my face and not speak and smile all day.

Just a comment, but I am shocked at the infancy of consumer rights re: dentistry. It's not as if porcelain is a precious commodity and I don't know if an experienced technician needs to spend that much time making a front tooth. Surely, £315 for a small piece of porcelain - sorry to harp on about the price - which I think is a faulty product justifies rework.

 

[annie778]

Hi Tumbleweed. I know exactly how you feel about anxiety. It's a really horrible feeling to suddenly have this on your mind. The problem is that when you are anxious about other things you can usually take your mind off the problem, but when it is something in your mouth you are constantly reminded of it when you speak, eat etc. You simply cannot escape and anyone trying to make you feel better simply doesn't understand that the only way to feel better is to fix the tooth. You're right, tranquilisers are not much use and neither are anti depressants (doctors note - we are not depressed!). The best solution is remedial action, second opinions and someone to talk to about the way you feel.

I understand exactly how you feel about face to face contact and how important it is to have teeth you are comfortable with. I have a job with lots of face to face contact, mainly in meetings where I have to be confident and when I first had my current crowns fitted (before they were adjusted by the dentist) I was so self conscious in meetings and didn't like talking because I wasn't sure if people were listening to me or looking at my teeth because they were so much bigger than my old crowns. Even after they were adjusted I wasn't cured of the anxiety until I'd had some positive experiences where I looked good and felt confident. I mean of course a lot of this goes back to my own insecurities, but hey we are all insecure about our looks to a certain extent, but we accept that we look a certain way and our personality forms around the acceptance. Suddenly having a change for the worse is a shock to the system.

Luckily after the dentist adjusted my crowns they feel a lot more comfortable and my face does not feel strained and I am reasonably happy now.

With the overbite issue, it may be that the crown needs clearance so that you don't damage it when you bite. It may be down to the amount of tooth left when you had your accident. Sounds like most of it broke and that might affect what's possible and what isn't because it is weakened. Usually when a dentist prepares teeth for crowns there is a lot of flexibility in how the tooth is shaped. If part of it is missing this makes things less flexible. I'm just guessing that may have affected her options and the technician's options when making the crown. In my view crowns are a major feat of engineering and I am always impressed with how they work so well with so little tooth left. That does not excuse a bad fit or the wrong colour.

I am not sure I would want the same dentist to redo the crown. I would want my money back, unless you can get a guarantee that they will remake it and let you try it in until you are happy. Unfortunately once you have parted with the cash, you are in a weaker position and you may feel obliged to agree to a compromise you're not entirely happy with. The relationship with the dentist will be strained and you will know that she is not doing the work happily.

The £315 charge doesn't just pay for the porcelain. It pays for the dentist's time and overheads and the technician's time and overheads too. Part of it gets allocated to the fixed costs of running their business such as rent, electricity etc as well as variable costs of transportation, phone calls, salary etc and some profit so that the business does not fall over. That's why crowns are more expensive in places like central London. So when you ask for rework, the dentist and technician suddenly start to see their profits eaten away (no pun intended!) and that's why they are unhappy about it. If a good job were done in the first place this would not happen but that's another story.....

If I were you I would phone around or email a few dentists and ask whether they charge for a consultation just to give a second opinion. (they usually charge a small fee for second opinion depending of course on how in-depth you want them to go). There are still dentists who do not charge you to walk through the door. If the crown is private work, there is no reason why you should go to an nhs hospital based dentist for a second opinion. The second opinion should be neutral and not someone connected to the dentist in any way. You left the nhs system when you chose a private crown and have no recourse to their complaints procedure.

It's really good that you have the original tooth. Don't part with it! This is great evidence of what was there before. Show it to whoever does the second opinion.

 

[tumbleweed]

Thank goodness there are people out there who understand how it feels! It's easy to think that someone is neurotic about something seemingly trivial until the it happens to you. It's no good going through life feeling unhappy about your teeth.

As for the size, i can now see the point about the base of the crown ending up being thicker than a natural tooth but not the outward angulation at one end, especially as the tooth it sat next to on the mold was not that way inclined. (It has since been fixed to match the angulation - but that's another story. Basically, a corner broke off in the accident and was skilfully filled to shape but with the wrong colour. I thought she was only changing the colour at the time but unknown to me, she was also changing the angulation to reach the level of the crown. The filling ended up feeling too sharp so had to be filed down and is now shorter than the crown.)

I understand the need for clearance from opposing teeth but even if the crown was a couple of mm less protuded at the end, it would still not clash with others.

The £315 is for the crown itself. I paid extra fees for other things like 2 emergency appointments and other work such as root canal and filling the chipped tooth.

I can understand the reluctance on the dentist's part to repair it from an economic point of view. However, I feel indignant. I paid the premium price because I thought that a more thorough job would be done on the crown - someone taking a couple of minutes to look at it from all angles to ensure no irregularities.

Believe me, I dislike visits to the dentist and wanted to keep it to a minimum. I was afraid that if I chose a cheap (and potentially shoddily made) crown, it would wreak my self-confidence in socialising and I would have to have it redone in the near future. I prefer a job properly done the first time around rather than undoing a problem and doing it again.

As it so happens, what I was afraid would be a consequence of having a cheaper crown happened with an expensive crown. Ironic.

Just to add, I know it's conjecture, but I doubt that my own dentist would put up with having a squinted crown (also mismatched colour and length) in the front of her own mouth. (Or any other dentist. It would be bad advertisement for business for a start.) But she expects me to put up with it. This is no disrespect to her skill and the amount of work it takes to get things right. But I think that if she (or the lab) charges so much, they should at least be prepared to provide better service.


I don't know if anyone except Annie agrees with the above but the stress bad dental work causes is not to be underestimated.

And I acknowledge that imperfect dental work is better than no dental work but I wished I was told outright by the dentist that charging a higher rate does not mean it would be better quality. I would have chosen NHS work and not have high expectations. As it is, I feel scammed.

 

[tumbleweed]

Gordon,
Thanks for your reply to my original question. It was so short that I hadn't spotted it until now. Useful to know. Much obligated.