How many crowns or veneers do I have to do to fix my smile?

How do I fix a really dark front tooth?

Are you noticing that one of your teeth looks darker than the others? Does it seem like it’s getting worse and more noticeable in photos? This is very common. Many front teeth are traumatized, bumped or hit during their lifespan. This can result in “necrosis” of the tissue inside the pulp or chamber inside the tooth. This tissue contains red blood cells, nerves and other material that can the internal chamber of the tooth. Since red blood cells contain iron compounds, these break down and are retained in the now empty internal chamber of the tooth. This dark stain becomes visible externally and results in a dark looking tooth. Take a peak at the photo to the right and you will notice an example of an internally stained tooth.

So what can be done? Luckily there are a number of options ranging from simple teeth whitening to crowns or veneers. If the structure of the tooth is healthy and intact, we lean towards trying the most conservative approach. This often leads us to our gold standard of external teeth whitening using our renown Kor teeth whitening system as well as internal teeth whitening. “Internal teeth whitening” involves actually physically cleaning out the internal chamber, sometimes placing a root canal filling and then delivering whitening gel directly inside the tooth. When we whiten the teeth both internally AND externally we have a very predicable result and effective treatment combination.

If the tooth is also broken down, has large existing fillings or does not respond to teeth whitening - it is possible to cover the tooth with a porcelain restoration in order to make the color match “perfect”. This option involves placing a porcelain veneer or crown over the existing structure of the tooth in order to mask the discolored or broken down tooth structure. This is a great treatment option, as we can make the tooth shape as well as the color perfectly mimic the surrounding dentition. The drawback is that we often have to remove tooth structure or “shave down” the tooth in order to make room for the porcelain material that is placed over the tooth.

If you’re interested in learning more about how to fix your dark tooth - check out our cosmetic dentistry gallery and treatment page. Go ahead and REQUEST A CONSULT. We’d love to meet with you and show you what options are available to you!

~Dr B

Porcelain Veneer vs Porcelain Crown: What option is right for me?

When we discuss cosmetic dentistry with patients , they often are confused about the difference between porcelain veneers and crowns. Which one will be the most aesthetic? Is there a cost difference? Is one more durable than another? These are often the most common questions that patients mention. The truth is BOTH veneers and crowns are equally aesthetic and beautiful. Both are made of high strength ceramic. The decision comes down to the amount of tooth reduction is needed, how healthy the existing teeth are and how much we need to change the tooth shape or position with the porcelain restoration. Crooked, severely rotated teeth, or teeth with big fillings will benefit from “full coverage” (crowns). Teeth that have good enamel and require minimal repositioning will benefit from less reduction and the use of a porcelain veneer.

The example noted in the photo shows how restoring crooked teeth with a crown can allow us to (in a sense) “move” a tooth to a better position by using a full coverage crown. By reducing more tooth structure - we are able to reposition the tooth (aesthetically) so that it doesn’t look cooked or misplaced in the dental arch. This case also highlights an additional benefit of going “full coverage” vs a veneer. In cases where there are very dark teeth - we often need more material thickness (more porcelain) in order to mask the dark color of the natural tooth. If the porcelain is too thin - the darkness with show through and compromise the final color of the new restoration.

A veneer is a great option for minor color, tooth position corrections and improvement of tooth appearance. The benefit is less reduction (basically less tooth drilled away). In many case we can simply ADD porcelain to the tooth without even having to remove ANY tooth structure. These are called “prepless” veneers. The photo below highlights a before/after example of using veneers to broaden the smile, reshape and cover existing teeth: in order to make them brighter, bigger and more aesthetic!

So whether you are from Minneapolis, Plymouth, Wayzata, Edina or any town in Minnesota for that matter…Come to Ivory. Request a free consult and learn more about how cosmetic dentistry can transform your smile and leave you feeling great!

~ Dr Brenny

What is the BEST teeth whitening option?

When patients ask what I think about teeth whitening - I respond: “ I love teeth whitening…I think EVERYONE should have it!” It is an appropriate treatment for most people, and it is often the easiest and most cost effective way to make your smile really pop. Who benefits most from teeth whitening? People without fillings or crowns on front teeth, people who have a fairly uniform tooth shade (not a lot of white patches or different colorations) and obviously people who have discolored teeth! We use a tooth that helps us measure the color and value (brightness) of your teeth. This shade is called a “vita shade guide”. We use both the classic and the 3D. The the photos and note how there are several different letters (A,B,C,D) and also numbers associated with the letters. In this case 1 is the brightest (high value) and 4 is the darkest (low value). The photo showing the VITA 3D is in black and white - and highlights well how the “values” of teeth can vary across the spectrum.

