Hello Didi,

I read your post a few days ago, but had to make sure I had time to sit and write my reply. I can understand your concerns and I agree that things did not go as they maybe should have. However, there are alot of issues with your situation that you may or may not be aware of. I will do my best to acknowledge them one issue at a time as if we were sitting and having a conversation. First let me tell you that your case type is commonly seen in dental offices who perform whole mouth reconstructive dentistry. I am very familiar with this type of dentistry....... hopefully I can enlighten you and be of some help to you! To make this easier, your quotes will be in brackets <<>>. My reply will follow.


<<In December 2007 I underwent anterior crown replacement of teeth 5,6,7,8,9,10. At this time the dentist also suggested I install veneers on teeth 3, and 4 and 11 and 12. The front six crowns that I had prior to this procedure had been in place for over 25 years without any problems, root canals, cracked teeth, sensitivity, jaw pain, etc.>>

Twenty five years is a long time to have the same crowns. The actual cement that seals the crown to the tooth generally has a life span of about 10-15 years and that's if the cementation was done near perfect. So even though you may not have been aware of any real physical changes, the margins of the crowns had to be leaking for quite some time. This leakage allows bacteria to get in under the crown which eventuallly weakens the tooth sometimes to the point that the nerve dies. Sometimes a crown will pop off when the cementation gives out and sometimes not. The suggestion by the dentist to place veneers on #'s 3,4,11 and 12 were for esthetics which is a standard treatment option when someone has a broad smile or wants a broad smile line.

<<The only reason I replaced the crowns was a dentist told me since I had insurance and the crowns were old and somehwat discolored, I should replace them now. The crowns were somewhat discolored and were the old porcelain over metal type which with a small amount of gum recession, resulted in some of the metal showing.>>

IMO, the dentist should have told you about crown history just as I have. Perhaps she did tell you in a way that seemed matter of fact and you didn't think too much of it because you were not experiencing any discomfort at the time?? In actuality, the discoloring of the crown is one physical sign that the crowns are wearing out. Of course, most people out of the dental field would not suspect that the crowns are breaking down on the inside as well.
The porcelain to metal crowns are still used in many dental offices on patients who have certain types of bite discrepancies. But most of the time all porcelain crowns made from zirconium or something of that resiliency can be used anyplace in the mouth. The gum recession was also an indication that the crowns had leaky margins. When the gum pulls away from a crown, a gumline filling or a natural tooth, it is usually due to either a sensitivity to the material that the crown or filling is made from or a buildup of plaque. Gum recession occurs as a defensive mechanism to a chronic irritant. It can also occur over time if the person brushes too aggressively and repeatedly injures the gum tissue or the persons bite is unbalanced which causes an unnatural wear pattern on the teeth causing them to shift away from the gum tissue.

<<Unfortunately the crown replacement did not go well. When I got home and the novacaine wore off, I noticed my smile was drastically altered. I was extremely unhappy with my appearance and felt that the crown replacement "aged" my face. My smile seemed collapsed and my teeth were not visible when my mouth was in a semi-smile or relaxed state. Additionally, 3 of 6 permanently cemented crowns dislodged within the first week on 3 different occasions.>>

What did the temporary crowns look like?? Did she have them professionally made by a dental lab or did she make them herself chairside?? Professional temps are meant to resemble the size and shape of the permanent crowns so the patient gets a good idea of what they will look like. In the temporary stage, the patient and dentist can tweak the esthetics and fit so that the permanent ones can be ordered to fit well into the patients bite and will hopefully be to the patients liking. There is no reason for having a crooked smile or one that was drastically different from the original unless the teeth needed to be shortened/changed because of misaligned bite issues. Did she mention any of that to you? Crowns that are permanently cemented are just that, permanently cemented until the bonding agent in the cement wears out. If the crowns came off after a few weeks, then they were either not cemented on properly, the crowns did not fit the prepped teeth properly or the crowns did not fit into the bite properly. Once maybe........ three times, no way!!!

<<When I visited the dentist (not the one who did the work) who owned the practice for crown reattachment after dislodgement, he acknowledged that my teeth were shorter than before and suggested I speak to the dentist who performed the work.>>

Typical situation where one dentist does not want to step on another ones toes. They all have their own way of doing things and sometimes they do crappy work and sometimes they just go about it in a different way. He was not about to engage in any real discussion about this with you without the other dentist being present.

