When I started dental school at USC in 1982 , gold crowns were considered the best in dental restorations . There were many kinds of gold crowns like ¾ crowns , 7/8 crowns , onlays and full crowns . Our instructors praised the perfection that could be achieved with gold and they praised the longevity these restorations had when made properly . For many years metals were the only substances available for making dental crowns and gold was the best among the metals .
Most people in the 50’s and 60’s and even 70’s didn’t mind the look of gold in their mouth and in some parts of the world the gold was considered a status symbol .
By the early sixties, however, there was already a demand for crowns that looked more natural. People wanted a more “real” look in their mouth and the “Pirate look” of gold was considered unattractive. Porcelain fused to metal crowns (PFM) started to become more popular during this era but were mostly used for front teeth where gold was absolutely not tolerated . These crowns basically had a metal core with porcelain baked on top of it. They first baked an opaque layer of porcelain on the core to mask the grey of the metal and then baked layers of body and incisal porcelain on top of that to give the crown the shape and color of a tooth. Cosmetically this was a great improvement over the gold crown and by the late 80’s most crowns being made were Porcelain fused to metal crowns .
As time progressed and people’s esthetic expectations grew , the porcelain fused to metal crown was no longer cosmetic enough . Patients complained about the dull none vibrant look some of these crowns had as well as the grayish color that showed by the gum line from the underlying metal in the crown . Some patients didn’t want to have any metal in their mouth and wanted an alternative to the PFM . This is when the new generation of crowns were developed without metal in them .These crowns were collectively reffered to as Zirconia crowns and were divided into different classes which I will not bore you with .
As the new millennium kicked off, the metal free crowns were becoming more mainstream , names like Lava , Cerec and Impress were the leading brands .Patients enjoyed the more natural look the Zirconia crowns offered with a more 3-dimensional appearance to the crown instead of that flat look and gone were the gray lines along the gum . The gum tissue also seemed to prefer the absence of metal and people had less bleeding around the metal-free crowns .
During the past 25 years ,I have seen my practice go thru the phases I described above .I cemented my last gold crown over 15 years ago because patients did not want the gold look anywhere in their mouths anymore. For the longest time PFM crowns were the standard crown of my practice , until” smile makeovers” became popular and once again the status quo was not good enough anymore .Patients demanded more and more natural looking crowns and that slowly pushed metals out of the picture . Today , one third of all crowns I seat are Zirconia type while the rest are the latest generation of PFM .The reason for this is simply the cost factor ; Zirconia crowns are 30% more expensive. In another 10 years I believe that metal in crowns will disappear just like silver fillings .
If you have good gold or PFM crowns in your mouth I don’t suggest you replace them with new Zirconia variety .But if you are not pleased with the esthetics , have decay under the old crowns or have constant bleeding around your old crown then I would suggest looking into metal-free Zirconia crowns . I think you will like what you see .
With all the technology available today you are able to get a lot of information about a dentist just by surfing the web .So once you find out how long they have been practicing, where they graduated from and what their fortes are, then what? Then nothing!!!!
Unless you received a referral from some one you trust, you really don’t have much to go by. It is not just the technical abilities of your dentist that are going to determine your dental experience .It is your ability to bond with your dentist that is going to determine whether you are going to be comfortable in their office.
Chose your dentist the same way you chose a friend .Go with your instincts and comfort level. What impression do you get when you first meet your new dentist? Do you get eye contact or are they always looking away? Do they talk with you or at you? Are you able to understand the points they are putting across? Do you like the way they look? Do they have a sense of humor? The above points are all criteria we use when we are choosing our friends because at the end of the day we need to be comfortable around them. Same thing with the dentist.
Another thing to look out for is the type of office you are considering .Is it a private practice or a clinic. Private practices will tend to have one dentist and you will only see them when you come in .So once you have created a bond with your dentist you are able to build on it .In clinics, typically you will see the dentist that is available when you arrive, so it is a little harder to create a bond. Also inquire about how long the staff has been with the practice .A solid practice will have employees that have been there for a long time because the work place is happy and fair. This also is a clue for you that you are indeed in the right place.
So as you can tell you will have to make a little effort to find a dentist and your information will come from their websites as well as your personal assessment of their character .If after you make your first appointment you are not comfortable then don’t return to that office and have your records sent to your next choice .I know it would mean doing homework all over again, which is a drag but it is worth establishing a good relationship with your dentist knowing they will take care of your concerns every time and be there for you .
Your Buddy Dr. G
I think teeth bleaching is one of the greatest advances in cosmetic dentistry .In the past people with discolored teeth had only one option, crowns!
So many perfectly healthy teeth were ground down needlessly just to change their shade or color. With teeth bleaching this is accomplished very conservatively, safely and for a fraction of the cost.
For the most part there are two ways to bleach your teeth, either in-office or take home. In-office bleaching usually relies on high concentrations of bleach to give you an effect right away. These high concentrations however also can cause a lot of tooth and gum sensitivity and whenever you want to bleach again you need to go back to the office to have it done which makes it the more expensive method. The take home method involves making custom bleach trays, which then you wear in the comfort of your home. This method allows you to choose the strength of the bleach you want to use depending on your tolerance and achieves or exceeds the results of the in-office method. I also like the fact that when the time comes to bleach again you can acquire the bleach from your dentist for a nominal price and not have to pay for a whole bleaching procedure from scratch, more bang for your buck if you ask me.
However before you bleach consider a few factors .Do you have any crowns or fillings on your front teeth? If you do, you have to take into account that bleaching works only on natural tooth structure, so as your teeth get whiter your restorations remain the same color which might not give you the most cosmetic result .So before you bleach, have a chat with your dentist and see where you stand. Your old crowns and fillings can be changed to match your new white teeth but you need to plan for that prior to bleaching. That way you are making the choices for the overall appearance of your front teeth and will not be disappointed with the results or the cost.
Smile makeover is a term that became a household concept thanks to reality shows. It’s a catchall term that encompasses a vast number of dental procedures. Smile makeovers are commonly thought to be very expensive but do they need to be always? What am I talking about?
If you have some old crowns and fillings that make your smile not quite the opening statement you would like it to be, then you would probably need to have them replaced with veneers or other all-ceramic restorations. These new restorations will give your smile a new vibrancy, and a brighter look.
You will require 6 to 8 crowns or veneers, which would cost near $10,000.
On the other hand what if your front teeth had no restorations and were healthy but they were a little bit crooked and their color darker than you would like? You could go with veneers like the case above but you may have a much more conservative option that will be better for you. You can straighten your front teeth with clear, removable orthodontic appliances, such as invisalign , and then bleach your teeth and get the look you crave. The orthodontics can be achieved within 3-5 months and the cost would be $2500, a quarter of the above scenario .The biggest bonus here would be all that healthy tooth structure you would have saved.
A smile makeover will boost your confidence but remember you are special and no one solution fits everyone’s needs. Have a heart to heart with your dentist and see what can be achieved.
Your Buddy Dr. G