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Re: To CS and anyone else for opinion pls!

Posted by cs on 10/8/2009, 11:22 am, in reply to "To CS and anyone else for opinion pls!"

Wow, Regina! Your revised description paints a different picture (. . . or maybe just seems that way because the sequence of events is easier to follow.) To be honest, I did start to answer your email by discussing the issues you experienced but after re-reading your message, decided that the questions at the bottom of your message were more important. So here goes. . . First though, I want to say that I am NOT a dental professional; just a fellow patient with relatively healthy teeth, but one who has lived long enough to have encountered and dealt with my share of dental dilemmas along the way. So any comments I may offer really are just as an observer, with a long and wide perspective on which to draw <<First of all, I did not DEMAND any particular length he chose the length of the crowns initially, Isnt it possible that he just made them too short.. Why are you assuming that I am being difficult?>> Sorry if I gave you that impression, but as I've mentioned, based on your two previous postings, I did not fully understand the situation. Your last message (to me) cleared a lot of that up. Re: the length of the crowns: Based on the above, it does seem like your smile makeover got off on the wrong foot from the start. If the length of the crowns (or initial bridge, which is what it sounds like) was marginal, it would have made sense to at least protect them with a night guard. It's too bad your dentist didn't recommend one at that point. But with one of the teeth chipping within 6 months and another soon after, you'd think that would be a signal that their might be a problem with the length of the bridge. Since I only have a zirconium abutment beneath my implant crown, I don't know if or why a Lava bridge (which essentially also is made of zirconium) would be thicker than an Empress crown, which I believe is all-porcelain. But since the latter also are known to chip under pressure, your dentist probably figured Lava's reputation for strength would avoid that problem in the future. Zirconium crowns and bridges also avoid the dreaded dark line at the gum, often associated with crowns made of porcelain-fused-to-metal (i.e., PFMs) — so if you had been trying to make your teeth look longer by reducing a gummy smile, they might have been a great solution! But aside from possibly offering more support, they probably don't address the real question: what is the best length for your teeth? Since you also describe the new bridge as feeling thick and looking bulky, it sounds like he also may have ordered them slightly wider, to preserve that "famous" ratio of length to width. But that does not explain why he then shaved them down. He's probably the only one who can answer that and there may be other explanations, but as a lay person, it seems to me that shortening them would just negate the purpose of widening them (if they were widened) and leave the tooth looking "boxy." Re: Color <<I was not consulted regarding color and I am just asking for the bridge to be a tad longer>> But in your previous message you also wrote: ""We had always gone with B1 as the primary color and I had always been satisfied when the Empress crowns were in my mouth. When the LAVA bridge came back I immediately thought they looked too opague and too yellow." I thought that was the reason he sent the bridge back to the lab and had them improve the color but they came back looking too white. I've also read that the zirconia from which Lava crowns are made is a ceramic material that is barely distinguishable from the natural ceramic of real teeth . . . and that because Lava crowns and bridges contain no metal and the inner layers can be matched to the color of each patient's teeth, they not only allow light to shine thru, but theoretically should look as life-like as Empress and other all-porcelain crowns. While it's true that different substances absorb color in different ways, you'd think that when it comes to dentistry, that possibility is taken into consideration in the selection of colors and fabrication of prosthetic teeth. After all, when given the opportunity, most patients only receive a strip of paper or at best a porcelain model tooth from which to choose and usually are satisfied with the result. If all your other crowns are B1, you'd think that if necessary, the lab would be able to make any necessary adjustments for the difference between Empress and Lava crowns, so it's hard to understand why your bridge came back looking too opaque and too yellow the first time, and too white the second. For what it's worth, I believe your dentist is right one point — though only TO a point: . . . front teeth are supposed to be whiter and brighter than the adjacent teeth. But not so bright that they look strange or out of place. It's a matter of degree, but natural teeth do tend to be a little darker as they proceed toward the back of the mouth. Since your dentist already knew that your other crowns were B1, that might explain why he didn't consult you about the color. Just one thought on that,however: Although porcelain crowns are not supposed to change color, is it possible that a professional cleaning might brighten them up a bit, so they match your new crowns more closely? As for making a new bridge a tad longer, it seems clear that your dentist is not willing to do that . . . at least not at his expense. I know you mentioned in a previous posting that you'd be willing to assume full responsibility for that. Considering your past experience, that seems like a pretty high risk, but personally, I don't see why he should refuse, as long as he has your word (and probably signature, as well). Re: Temporary cement << I also asked if I could live with them a little while and see them in different lite and was told that the adhesive that they had was only for temporaries. The difference in the color makes me feel self conscious.>> I'm not sure, but I think you must have meant your dentist said the adhesive was only used for permanent teeth. If so, he may be correct. He may only have material on hand for permanent installations. But that does not mean temporary adhesives are not available. Mine uses them all the time . . . not only for short-term use, but indefinitely. Like you, my top 4 front teeth have all been worked on; one implant and independent crowns on the adjacent three. My temps were fused together (like a bridge) and attached with a temporary cement that held them in place for about 6 weeks. When the perms were attached, he used the same or a similar product, which held my crowns a for the next two years, until all were replaced due to a problem we had identified shortly after they had been placed (but which needed time for the site to heal completely.) The crowns that replaced them also were attached with the same cement. All-in-all, it's been 6 years since the first work was done and I've never had a crown come loose! According to my dentist, temp cements come in various strengths designed for different situations. Personally, I'd give your dentist low marks for his answer to this question. it's totally reasonable for you to want to live with your bridge in different settings for a while before having it permanently attached. Many dentists offer that opportunity routinely. If I were you, I'd ask him what kind of product he uses on other patients who require a temporary crown while waiting for the lab to deliver a permanent one. Re: Night guard As for that night guard . . . I have one myself, though in my case it's for orthodontic purposes. But since receiving it, I've also discovered that I'm a "night-time" grinder — something I never had realized before. I'm not sure why but they seem to be recommended more often now than in the past. Since there are lots of channels for ordering them, it's not necessarily a profit maker for dentists, so I'm not sure what accounts for the increased interest, but that recommendation you received for getting one, might be valid — especially if you, too, grind your teeth at night. But if the sole purpose is to protect your teeth from chipping, if I were you, I'd be asking myself what happens during the day? Unless those last two teeth chipped while you were sleeping, would a night guard have prevented it from occurring . . . when you bit into an apple . . . chewy piece of bread or meat . . . or peanut brittle? <<As the cosmetic dentist...if he thought that the bridge should not be made as long as the crowns why did he not tell me or why did he not tell me that it would mean that they would have too be thick and protrude...should that not have been discussed or should that just be accepted. I am very confused.>> I agree with you on both points — particularly since two teeth on your original crowns (or bridge) had already chipped. You should have been consulted — every step of the way (including color). Re: Who's at fault? <<I am open to feedback but I just dont get where I am the one at fault here and he is trying to placate me...the difficult patient. Pls. explain?>> I don't think you are a difficult patient; but I do think your dentist has been trying hard to satisfy you. If I were you, before proceeding further, I would sit down with him and hash out what can/cannot be done re: the length, color, temporary placement, etc. and the best way to accomplish that. If you can't agree, it might be time to at least consult another cosmetic dentist to see if there are other options.

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