<<The dentist (DR.X) stated that she took my previous overjet of 6mm down to 1mm and subsequently, the teeth were shortened as well. I was completely distraught and complained also about the left teeth, 8, 9, 10, veneers 11 and 12 were shorter than the left side. I also visited two other dentists who agreed with me regarding the teeth "running up hill".>>

Did she talk to you about changing your overjet?? If not, then she should have before she made such drastic changes. She sure had to cut your natural teeth down alot to shorten your overjet by 5 mm's. And to boot, she didn't make them straight across! Here is where you had some risks to the health of your teeth that should have been explained to you in the beginning. Number one, any time you drill into a tooth you risk killing the nerve in the tooth from the trauma of the high speed drill. Secondly, your 25 yr old crowns had to be leaking for several years which predisposed the teeth to a weaken state in comparison to other teeth that have never been crowned or filled. Thirdly, the severe cutting down of the tooth structure may have been too much trauma for these teeth to undergo and you ended up with irreversible pulpitis.

<<The dental office agreed to a full refund but Dr. X would not allow release of my tooth "preps" to my new dentists. She did release the mold of my original crowns but not the "preps". The other dentists were hesitant to perform the work without the preps, so I felt I had no other choice but to let this same dentist replace the crowns one last time.>>

She may not have kept the modeled preps because they would have shown the severity of the prepped teeth and that would not be in her favor. Other dentists were hesitant to take on your case for a few reasons.....One, they may have claimed to have no idea what was under those new crowns, but they absolutely had a good idea because they've all done it at some time themselves and were not going to touch those teeth with a ten foot pole. Two, if the teeth are prepped too far down, reprepping them can kill the nerve and they did not want to be blamed for that happening. Three, crowns ideally should have some solid tooth structure to be cemented onto. However, my guess is she had to do some major composite build ups to make the reprepped teeth larger. This build up is ok to a point, but if too large it doesn't allow much tooth structure for the crown to be cemented onto. If the buildups are done properly, the crowns fit well and are cemented properly and the bite is near perfect, then they should stay on ok.

<<On the advice of the other dentists, before I had Dr. X perform the work again, I paid an additional $1700.00 extra to have a "mock up" temporary made to wear for a few weeks to make sure I new what I was buying/getting before the next set of crowns were permanently installed. The mock up appeared compositionally much more inline with what I had before. The overjet was back and the tooth length seemed satisfactory.>>

These are the temporaries that I spoke of earlier. In large cases like yours, this step is imperative!! IMO, she should have paid for these herself and most likely you got charged more than what the lab fee was on these. Usually they double the amount of the lab fee for mock up temps when they are to be worn as a cosmetic test.

<< Unfortunately, something happened between the mockup and the final installation because when the novacaine wore off and I smiled, the teeth still were slightly shorter on the left, my bite was extremely tight (making me look old and scrunched in the face) and the teeth are still not long enough. I have learned since then there are really no laws governing who can call themselves a cosmetic dentist.>>

Did she cement your new crowns with permanent or temporary cement?? Generally, in large cases like yours, the new crowns are cemented with a temporary cement so the patient can wear them for about 2 weeks so they can critique them. Then any changes can be made before they are permanently cemented or if all is well, they can be permanently cemented on after the two week period.

<<I am now at a loss as to what to do. I detest my appearance, I look worse than before I began after undergoing two full anterior crown replacements and the replacement of two of the four original veneers. I have exhausted all of my insurance as Dr. X billed both of my insurance companies for all of my benefits allocated for 2007/2008 (even though all of the original work was performed in 2007 - which I later learned is considered to be insurance fraud).>>

I am SO sorry you have gone through such an ordeal and now you're unhappy with your new crowns. I am not doubting you one bit when you say that they are not what you were expecting and alot of the work was due to miscalculations by Dr X....... to put it politely.

My guess is the new crowns are alot lighter or brighter (whiter) than your old ones. Correct? They are also full porcelain without the metal substructure, correct? Full porcelain crowns/veneers in a light white shade when there are many in a row can sometimes exaggerate even the slightest imperfections. I am not justifying or making light of the difficult experience you have been through nor that the teeth may not be angled properly. I am just saying that you were use to seeing yourself a certain way for 25 yrs and your darker, metal to porcelain crowns are completely different in appearance than what you have now. You also have extended your smile line with 2 veneers on each side which totally change the perception of your smile. And please take this comment gently from one middle aged woman to another........... your skin tone/texture is not what it was 25 yrs ago and the brightness of the porcelain may be something that you'll need to get use to. Sometimes, and this may or may not be your case, the shade chosen for the crowns/veneers is much lighter than natural teeth would be at middle age. Very often this is what people want no matter how unnatural looking it may be. Did Dr X discuss shade color with you......... she should have.

