John Schmid, DDS, LVIF

Marley,

Normally we would perform a root canal on the tooth and bleach it internally.  The problem is  the discoloration is coming from inside the tooth, so conventional bleaching typically does not help. Since there is no pulp chamber present you have basically 2 options.  Create a new pulp chamber space and attempt to bleach it internally.  The only other option is to mask out the discoloration with porcelain (veneer).  This options requires a skilled lab and a lot of communication between the lab and the Dr.

In my opinion, the most predictable option would be to veneer the tooth.

Hope this helps,

Dr John Schmid DDS LVIF

Monica,

This is why we always evaluate temporaries after the anesthesia is worn off (usually the next day or so).  The reason for this is it is impossible to determine proper length regarding lip lines when the patient is numb.  A good cosmetic dentist will always start off with a length that is determined by the width of the central, ie optimum height to width ratio.  Somethings can alter this like the bite,  adjacent teeth that aren't being treated,  root length  etc.

Once I have the patient back for evaluation we look at how the soft tissue plays with the temps.  Questions like how do the incisal edges approximate the lower lip?  Is there to much space between the premolars and the inside of the cheeks.  We also look at things like overall size, shape, and position.  Then we add or subtract temporary material until everything is right and communicate this to the lab so the can duplicate in porcelain.  Sometimes they're perfect and don't need a thing, sometimes significant change is needed.

So to answer your question, Yes.  Not only can they be altered,  they should be evaluated for change before making the final veneers.

 

Hope this helps,

John Schmid DDS LVIF

Kathy,

Your bridge is chipping because your lower front teeth are somehow coming into contact with the uppers in a way that is chipping the incisal surface (lower edges).  This can occur  during natural chewing cycles where the lower jaw actually moves side to side as it goes down and comes up.  Or, you could be grinding your teeth at night time unknowingly.  For what ever reason something changed between the old bridge and the new bridge.  I'm guessing that an interference was "unintentionally" built in.  This happens often when teeth are lengthened for cosmetic purposes.  Interferences can cause parafunction (grinding or gritting) and/or touch prematurely during normal function.  Sometimes we can even see a change in phonetics (lisping).

It appears that your occlusion needs to be addressed in this area of recurrent chipping.  The interferences need to be identified and removed.

 

Hope this helps,

 

John Schmid DDS LVIF

I have not placed porcelain fused to metal (PFM) crowns in the anterior for over 15 years with the exception of some captek crowns where I could not block out bleed though of a very discolored tooth.  PFM's are not the most esthetic option due to the fact that there is no light coming through the crown.   How a restoration acts in regards to light is very important.   Three things are critical 1) light has to bounce off in different directions 2) light has to enter and then bounce back in different directions 3) light needs to travel all the way through.

Without light traveling through it is virtually impossible to mimic natural teeth in all conditions.

Hope this helps,

John Schmid DDS LVIF

Utgrad,

It really depends on what materials were used and where the restoration is.  Newer materials allow us to place all porcelain crowns / on-lays away from the gum line.  This is by virtue of the fact that bonds strengths of porcelain fused to tooth structure are a lot higher than those of conventional crowns cemented in.  With these bond strengths we no longer have to rely on mechanical retention to keep crowns in, meaning we don't have to remove as much tooth structure. 

In the back it is common to have margins above the gum line when using these newer materials.  Not only is it more hygienic for the patient but it helps with isolation during the bonding process (which is very technique sensitive).  Sometimes the margin where the porcelain stops and the tooth starts can show.  This is not a problem if 1) it is totally closed and sealed 2) it does not show during conversation or smiling.

Obviously in the front we want to hide margins either by carefully blending to the natural color of the teeth or by placing the margin at or below the gum line.

The short answer is,  if it is modern adhesive dentistry in the posterior then it is fine and probably will help preserve gum health and prevent recurrent decay.  If not and you have reason to believe it is not an all ceramic/ resin restoration then you may want to have it looked at.

 

Hope this helps,

John Schmid DDS LVIF