In my opinion the BEST teeth whitening option is 1) predictable 2) relatively quick and easy to use and 3) causes minimal teeth sensitivity. There is NO magic bullet for teeth whitening…there is no one stop transformation for MOST people. We have found same day (one appt) in office teeth whitening to be very unpredictable. And, we have found lasers, and UV lights and all the other marketing gimmick to be no more effective (over the long term) than our custom make take home whitening tray with Kor formulated gel. We do a TON of teeth whitening at our office - and we get results. The trays are made and trimmed in a specific way to keep the gel in close contact with your teeth, and off your gum tissue. The gel is specially formulated to deliver the most consistent whitening session with the least amount of sensitivity. There are gels with HIGHTER concentration…and initially they may seem to be more effective the first couple of sessions. But, at mid treatment and end of treatment (20-5 sessions) the Kor take home gel delivers the same level of whitening with much less sensitivity. How long is a session? We instruct patients to wear the tray every night if possible (1 session) OR wear it (1-2hrs) during the day while cooking, watching a movie or driving in their car. On average most of our patients reach their desired tooth brightness in 20-25 session. The beauty of the take home product is if you want to whiten more…you just add more sessions. The other aspect I love about custom take home trays is you can continue to do “touch up” whitening session (1-2 sessions every couple months) in order to KEEP your teeth bright, white and pretty!

If you want to learn more check out our “teeth whitening” section on our website and/or come in for a consult and get the process started. You can start whitening after just two quick appointments!

~ Dr Brenny

Fixing old crooked teeth without braces!

Sometimes orthodontics is just not a viable options. Invisalign (clear tray aligners) or full braces (metal brackets) can be a daunting decision for adult patients. But, often orthodontic treatment BEST way to align your natural teeth, fix teeth gaps, level and align your smile and improve the edge position of teeth. At Ivory, we use orthodontics as one of several “tools” to transform your smile - and often we use it as part of an overall cosmetic smile makeover. Sometimes patients that could benefit from orthodontic corrections prior to cosmetic porcelain restorations say “ no way, no how"…They are NOT going to have braces or wear aligners!

If the set up allows - some patients will have the option to correct the overall appearance AND position of their teeth with cosmetic porcelain crowns, veneers and or composite bonding. When the teeth are worn and discolored, the appearance (and position) can be greatly improved by covering the tooth with a porcelain jacket - called a crown. A porcelain veneer is also an option where we only need to cover one surface of the tooth with porcelain in order to improve its overall appearance. See the photos Below…This patient had lived with crooked and worn teeth into her 70’s and finally wanted to improve her smile. Invisalign was ruled out, so we recommended full crowns in order to reposition the teeth (straighten them) and transform the appearance of the tooth with beautiful cosmetic porcelain. The result is a much improved smile and teeth that are no longer worn down, dark, stained and unappealing.

If you look closely at the before image, you can see that the front 4 teeth are crooked and worn to different heights. They are also discolored and full of composite fillings. The first step was to use our amazing Kor teeth whitening system to whiten all the teeth. The goal is to achieve a beautiful whitened tooth color before we begin tooth preparation. Then, by simply preparing the front 4 teeth for a crowns, we are able to cover the teeth and match the whitened color of the adjacent teeth. The edges are even, the surface of the teeth are perfect & life-like…all done without orthodontics!

If time and age have worn and discolored your teeth, it’s never too late to refresh your smile! Check out our cosmetic dentistry page to learn more!

~ Dr Brenny

How replacing old crowns or veneers can transform your smile

Dental materials have changed significantly over the past 2 decades. In the past, the only options we have to create beautiful cosmetic restorations were soft porcelain (feldspathic) or with porcelain to metal crowns (a metal coping with feldspathic porcelain stacked over the top. Both of these options were adequate, but lacked long term durability and great aesthetics. Maybe you’ve seen someone with a front tooth crown that looks “not quite natural”, and has a dark line right next to the gum line? These are usually older “porcelain/metal” crowns that lack translucency and have an exposed metal collar at the gum line. These crowns are often replaced with newer - more aesthetic - porcelain crowns, not because the old crowns are broken or defective, but rather because the old crown no longer look good. See the image below - and notice the dark line at the gum area of the crown and the dull/flat appearance of the front tooth crown when compared to the adjacent natural tooth.

Porcelain technology has improved significantly and we not have material like Lithium Disilicate and Zirconia - which have no metal coping, are super strong and durable as well as aesthetic. The challenge for any cosmetic dentist is to create restorations that mimic real life - meaning using porcelain that allows not only the correct color match; but also the right translucency, opalescence, characterization and surface texture. We want to create veneers and crowns that are truly lifelike and indistinguishable from natural teeth.

So, what do you do when your old crowns catch your eye in your most recent family photos? Maybe the dark line at the gingiva is driving you crazy, you have chips or fractures in your old crown or veneers or the old crowns no longer match your teeth? The first step is bring these concerns up at your next visit or cosmetic dental consult. Often we recommend replacement of the old materials with newer materials AFTER you have a chance to full whiten your smile. I always recommend using this time to get your natural teeth back to the color you always wanted with our take home professional whitening system - then we replace the old veneers or crowns to the new color of your adjacent teeth. Remember, teeth change color but porcelain is forever the same color. If you don’t take the time to first whiten - you’ll be stuck at that shade, unable to whiten your other teeth because it will create a contrast between your crown and natural teeth.

Here is a case where the patient presented with broken (soft porcelain) veneers that were also very gray in appearance. We recommended replacing the restorations with new "lithium disilicate” restorations that were brighter, a bit longer and more aesthetic and durable. The patient loved the result and the case was completed in 2 visits!

So, if your old crowns or veneers are not looking the best - mention it to your cosmetic dentist and learn about what options are out there to reguvinate your smile. It might be easier than you think!

~ Dr B