As for the insurance part of this.... depending on the insurance company, some allow payment to be made on the prep date of crowns/veneers and others will only pay upon insertion date. You would have to ask your ins companies which way they pay out.

<<One additional thing, tooth number twelve, a tooth that had never had a crown or any problems in 51 years, became extremely sore after the installation of the first set of veneers. I complained to the dentist at the time but she indicated that the tissue was probably bruised or swollen and the tooth would calm down. When she replaced that veneer with the second veneer, I told her the tooth was still very painful and she said the tooth looked cracked. This was after the second installation.>>

Tooth #12 could have had a hairline crack in it which didn't cause any symptoms prior to the first veneer and when she prepped for the veneer it cracked further and you developed symptoms. OR, the veneer didn't fit properly in your bite and when you bit down, you cracked the tooth. Chances of her initially cracking the tooth while prepping for the veneer are slim because there is minimal prepping for veneers ....... unless she prepped those teeth too severe too!!

<<Also within 10 days of the second crown installation, I developed extreme pain in tooth number 8. I had an emergency root canal (extemely painful) and had to endure 3 rounds of antibiotics to quell the infection. What amazes me is that I never had trouble with any of the crowns or had never had a root canal prior to this work. I now have endured 3 root canals, two after the dentists removed my original crowns, and the one described above. I have also never had a cracked tooth and tooth twelve is now cracked with a veneer covering it.>>

If you have read any of my posts with regard to root canal therapy you will see that I am not a proponent of root canal treatment. Of course the only alternative to a root canal is extraction and I can certainly understand why you would be hesitant to remove your front tooth. However, from a health standpoint, root canaled teeth are not healthy teeth because they harbor numerous types of bacteria inside the tiny microscopic canals that can never been cleaned out. The vitality of these teeth is removed when the nerve is removed. This could be compared to cutting off the circulation of a finger or toe. No circulation means death of tissue which is never a healthy situation anyplace in the body. When you need to readdress these root canaled teeth, perhaps your dentist at the time will discuss the options available to you which currently are:

1)Retreat the tooth with another root canal which serves to accomplish nothing different than the first root canal
2)An apicoectomy which is a surgical procedure which again accomplishes the same end result as a second root canal
3) Extraction and replacement of the teeth with either something removable or dental implants.

<<I really wish I would have stuck with my original crowns. This whole ordeal has been depressing and frustrating. As a professional who is engaged in public speaking, it has been extremely humiliating when coworkers I have known for over 20 years ask what has happened to my mouth. Additionally, I am in a great deal of pain each day in my jaws which I have never had before.>>

Your original crowns were failing after 25 yrs. Sooner than later you would have experienced discomfort due to decay or worse. Who knows what was going on underneath them but your situation probably did not have to end up as extreme as it has. If the teeth underneath the old crowns were healthy and they had been prepped conservatively, you may or may not have had any problems with infected teeth requiring root canal treatment. But truely, only Dr X knows the answer to that question. Even old radiographs would not show decay through metal to porcelain crowns unless it was very extensive. But xrays will show the relation between the gumline and the edge of the tooth.

<<My questions are as follows:
I need to get some relief from my tight bite: Did the placement of veneers on teeth 3 and 4 and 11 and 12 change my bite? Since I bite mostly on my back teeth and these teeth are the furthest back in my mouth of all the ones altered, I figured that may be contributing to my tighter bite. Also the porcelain crowns are of thinner material than my original crowns, could this be responsible for a tighter bite? Do you have any recommendations for what I can do about this?>>

It is not unusual for new crowns/veneers, especially 9 in a row, to feel tighter than the old ones you had before. But they should not be uncomfortable. Do the gums looks puffy or red along the gumline? Is there any pain, tenderness or a lump along the bony ridge where you had the root canals done? Do you develop alot of plaque along the gumline? Any of these things will cause inflammation to occur and the result would be a tight, uncomfortable, painful feeling where the new crown work is done.
The veneers should fit properly into your bite when you open and close and when you move your jaw side to side when chewing. If you are hitting these teeth unnaturally, yes they can contribute to that feeling of a tighter bite.
The porcelain crowns are thinner than the old ones that you had but if they too fit properly, then they should feel like nothing is there.
My recommendation, have the dentist (a new one preferably) check your bite for any discrepancies.

