What to do for six front teeth crowns

I had 2 root canals on my front teeth last year (#9, #10) and need to get the crowns replaced now that the backs to the crowns came off during the root canals. I have decided I would like to get all of my 6 front teeth crowned at the same time. They actually are already crowned but the crowns are over 20 years old and I would like to make some changes to the shape and color of them.

I have had consults with 2 dentists and they were quite different. Dentist #1 insists that I need crown build ups for #9 & #10 because of the root canals and that possibly some of the other 4 may need build ups as well. Dentist #2 does not think build ups will be needed. They also differ in price, while I am not trying to be cheap I do not want to be taken either. I saw dentist #1 twice and he had to revise my ‘treatment plan’ cost because he left out a fee the first time. It was an $1800 fee for ‘customization’ — dentist #2 does not charge this fee. It that a common fee to have, I am suspicious of it because on the first visit he did not mention it, it was not until visit #2 when he realized I wanted to maybe round out the edges of my teeth that there was suddenly a fee. Dentist #2 suggested the rounding of the edges. Dentist #1 uses empress c! rowns, dentist #2 lets the lab pick the material based on my molds. De ntist #1 is much more expensive than #2 mainly because of the customization fee. So, I guess my questions are as follows: 1. what fees are standard for crowns (crown, crown build up, diagnostic cast) 2. should the dentist decide the material (empress, procera, etc) or the lab 3. does it matter what lab is used? #1 uses Williams Dental Lab in CA, while #2 uses Georgia Dental Labs) 4. On teeth that are already crowned is it typical to need to do a crown build up on them? 5. Is a customization fee normal? Thank you.
– Mitch from Georgia

Mitch,
There isn’t enough information for me to tell you if either of these dentists will do good work for you, but I’m getting negative vibes about both of them. The “customization” fee of dentist #1 really bothers me, because to me, every case where there are six crowns on the six front teeth should be customized. This after all is your smile and your personality. Was dentist #1 really thinking of just giving you a “one-size-fits-all” smile until you wanted to bring some personality into it?

A question you didn’t address is whether or not the appearance of this work matters to you. If you just want the teeth protected and it doesn’t matter if your smile looks real or fake, then I think you’re on the right track. But if you want this to look lifelike, then I think you need to seek out an expert cosmetic dentist. And I suspect that neither one of these dentists is an artist. Only about one out of every fifty dentists is. And once you’re in the hands of a dentist who is passionate about creating a beautiful smile for you,  he or she will start by asking questions about the kind of personality you want to project with your smile and exactly what customizations you will want – before they even start.

A real cosmetic dentist will insist on doing all-porcelain crowns on these teeth. Empress is one brand of all-porcelain. I’m not impressed with dentist #2 letting the lab choose the material for these six crowns. The choice of material can make a big difference in how the result looks, and there are different preparation requirements for different materials. The material needs to be chosen before you start. A good cosmetic dentist will have a definite opinion about what material works best in their hands and gives the most beautiful result for a particular case.

About the buildups – if they are needed, then you should go with the dentist who recommends them. If they aren’t then that isn’t necessary. I don’t know what to tell you on that one. For natural-looking all-porcelain crowns on these front teeth, it would be common to have a translucent or white fiberglass post and buildup in each of these teeth, if one hasn’t been done. And I can’t tell the quality of the dentist from the laboratory. Different dentists can use the same lab and get very different results. The lab will try to meet the dentist’s standards. An excellent cosmetic dentist does need an excellent cosmetic dental laboratory technician to produce beautiful results.

I hope this is helpful.