Crowns and Bridges

Smile and the whole world smiles back…

Last month, I introduced an interesting, but frustrating dilemma facing patients today. The fact that advances in dentistry, which allow for more natural looking crowns and repair, are causing patients to consider additional cosmetic dentistry so that all of their teeth and dental work look the same and natural.

In my last column I explain that to have a natural looking tooth, light must easily travel through it. And that old-style porcelain crown have a metal substructure that block the light, causing off- color teeth with black lines.

The new all porcelain crowns contain no metal allowing the light to pass through, making the repaired tooth look like a real tooth. I also discussed that beauty is in the eyes of the beholder and that new technology can give patients a confusing list of options. The only way to overcome the confusion is to know what you want as the end result and to have open dialog with your dentist and dental team.

Joan’s motivating factor

Joan (not her real name) came to us with concerns in various areas of her mouth. After a nice informative interview, she expressed the fact she did not like her smile. She told us she has never liked the bridge in front of her mouth. She feels the bridge is to short; she hates its black lines, the color, and the fact that food catches in its spaces at the gum line. She also dislikes the other crowns in her mouth because they do not match her remaining natural teeth.

Our exam revealed major decay in one of the teeth in the bridge, which means it needed to be replaced. If not, the decay would become so large that Joan would lose the tooth and lose the foundation for this and any future bridge.

If there were no decay, Joan wouldn’t need any additional dental work to have a healthy mouth. She could have stayed just the way she is although she would continue to dislike her smile. But now she has to make a choice.

The dilemma

A new bridge is not going to look any better unless the other teeth are crowned using new technology. How many crowns is she going to need?

Option one – functional
Replace the bridge with an all porcelain bridge to get rid of the decay. This can be done in a way that will close the spaces Joan dislikes and will get rid of the black lines at her gums but that is about it from a cosmetic standpoint. The cost for this procedure will be $3,000 to $6,000 for two to three crowns.

The issue with only replacing the bridge is the color. Does she match her natural teeth, which she feels are too dark? Or does she decide to match the lighter color of her back crowns?

Option two – functional and cosmetic
Joan can achieve the look she desires, a natural and beautiful smile that is uniform in color and shape with no spaces or black lines at the gums. This results would be accomplished by crowning all her upper teeth, along with replacing the bridge, using the new all-porcelain material.

The cost of this new technology ranges from $1,000 to $2,000 per tooth and Joan will need to repair at least 10 teeth. What would you do? Remember it’s your time, your money and most importantly your smile.

Original Article