<<I feel that my only option is to have all 12 teeth replaced once again (this would be the third time) but I do not know who to trust. I visited two dentists who claim to be "LVI", Las Vegas Institute of Cosmetic Dentristy graduates. While it seems from the before and after photos in their offices I visited, that the dentists do great work, I am concerned that part of their training includes courses in revenue generation. Even though these two LVI dentists I visited were in different states, their routine was the same: Consult with an aesthetic consultant first before actualling seeing the dentist, consultant took photographs immediately and pointed out what was wrong with my mouth, and both quoted prices that seemed higher than usual. (One said I needed a full mouth restoration at $50,000.00 and the other said they could correct my situation with restoring the whole upper arch at a cost of $28,000.00.>>

Chances are if you have your teeth prepped a third time, your teeth will die and they will all require root canal therapy or removal. There is only a very slim chance that this won't occur, but I wouldn't bet my worst enemy on it. I would bet that both of the estimates that you got to do this a third time, included automatic root canal therapy. I think you really need to weigh the risks associated with doing this a third time. I know you are very unpleased with the outcome, but at what expense are you willing to go through this again and there are no guarantees you will like their work any more than what you currently have.

Yes, a big part of cosmetic dental training is hard core marketing.... even the staff gets programmed to market the treatment. I worked with someone like this for about 3 years...... I could never bring myself to sell the BS to anyone. Sorry, I'm just being completely truthful with you.

<<Please help me. I am desperate. I am currently paying $300.00 a month for the next few years for the dental work that has already been done. I don't know what to do. Is it dangerous to replace these crowns once again? The first replacement was in December 2007 and the second replacement was in early April 2008. As I mentioned, I have jaw pain, a cracked tooth (which I believe may be attributed to the veneer installation), asymmetrical front teeth, and an extemely tight bite. How do I find a dentist that is skilled and knows the basics in crown replacement and tailoring the tooth size, shape, length, and overjet to one's face? How do I find a dentist that will not over charge me?>>

If you were my friend, my sister or me......... I would first suggest you reconsider your financial obligation to Dr X by letting her know how displeased you are and how emotionally affected you are by her work in your mouth. If she is smart, she will zero out your account and hope you don't decide to report her to the state board of dentistry. I think you have a 2 year window to file a complaint, but I'm not sure. I tell people all of the time, if you feel you have been mistreated, speak up and be heard. If the dentist/doctor is deaf to your concerns then follow your intuition. The board will look into your case by asking her for your records including all of her models for both sets of crowns/veneers. They will read her chart notes and review your radiographs and sometimes interview the other staff including any dentists. If they don't think your case is worth looking into, they will discuss that with you. They generally only investigate the ones that look pretty obvious or the repeat offenders.

I think you need to see a new dentist for the jaw pain and one who can help realign your bite. But the treatment should be conservative and not entail redoing your crowns/veneers. I would not do it a third time if it were me.......

<<Please help me. I currently live in Colorado and if anyone knows of a dentist who is certified and skilled in Cosmetic Dentristy and not out to overcharge the patient, please forward me to a website or help me some how figure out what I can do next. Thanks so much for listening and for any advice that anyone can offer to me. Didi[/QUOTE]>>

I do not personally know of any dentist in CO and I think it will be quite a task to find someone who is willing to touch her work. It may be best to try and adjust to the esthetic issues of the new crowns/veneers and have a new dentist make them more comfortable fit/shape wise. I know that is a really tough thing to do and I do respect how unhappy you are with the result. But it may be more important to weigh the risks (your health) vs the benefits (cosmetic) before allowing someone else to redo the work their way. Remember, there are no guarantees it will look any different and unfortunately, it could end up worse because there is little tooth structure to work with.

Didi, I have been extremely honest and straight forward with you because I felt that you were seeking sincerity and that's what I am here for. Over the last 30+ yrs, I have seen countless people with the same or similar situation as yours. My heart goes out to you and I do believe you have suffered needlessly. Please keep in mind that to hate your appearance will only cause you more heartache. There are people who are permanently disfigured who would give their right arm to have your crooked smile.......... please try to see the positive in your life and remember that it could always be worse.

I'm here if you need to vent or ask more questions or just want to give me feedback of what I have written......

Bryanna ~'.'~