I had four porcelain-fused-to-metal crowns placed on my front teeth in 2018. They were long and prominent, but I liked my smile and was used to seeing it that way in photos.

In early 2024, I wanted to replace the crowns because I had whitened my teeth and the older crowns no longer matched. I consulted one cosmetic dentist but couldn’t afford the required advance payment. A second dentist recommended eight crowns instead of four because she felt four wouldn’t give me the result I wanted. I paid $900 for a wax-up but changed my mind before moving forward.

I finally decided to have my general dentist replace the four crowns. Unfortunately, I’ve never been happy with the result. The new crowns look too short compared with my old ones, and my smile doesn’t look like the smile I had for most of my life.

Nearly three years later, this still bothers me. I would like to know whether it makes sense to pursue another set of crowns with a cosmetic dentist or whether I should leave them alone. – Thanks. Yadi from Chicago

 

Yadi,

A complete cosmetic plan before whitening would have given you a clearer idea of what to expect. KöR whitening can lighten natural teeth, but it cannot change the color of porcelain crowns. With four older crowns on your front teeth, whitening the surrounding natural teeth could make those crowns stand out more.

Ideally, the discussion before whitening would include the effects on your crowns and natural teeth. When the work involves the front teeth that show when you smile, it is often better to wait rather than choose a less expensive option that requires significant cosmetic compromises.

Why Might a Dentist Recommend Replacing Eight Crowns?

The dentist likely believed that treating eight teeth would give her better control over your smile’s appearance. Cosmetic dentists do not always agree on exactly how many teeth need treatment, even when both are experienced.

One dentist might feel that four crowns could produce an attractive result but with certain limitations. Another may believe that eight teeth need treatment to achieve the proportions, color, symmetry, and overall appearance expected from the case.

What matters is whether the dentist can explain:

• What can realistically be accomplished with four crowns
• What additional cosmetic benefit you would gain with eight crowns
• Whether your desired tooth length can be achieved
• What compromises, if any, you would make by treating fewer teeth

You were accustomed to a particular smile for many years, including longer and more prominent front teeth. Wanting the replacement crowns to preserve those characteristics is a legitimate cosmetic concern. Before having the crowns redone again, ensure you and the dentist clearly agree on the intended length, shape, and overall appearance.

Brian LeSage, DDS, an accredited fellow of cosmetic dentistry in Beverly Hills, sponsors this post. Read how his training and education have helped him provide some of the best cosmetic dentistry in Beverly Hills.