Dr. Whitmore’s Dentistry Blog

I need three root canals on three of my front teeth.

My dentist tells me that I need crowns. I can accept crowns for the root canal teeth, but he wants to crown all six front teeth. There is nothing wrong with the other 3 - he tells me that he wants to do them so that they match. He said the porcelain would not match my other teeth.

Should I seek a second opinion?

Thank you,
- Pam from New York

Pam,
I haven’t seen you or your teeth, so take these comments in that context.

Just from what you’re telling me, it appears that your dentist either lacks confidence in his ability to match the color of your crowns to your existing teeth or doesn’t want to take the extra trouble that would be required to do that. Dentists can match porcelain to teeth perfectly. There are various tints and basic shades so that any color or color pattern can be matched. But it takes an understanding of color that many dentists don’t possess, and an eye for color. And it’s extra trouble - it may take a couple of appointments and sending the case back to the dental laboratory a couple of times to get that perfect match. This is troublesome for the dentist. If it were me, I would not accept the extra crowns on the teeth that have nothing wrong, but would find someone who was willing to color match the crowns to my existing teeth.

But there are other important issues here, too. What kind of crowns are being done? Many dentists who have little artistic sense do the type of crown they were trained to do in dental school - porcelain fused to metal. These crowns approximate the appearance of your natural teeth but are opaque, tend to have a lifeless look to them, and eventually develop a dark line at the gumline. Now the worst thing for you to do would be to try to push your dentist out of his or her comfort zone by asking for an all-porcelain crown when he would prefer to do a porcelain-fused-to-metal crown - that can invite disaster. But I advise, when you need a crown on a front tooth, going to a dentist who is comfortable doing the newer more difficult technology of the all-porcelain crowns.

Now I want to qualify this answer by saying there may be something about your case I don’t understand that makes it desirable to crown these other three teeth. But just from what you’ve told me, I would recommend you seek another opinion and see if you can find a better answer.

Links:
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Visit the website of Plano dentist Dr. Marc Whitmore
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I broke my left front tooth. My dentist did a root canal and a post. After 6 months, the tooth has discolored already. My dentist advised that I get a porcelain crown. Is there a better option in my case because I don’t really like the crown.
- Christina from New York

Christina,
I can’t tell for sure if you need a crown on your tooth or not without an examination, but let me give you some guidelines and principles.

On a back tooth, when you have a root canal treatment, it’s especially important to get a crown, because the tooth otherwise is very susceptible to vertical fracture, and if that happens, you could lose the tooth.

On a front tooth, there isn’t so much risk of vertical fracture, but we still often will do a porcelain crown. It doesn’t always need a crown. Sometimes, the right kind of post will strengthen the tooth enough. But then you have the problem of discoloration. Although it should take several years before a root canal treated front tooth will discolor, if the dentist doesn’t seal off certain root canal filling materials and confine them just to the root of the tooth, it will discolor sooner.

And there are other ways to treat a discolored root canal tooth. It can be whitened from the inside. Or a porcelain veneer can correct the color. But if a large portion of your tooth has broken off, I would probably lean toward having the crown.

A problem with the crowns most dentists do for front teeth is that they have metal in them, which makes them opaque and will cause them to eventually get a dark line at the gumline. We do all-porcelain crowns on front teeth, and they look beautiful and perfectly natural, so that you can’t tell them from a natural tooth. But I wouldn’t advise asking your dentist to do this type of crown for you unless he or she suggests it, because many dentists aren’t trained in the highly specialized techniques required to place these but may be tempted to try it by your encouragement.

I hope this helps sort things out for you.