I have monolithic zirconia crowns on all my upper front teeth. I wasn’t aware that they would look so solid white and fake. My bigger concern is that my upper lip now seems to protrude.

I’ve talked with dentists who are willing to replace the crowns, but I’m not sure whether changing to a different crown material would make a noticeable difference. One dentist commented on my protruding lips, and that made me more self-conscious about how I look.

I’m also worried because I’ve read that removing zirconia crowns can be challenging. I don’t want to risk creating new dental problems or spending a lot of money and still be unhappy with the results. Would replacing these crowns with a different material help? – Kellie from NJ

Kellie,

The challenge comes when zirconia is used on teeth that show prominently in the smile. Natural teeth contain gradations of color and translucency that are difficult to duplicate with a crown milled from a solid block.

Would a Different Type of Crown Make A Difference?

Using a non-zirconia restoration designed for better aesthetics could make a significant difference. The problem isn’t simply that the existing crowns are made of zirconia; it is that they are monolithic zirconia rather than zirconia layered with porcelain.

With layered zirconia, a laboratory technician applies porcelain over the zirconia framework as a paste and then fires it. This allows a talented technician to incorporate different shades, translucencies, and other subtle characteristics found in natural teeth. The finished crown can look so natural that most people won’t recognize it as a crown.

Is the Crown Material Causing Your Upper Lip to Protrude?

The crown material alone probably isn’t responsible for the change in the upper lip. The position and contour of the crowns are more likely contributing to that concern.

When every upper front tooth is crowned, planning becomes more complicated. Several details must work together for a natural-looking result. These include:

• How far forward the facial surfaces of the crowns sit.
• The thickness and contours of each crown.
• The relationship between the crowns and the upper lip.
• The shape, proportions, color, and translucency of the teeth.
• How all the crowns work together as part of the overall smile.

With one or two crowns, neighboring natural teeth help guide the position and shape. When all the front teeth have crowns, recreating those relationships requires more advanced cosmetic planning.

How Can You Find a Dentist to Replace the Crowns?

Seek a dentist with considerable experience in complex cosmetic cases involving multiple front teeth. Accreditation by the American Academy of Cosmetic Dentistry is one excellent way to identify this level of training.

AACD accreditation requires dentists to pass demanding written and clinical examinations demonstrating both technical knowledge and artistic ability. Not every excellent cosmetic dentist pursues accreditation, though, so we wouldn’t consider it the only measure of a dentist’s skill and talent.

Also, ask to see before-and-after photographs of patients who had similar work. A dentist considering replacement of all the upper front crowns should be able to show examples demonstrating natural color, shape, proportion, and smile design.

Should Cost Influence Your Decision?

Cost matters, but be careful not to make it the deciding factor for a case this visible and extensive. Some excellent cosmetic dentists charge high fees, while others charge fees comparable to those of other dentists in their communities.

Quality cosmetic dentistry does require an investment in excellent materials and laboratory work, along with the dentist’s time and expertise. With front crowns, focus on finding someone who can create the result you want, then discuss the cost.

Brian LeSage, DDS, an accredited fellow of cosmetic dentistry in Beverly Hills, sponsors this post. Read why his patients say he is the best cosmetic dentist in Beverly Hills.