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crowns 2
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QUESTION: I had 5 veneers that were 15 yrs old replaced.  The dentist said it would be better to use crowns as there was some leakage and decay under the veneers.  To make a long story short, the crowns have been absolutely horrible and I have had the 4th set temporarily seated.  The problems are gaps in the margins, especially the backside where there are gaps between the crowns and the gum.  These are large enough to see.  I enclosed a photo of the fronts, to me there are many inconsistencies.  The fit is terrible.  This process has been going on for nearly 3 months.  The odd thing is that the temps the dentist makes are beautiful, fit like a glove and look great.  My concern is that the gum margin will be adversely affected from the on and off again scenario.  I am so frustrated at this point and I am not sure what to do.  I am also concerned because I feel the dentist is the one with the knowledge and should not even temporarily put crowns of this caliber on at all..  I need direction and another opinion...please help.

ANSWER: Dear Debbi,

It's very difficult to graduate from veneers to crowns on the front teeth because of the difficulty duplicating the esthetics of veneers.  But now that you're committed to crowns, ask your dentist if he will make your crowns of all-ceramic materials that require no metal under them.  It is usually the metal line at the gum that is hard to hide.  If there is no metal used, then your crowns should end up looking great.

Or better still, ask your dentist if he has heard of Instacrown or Cerec.  These are machines that make your crowns in his office, using CAD-CAM technology, without the use of impression materials that can distort, or lab technicians, who can make mistakes.  These mill your crown from a block of porcelain.  They fit your teeth better than I have ever seen a crown that comes from a lab.  And ther is no metal used.

I have been using one of these for several months now with excellent results.   I will be happy to speak to your dentist, if you want to give him my name.  He can contact me through AllExperts.com, and I will respond.

Please let me know what you decide to do.

---------- FOLLOW-UP ----------

veneer photo
veneer photo  
QUESTION: The crowns that are currently in place are Zirconium.  The dark lines are gaps between the crown and the tooth.  I have heard of the machines that make crowns onsite.  I have asked him about it before and he didn't say to much.  I have been dealing with these crowns falling out since Friday and they were placed Thursday.  I am beside myself.  I will let him know again about the machine and would be glad to give him your name and suggest he contact you.  I appreciate your input and quick response.  Enclosed is a photo of the veneers I used to have, granted crowns are "heavier" in appearance, it is still my opinion that these that are in place are not acceptable in appearance or fit.  Another thing I didn't mention is I have been getting horrible headaches the last few days and that also has caused me frustration.  I am worried that the end result will be loss of these teeth.

ANSWER: Veneers look great!  My suggestion as of now is to ask your dentist to remake your crowns so that they both fit AND look like your veneers did. If his lab tech cannot do this from your photo, suggest that he find another tech who can. Again, if he wishes to contact me, I can make suggestions that might help both him and you.

I wish I could help you myself.  But right now, for practical reasons, in my opinion, you should stay with him and give him a chance to do better.  If he cannot, you will want to find another dentist.

Let me know what happens.

---------- FOLLOW-UP ----------

QUESTION: Thank You, I loved the veneers but alas I will need crowns.  I will be seeing the Dentist tomorrow.  I entirely agree that I should give him another opportunity to correct the issues at hand. (mid-line misalignment as well as axial inclination being off.  marginal issues, shape, contour color and fit.)
It is a bit redundant but I feel it is only fair to him.  I have put together a profile of the pictures of the pre-crown veneers, the current crowns and pictures of what I feel is an acceptable solution. (smile examples)  I also compiled a list of what I find to be the problems and the expected outcome of each.  I don't know if this is the politically correct way to do it and I am by no means a Dentist.  It is my opinion that this will give a clear picture of what my expectations are.  I am going to make a suggestion that he contact you as this may be a benefit that we both will learn from.  Thank You ...Much appreciation.

Answer
Compiling a list is brilliant.  I ask my patients with complaints to do this.  This way I have a list of issues to check off after they have been corrected to the patient's satisfaction.

Political correctness has nothing to do with it.  Your satisfaction with the result has everything to do with it.  That the crowns fit well and look good has everything to do with it.

I look forward to hearing from your dentist.  Both he and I can learn from your case.

I wish you well in this endeavor.  Know that, no matter what, it will all turn out fine.

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Howard Finnk, D.D.S., P.A., CEO

Expertise

I am a Family, Implant and Cosmetic dentist. I will answer questions on any aspect of dentistry and matters relating to the smile, gums, jaws and lower face. Member American Dental Association, Florida Dental Association, Broward County Dental Association, and Atlantic Coast District Dental Association. I have served as District Council Member of Alpha Omega, as well as serving for one term as its President. I am also a member of The Vedder Honors Society, Broward Dental Research Clinic, and Mount Sinai Hospital Guild. I have served as a Volunteer for Project Dental Health and The Tri-County Dental Health Council.

Experience

Having attained over 30 years of clinical experience in private practice in Michigan, in 2001 I was re-certified by taking and passing the Florida State Dental Board Examination. After moving to Florida, I spent nearly 10 years re-honing my skills while working as an Associate Dentist for several large dental groups. In September, 2004, I was appointed Adjunct Clinical Professor at Nova University's College of Dental Medicine. I am certified in placement of Mini Dental Implants, and I am Director of The Florida Implant Center (floridaimplantcenter.com). On March 1, 2010, at the age of 62, I began all over again by buying a dental practice near my home in the Fort Lauderdale area. As sole owner and Chief Dental Officer of the new Nob Hill Dental Center (nobhilldentalcenter.com), I can now carefully provide dental care to patients who care, all within a caring, joyful environment. Over my career lifetime, I have provided thousands of diagnoses, fillings, crowns, bridges, root canals, periodontal treatments, TMJ therapies, partials, dentures and extractions, and dozens of implants for my patients. The only aspect of dentistry with which I have very little experience is orthodontics.

Organizations
American Dental Association, Florida Dental Association, Broward County Dental Association, Atlantic Coast District Dental Society, Vedder Honors Society, Broward Dental Research Clinic, Alpha Omega Alumni Association, and American Association of Dental Implantologists. Formerly, American Academy of General Dentistry, Michigan Dental Association, Macomb Dental Society, Detroit District Dental Society, Tri-County Dental Health Council (a charitable dental care organization)

Publications
"How To Save Money At The Dentist" Going to press soon.

Education/Credentials
Bachelor of Arts and Sciences in Psychology from Wayne State University Doctor of Dental Surgery from University of Detroit College of Dentistry Adjunct Clinical Professor, Special Needs Department, Nova Southeastern University College of Dental Medicine, Fort Lauderdale, Florida

Awards and Honors
Membership in The Vedder Honors Society

Past/Present Clients
HIPAA rules do not allow me to post this information.

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