Problem: “What started out years ago as a nice looking dentistry has turned into a dark tooth with metal under the crown. There’s a black line where the gum meets the tooth, too. That tooth looks completely fake now, and I’m embarrassed when people see it. “I’ve started to intentionally not open my mouth wide in public. I cover my mouth when I laugh so that no one sees my teeth. Help!”
Solution: It sounds like you’re dealing with an aging restoration, specifically with a porcelain-fused-to-metal (PFM) dental crown. You can have the issue corrected by getting a new restoration. Unfortunately, the cap in your mouth now cannot be whitened or refreshed to look like it did when it was new.
No one wants fake-looking teeth, so in this article, you’ll learn about:
- Crown material options
- Benefits and drawbacks of each material
- How to find a dentist who can provide you with dental restorations that feature the best results and longevity.
What else causes darkness at the gumline?
The restoration is leaking. The cement that holds your restoration on is similar to tile grout. It is normally protected by the gums covering over the margin. ass the gums recede, the margin becomes exposed. This cement begins to wash out. As the margin seal leaks, it accumulates stains. These stains can be very dark.
If the porcelain overlying your tooth is too thin, the dark tooth underneath will show through. This especially common when the tooth has had a root canal.
Why does your crown have metal in the first place?
Metal is a more durable material than ceramic, but ceramic looks like enamel. In fact, dentists use a shade guide to match it to the teeth that will reside on either side of a new restoration. The result is a seamless restoration, meaning that the new crown looks just like a natural tooth.
To get the benefits of metal’s strength and ceramic’s whiteness, a porcelain-fused-to-metal crown may be used. The problem is, most dentists design PFMs so that the porcelain does not extend to the very edge of the metal. If the gums are thin or recede the dark metal becomes obvious. As the edge or margin becomes more exposed, a dark line may show up at the gum line.
Types of Crowns
A dentist has many materials to choose from when designing restorations:
- PFM -porcelain fused to metal – usually base metal alloys
- Porcelain fused to gold – high noble alloys
- Dental implant – Zirconium is now used most frequently
- All-porcelain or ceramic crowns
- Gold (precious metal)
The material a dentist selects depends upon the patient’s goals and where the restoration will be located in the mouth. Generally, a front tooth crown is well served with all porcelain caps. Teeth that require more strength does well with PFMs. Both of these types o restorations are tooth colored, so the patient’s smile will retain its white beauty.
Back teeth, which have to endure 70 pounds of pressure per square inch when chewing, require a strong, sturdy material. Zirconia and all-metal crowns are preferred for back teeth. However, metal is dark and/or metallic, so it stands out against white, natural teeth.
Some people don’t mind having metallic restorations (like stainless steel crowns or gold alloy) on molars because they don’t show in the person’s smile. However, to maintain a natural-looking set of teeth throughout the mouth, zirconia provides durability similar to metal. But zirconia is white and reflective, so it looks like tooth enamel.
Are there alternatives for strong crowns for molars, besides those with metal?
Absolutely! There are two specific ways to create a strong dental restoration that does not reveal dark metal under the crown. One has to do with how a PFM is designed, the other is an alternative material.
A cosmetic and restorative dentist can eliminate the potential for a dark margin by:
- Using better quality porcelain and extending the porcelain to the margin
- Using zirconia which has no dark metal
What happens if the metal under crowns unseals from the natural tooth below?
Over time, all permanent crowns will degrade. Dental restorations can be designed to last a long time, especially with modern materials and processes. However, no dental restoration will last forever. In most cases,
- PFM crowns last 10 years esthetically and 20 years functionally
- All-porcelain crowns last an average of 15 years
- Metal caps last an average of 15 years
- Zirconia crowns can last a lifetime
- Gold crowns can last a lifetime and they are kinder to the opposing teeth
If you have a toothache on a crowned tooth or suspect that a restoration is failing, see your dentist immediately. A broken seal allows bacteria to infiltrate the tooth beneath the restoration. This can cause hidden cavities, which may grow rapidly in the dark, moist environment between the margin and the underlying tooth.
Left untreated, cavities beneath crowns can penetrate deep into a tooth, hurting the root. When this happens, the tooth may need a root canal or, in some cases, the tooth may require removal.
The Dental Ceramist’s Job
The best cosmetic dentists tend to partner with the best ceramists. They are technicians who work in a dental lab. The best ones work with fine porcelains and the highest quality dental materials. They have years of experience, in which time they’ve perfected the craft of layering ceramic so that looks tooth enamel.
Once a cosmetic dentist finds a ceramist to partner with, the dentist can offer gorgeous restorations to patients. You should know that when it comes to restorations, you will pay more for a great product. A master ceramist will invest in quality materials and spend more time making a restoration.
For cheaper restorations, a dentist may employ an overseas dental lab. You should beware of this. Many countries have unregulated labs. Chinese made crowns have been known to have harmful effects. With that said, some overseas dental labs are world-renown. Ask your dentist about the lab and ceramist he will use for your crown. If you don’t trust your dentist to work with a quality lab, then you may need to keep searching for a dentist.
How to Find a Dentist Who Can Correct Obvious Metal Under a Crown
With all you now know, it’s time to find a dentist who can transform your smile. Fortunately, you’re equipped with the knowledge to do so. For excellent looks in a dental crown and optimal life span, you need a talented, respected cosmetic dentist. It’s important to trust your dentist with your smile and oral health.
The training a dentist invests in greatly impacts the dental work he provides. Look for a dentist with training that involves many continuing education hours and hands-on courses. He or she will have the education to provide superior cosmetic smile makeovers. You should learn about a dentist’s training, experience, and other accolades on the about page of his or her website.
In addition, a dentist’s experience counts. When searching for a dentist who can deliver great crowns, you’ll learn a lot by exploring his or her before-and-after gallery. Usually a page on the dentist’s website, the gallery features actual cases the dentist completed. You can literally see the changes on the screen.
Learn if patients respect a dentist by reading his or her patient stories. You may find patient reviews on the dentist’s website. You can also just go to the Google Business page for a dentist or dental practice to see Google Reviews. Looking at Facebook and Yelp may also provide insight into what patients think about a dentist.
Once you’ve found a great cosmetic dentist, schedule a meeting to discuss your issues. While you’re at it, you may want to explore options in teeth whitening, porcelain veneers, adult braces, gum contouring, bonding, or tooth reshaping. Your dentist can combine any of these treatments in a smile makeover plan to give you your ideal smile.
Dr. James Fondriest has spent years developing his skill as a cosmetic dentist, as well as his eye for esthetics. He offers comprehensive restorative dental care. Dr. Fondriest is also known in professional circles as a speaker, educator, and author.
In addition to his extensive education, training, and experience in cosmetic and restorative dentistry, he’s a photographer. All of the images on his website were taken by him. If you look at these photographs, you will notice his talent and eye for detail.
If you’d like to schedule a time to talk with Dr. Fondriest about your smile, call his office. It’s located in Lake Forest, just outside of Chicago.