Color mismatch of existing dental restorations.
This digital makeover provides an example of some of the color-management obstacles that crowns and veneers can pose.
Knowing about these challenges might help you to decide whether or not to have an elective cosmetic procedure done. Or, for planned or completed work, an understanding of what your long-term maintenance requirements may be.
Case issues and concerns:
Background. – When this person emailed us their picture, they stated that the teeth labeled numbers 1 and 3 have had porcelain veneers placed on them.
Getting the right color match can be difficult. – The color mismatch that’s obvious with these veneers testifies to the fact that accurate shade matching can be difficult when it comes to treating individual teeth.
(From a standpoint of appearance, any dentist would probably agree that the most difficult service to provide is placing a veneer or crown on an individual front tooth.)
In some cases, placing a set of off-color restorations may look OK. In fact, this is done all of the time as a cost-savings measure. For example, sometimes a person just has their six upper teeth (the teeth that show the most) veneered. A color mismatch with single tooth, however, always looks out of place.
Why don’t the existing veneers look right? – Clearly, the veneers that have already been placed don’t match well. So what went wrong? Here are some explanations of what may have taken place.
Dentist error. – As mentioned above, it can be incredibly difficult for a dentist to get a proper color match for a restoration. This is because there are so many variables involved (the characteristics of the materials, the characteristics of the type of restoration, communicating with the dental laboratory, etc… ).
Of course, overcoming these difficulties is the dentist’s problem, not the patient’s. And while perfection isn’t always possible, the work in this “before” picture is far from that. With this case, if this is what happened, the dentist who performed the work should have admitted failure and replaced it.
It’s possible that the veneers matched perfectly when they were first placed. – It’s normal that the shade of a person’s teeth will darken with age. And when this happens, the color of existing dental restorations (whose color hasn’t changed) can look out of place.
In this type of situation, it might be possible to use teeth-whitening treatments to lighten the color of the natural teeth back to the shade they were originally. This approach doesn’t always produce acceptable results but in cases where it does, treatments can then be performed periodically to keep things looking right. (This periodic-whitening approach may be needed for any smile that has one or more porcelain restorations.)
The “before” picture may represent one stage of piecemeal treatment. – It may be that this person’s long-term goal is having whiter crowns or veneers placed on all of her front teeth. But, possibly related to costs, she’s having her dentist initially treat just those teeth that need repair the most. The other restorations are planned for later.
Placing a series of veneers and/or crowns can have unintended consequences (such as making it more difficult to maintain gum health). If teeth need both a shape and color change (like the teeth marked numbers 1, 2 and 3 in this makeover), then this choice may be the only alternative. But placing a set of restorations just to create a color change alone should be thought through very carefully. Sometimes alternative treatments, while possibly less cosmetically perfect, provide the superior long-term solution.
“Before” photo submitted by website visitor.
This smile makeover is a difficult case, in the sense that there are no simple or cheap solutions. Here’s a way it might be completed, so to give the appearance we’ve illustrated in our “after” picture.
Step #1 : Whiten the teeth first. – Utilize professional/in-office or at-home teeth-whitening treatments to see how much generalized lightening can be achieved.
The idea here is that some of the teeth have a fairly reasonable appearance, with the exception that their color is too dark. If this can be improved enough by bleaching, they may not require any further treatment.
Step #2 : Place dental crowns. – Make dental crowns for the teeth labeled numbers 1, 2, and 3. These teeth need shape and alignment improvements. Dental crowns can make these changes.
Step #3 : Treatment for the remaining upper teeth. – It might be possible to reshape (buff and trim) the other upper front teeth so to give them a more refined look. This step assumes that the whitening treatments were successful.
Step #4 : Treating the lower teeth. – If the bleaching treatments have created a suitable color change for the lower teeth, a great way to improve their appearance would be through the use of some type of orthodontic treatment (braces). (Here’s a diagram showing how crowded lower teeth are sometimes treated.)
If not, a color improvement and similar alignment changes could possibly be made by placing dental crowns. This would, however, introduce the same set of challenges we have discussed elsewhere on this page to these teeth too.