Empress Crowns

Question:

I just had 11 of my top teeth prepared for full porcelain crowns. When the impressions were taken and the lab guy came in the match the color of my teeth, he was matching his color chart to my bottom teeth which are stained. I told him they were going to be bleached. He proceeded to pick a color from his chart and said that he was going to mix some yellow to the base of each porcelain crown to make it look more natural. Then, the dentist and the lab guy said they were going to use porcelain to metal crowns all the way around. I told them I didn't want porcelain to metal crowns because I do not want black gums or black lines on my gums, or gray teeth. I can always tell when someone has porcelain to metal crowns. They don't look natural at all. My temp crowns have been on for 4 days, I called the dentist and told them I wanted Empress crowns on the front 8 of my teeth and porcelain to gold crowns on the back. They called me back and said I need to come in because this should have been decided long ago. Well they spent about 10 minutes with me on it on July 1st and the lab guy just wanted to leave. I am spending thousands of dollars to have a beautiful smile and am afraid I am being sold on bunk. What is your recommendation?
—Chris in Oregon  

Chris,
There are two very fundamental problems here. One results from your lack of comfort with your dentist's cosmetic skills. You're starting to tell him what material to use for the porcelain crowns and other details about how to make your porcelain crowns. This approach will only cause problems. You need to pick a dentist that knows how to do what you want him or her to do and then trust that dentist. He has prescribed porcelain fused to metal crowns and you're telling him that Empress crowns are better. So you in essence are taking the role of teacher, telling the dentist how to do cosmetic dentistry. Not only does this strain your doctor-patient relationship, but how do you know he knows the proper techniques for Empress crowns? You're asking for trouble with this approach. You could well be pushing the dentist out of his comfort zone. And don't expect him to give you any clues if he is out of his comfort zone. Dentists are trained from very early in their education not to let the patient perceive their lack of confidence with any procedure that they do.

The second fundamental problem is that you are trying to get a general dentist to do cosmetic dentistry for you. Here are four key things a cosmetic dentist would have done differently in giving you porcelain crowns:
1. Cosmetic dentistry is all about communication. General dentists fix teeth. You have a hole in your tooth, the dentist fills it. You have a broken tooth, the dentist makes you a crown. The dentist knows what materials will hold up and keep you healthy, and your input isn't that important. Cosmetic dentistry is completely different—the beauty of the work is in the eye of the beholder, and a cosmetic dentist is very attuned to your individuality. He or she will do some type of mock-up of your case, either on a computer, on models, or in your mouth. Smile design will be an important issue, and the smile will be designed to fit your personality, facial shape, and personal preferences. You two obviously just skipped over this part.
2. General dentists are technicians. They fix things that are broken. Cosmetic dentists are artists. They create things. Two very, very different approaches to the subject matter.
3. General dentists aren't attuned to color. It takes a certain amount of talent and desire that is then expanded by training and experience to truly understand tooth color, translucency, the effect of various lighting situations, etc., etc. General dentists may talk about color and think they understand it, but they don't have a passion for it and don't really comprehend all of the subtleties. A cosmetic dentist would have discussed your desired tooth color with you ahead of time, and suggested bleaching your lower teeth. A cosmetic dentist would know that you would need to bleach your lower teeth FIRST, then pick a shade for the porcelain crowns for your upper teeth and plan the case out BEFORE the porcelain crowns are started. And having the LAB GUY pick the color for your porcelain crowns. PLEASE! They are making a real statement here that the dentist feels uncomfortable with the issue of color.
4. A cosmetic dentist would realize that with getting eleven porcelain crowns on your upper front teeth, that there is full latitude to make this a very beautiful case. She or he wouldn't have DREAMED of giving you porcelain fused to metal crowns in this situation. You are right--porcelain fused to metal crowns are opaque, unnatural, and will usually develop a dark black line at the gumline. The cosmetic dentist's standard operating procedure would be all-ceramic crowns for upper front teeth. Whether the dentist would use Empress or a feldspathic porcelain or some other esthetic material for your crowns would depend on the functional and esthetic demands of your situation.
My bottom-line advice: If you want a beautiful smile, pick a true cosmetic dentist to do your porcelain crowns. So either let this dentist do your porcelain crowns the way he wants to and live with the results, or transfer to a genuine cosmetic dentist, such as we have listed on our site. It's not too late.
—Dr. Hall

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