Dr. Mike Malone’s Blog

This may seem like it is coming after the fact, but I am curious about something. I recently had a smile makeover done. I thought I was going to have all porcelain veneers placed, but when I look at the backs of my teeth, it looks like the porcelain goes all the way around. Is it normal to place porcelain crowns instead of porcelain veneers for purely cosmetic reasons? I thought crowns were just for teeth that were damaged. I guess the reason this concerns me is that maybe my teeth were in worse shape than I though, if they needed crowns.

I’ve since seen my general dentist, and she seemed very impressed with the work, so I am not concerned about the quality of the workmanship. Is this standard, to have crowns instead of veneers for a cosmetic smile makeover?

Thanks for your insight,

Ben in Oregon

Dear Ben,

Porcelain crowns and veneers differ only in degree–there really is no specific line of demarcation where a veneer becomes a crown. The fee for a porcelain veneer is usually the same or nearly the same as that for a porcelain crown, because the effort to place each type of restoration is about the same.

It is actually quite common to see porcelain crowns used on the front teeth for cosmetic reasons rather than protective ones. If your teeth were not weakened or damaged, your dentist might have decided to go with crowns to control your bite.

It is surprising that the dentist did not discuss this in detail with you during the course of your treatment. Typically, smile makeovers involve a great deal of give and take between the dentist and the patient, because the dentist will want to make absolutely sure he or she knows exactly what the patient wants.

The simplest solution is simply to ask your cosmetic dentist why he decided to go with porcelain crowns rather than veneers. Crowns are the more aggressive form of treatment, and require more reduction of the natural tooth structure. Veneers require only a little bit of shaving on the front of the tooth. For that reason alone, I would expect your dentist to have a sound reasoning for choosing the crowns. Most dentists will always pursue the least aggressive form of treatment and strive to preserve as much of the natural tooth structure as possible.

I have porcelain fused to metal crowns on six of my top front teeth. What can be done to get rid of the the black line where the crowns meet my gums? It was not this bad when they were first placed but over the last two years it has really become noticeable. What are my options, from least expensive to most expensive?

Vienne from New Hampshire

Dear Vienne,

There really is not any inexpensive way to address this issue. The entire structure of your crowns is the problem. A dentist could try to drill away the black line and cover it over, but there is likely a serious color match issue between the roots of your natural teeth and the color of the veneers. Trying to blend those colors together in that tiny space would be incredibly difficult if not impossible, and the results would almost certainly be very unattractive.

Essentially, you have to options: live with the black line, or replace the porcelain-fused-to-metal crowns with all ceramic or all porcelain crowns. Be absolutely certain you chose a skilled, artistic, well-trained cosmetic dentist to do this procedure for you. I would hate to see you spend thousands of dollars to still be unhappy with the results.

My new dentist says I have “peg laterals” and suggests that I have porcelain crowns placed to correct them. My old dentist always said I would need braces to close those gaps in my teeth. I am confused about what to believe! My old dentist retired, and I don’t really know this new one very well yet. What are “peg laterals”, and what is usually done to correct them?

–Anthony in Topeka

Dear Anthony -

It is hard to develop trust with a new dentist. I would suggest you talk honesty with your dentist about your concerns regarding these apparent differences in opinion about how to address your dental issue.

Simply put, “peg laterals” are when your lateral incisors (the teeth on either side of your front teeth, or central incisors) are too small. This discrepancy in size makes them resemble small “pegs”, hence the term “peg laterals”. Without an examination, I could not presume to tell you how your particular case should be addressed, but I can tell you that you should really trust the dentist you choose to help you.

In some cases, a porcelain crown can be used, if there is adequate space surrounding the peg lateral. If there is not, some orthodontic work might be necessary to create a space for a natural looking crown or veneer. In your case, it could simply be that your teeth have shifted, and therefore the professional advice you have received has changed.

Whatever the case, it is very, very important that you trust your dentist. If you are unable to have an honest conversation with him about the best way to fix your peg laterals, then it is definitely time to seek a different dentist. We strongly recommend you find the services of an expert cosmetic dentist to help you with this - make sure they are accredited through the American Academy of Cosmetic Dentistry, and that they have pursued specialized training above and beyond that required by general dentistry schools.

When my daughter was 8 the dentist I used said she had a calcium deficiency because her front teeth were discolored. He put porcelain veneers on the front ones. She is 11 now and the veneers are discol ored and decaying. We started using another dentist and he said that we needed to put crowns on the front teeth and she also needs braces. I am concerened of how will they put braces on caps and why cant the veneers be replaced?

Thank You,
Suzanne in Alabama

Suzanne,
I’m not sure how many front teeth you’re talking about, and can’t tell whether your daughter needs crowns or not without an examination. But I can give you two possible reasons that the dentist wants to replace the porcelain veneers with crowns.

First would be that the dentist isn’t comfortable doing porcelain veneers. Many dentists aren’t. It isn’t taught in dental school, and many dentists just aren’t very excited about appearance-related dentistry because it is a very different field and they have to be artistic to enjoy that.

Or it could be that there is so much decay that now the teeth need porcelain crowns. Veneers only cover the fronts of the teeth. I would be surprised if your daughter at age 11 has that much tooth decay on these front teeth that she needs crowns, but maybe she does.

We really try to avoid doing porcelain crowns on young patients because when the teeth are young, they have very large pulp chambers, and the chances of irritating or injuring the tooth so that it needs a root canal treatment are large. And anytime we can do less grinding on the teeth to achieve the same result, the better it is.

As far as the braces go, the crowns wouldn’t be a problem. The orthodontist can work around that.

I think it would be prudent to seek a second opinion to see if she really needs crowns. Find a dentist who does a lot of porcelain veneers and see what he or she says.

I need a crown on my front tooth. The dentist suggests doing both front teeth so they match perfectly. Is this necessary?
- Laurie in South Dakota

Laurie,
It may be necessary for you, from this dentist, but it isn’t generally necessary. It is possible to match a front tooth crown perfectly to the tooth next to it, but it takes, skill, a strong knowledge of tooth color, translucency, and texture, and a certain amount of trouble. It may require sending the crown back to the dental laboratory more than once to get the color perfected. But it can be done.

Many dentists just aren’t good at that, and some just don’t want to take that trouble. So in your case, yes, it may be necessary to get both crowns if you want the front two teeth to match perfectly. But we don’t do it that way - we just match the single crown.

Read more about Louisiana porcelain crowns or Louisiana Zoom whitening.