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Medical Forum / General / Dentistry / June 2008Metal Backed Crowns - darkness falls!!!
My girlfriend has several crowns on her front teeth that were done some time ago. They are metal lined crowns and have started showing the dark edge around the base of the crown from the metal lining. Several of these are on front teeth and she's concerned about the appearance so she has gotten an estimate on replacing 4 crowns and adding the same white material on her other teeth to match. This came in (after insurance) at around $10,000. We were wondering if anyone knew of any other options for her as I am sure she is not the first one to have this issue and also not the first one to not have $10K sitting around for some detal upgrades. Any help would be greatly appreicated. > My girlfriend has several crowns on her front teeth that were done > some time ago. They are metal lined crowns and have started showing [quoted text clipped - 8 lines] > > Any help would be greatly appreicated. On front teeth, esp. when the gum edge is thin, there is almost always some gum recession--eventually. This may not be an issue if there is a low lip line (ie: the gumline doesn't show during smiling). But the edge will show eventually, even if you have to raise up the lip to do it. If all-ceramic crowns are made (or porcelain/metal with a porcelain margin) the edge will still show eventually, though obviously it won't show as much as a metal margin. I have not seen any material that can be successfully bonded over exposed metal margins, and roughness of some of the resins will attract plaque and encourage further gum recession. Remember that the esthetic issue is whether anyone else will see it; you may find that only some of the crowns will show the gumline when she smiles, so you may be able to redo only some of the crowns selectively. BTW, how many teeth are involved here? Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >If all-ceramic crowns are made (or porcelain/metal with a porcelain margin) the edge will still show eventually, though obviously it won't show as much as a metal margin. I would assume that the gray/dark metal color would not be there and that is the main visible detriment. >I have not seen any material that can be successfully bonded over exposed metal margins, and roughness of some of the resins will attract plaque and encourage further gum recession. So White-Out won't last? (Hey, got to keep a sense of humor with this). >Remember that the esthetic issue is whether anyone else will see it; you may find that only some of the crowns will show the gumline when she smiles, so you may be able to redo only some of the crowns selectively. Actually we bought a new makeup mirror and it has a really high magnification on one side. We set it up, she turned on the light and was set back seeing the metal on her crowns. Until she got the close up mirror she never noticed it. I did but to my it's not a major thing. >BTW, how many teeth are involved here? Six from what she said. >> If all-ceramic crowns are made (or porcelain/metal with a porcelain margin) the edge will still show eventually, though obviously it won't show as much as a metal margin. > [quoted text clipped - 17 lines] > > Six from what she said. $10K after insurance? I assume the insurance is only paying a fraction. Make sure they all really have to be done. However, mixing all-ceramic with porcelain/metal will compromise the esthetic result. Since this seems to be the motivation for replacing the crowns, you may have no viable alternative to replacing all the crowns. Sorry, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > $10K after insurance? I assume the insurance is only paying a fraction. I don't think they're paying anything for the cosmetic stuff. Most insurances are so tight lately that if it's not some medically required thing they don't want to touch it. She got these 20 years ago so not sure if she could squeeze any way to say they need replacing, then she could just cover the difference between the ceramic and the metal and the insurance company might cover the rest. Just a thought. > Make sure they all really have to be done. However, mixing all-ceramic with porcelain/metal will compromise the esthetic result. Since this seems to be the motivation for replacing the crowns, you may have no viable alternative to replacing all the crowns. Thanks for the help and it's nice to get the view from the other side of the chair. I am sure if she does it at all she will get them all done. She's not the type person to do something part way. >She got these 20 years >ago so not sure if she could squeeze any way to say they need >replacing, Decay or fracture is a reason for replacing. Esthetics is not. According to the ins co at least. >then she could just cover the difference between the >ceramic and the metal and the insurance company might cover the rest. Chances are slim and none. Max dental coverage hasn't changed much in 20+ years. $1,000 - 1,500 And ins co *at best* only pays 50% for a crown. >Just a thought. 10K still sounds pricey to me. Are we talking implants ? Or just crown replacement ? >>Or just crown replacement ? Just crown replacements. She was told they would last for 25 years or so and it's been 20 years so she was wondering if there was any way to check the intergrity of the existing crowns. At least that way if she needed them replaced soon she could do it, let the insurance company pick up the cost of the metal crowns and then she pick up the difference between that and the white. Partial help beats no help. :O/ Without interferring with the night-time isometric-bruxism, the problem will re-appear after a while >>>Or just crown replacement ? > [quoted text clipped - 5 lines] > difference between that and the white. Partial help beats no > help. :O/ >>BTW, how many teeth are involved here? > >Six from what she said. For 10K ? Pretty steep in my neck of the woods for just crown replacements. Are other services required such as RCT, Posts, etc... ? > For 10K ? > Pretty steep in my neck of the woods for just crown replacements. > Are other services required such as RCT, Posts, etc... ? Nope, just replacing crowns and I think doing some enamal work on some mating teeth so the color will match. You think we should get a second opinion (or quote)? Sounds a little steep to me too, but certain suburbs have fancy offices and large overhead (and dentists who make millions instead of thousands<G>). Getting the cheapest deal is probably not a good idea either. Making 6 anterior crowns really look beautiful isn't easy, but it isn't magic either. Around Kansas City, 6K would be reasonable (but some would be great looking, and some would not). JMO, Steve >>For 10K ? >>Pretty steep in my neck of the woods for just crown replacements. [quoted text clipped - 3 lines] > mating teeth so the color will match. You think we should get a > second opinion (or quote)? >> For 10K ? >> Pretty steep in my neck of the woods for just crown replacements. [quoted text clipped - 3 lines] >mating teeth so the color will match. You think we should get a >second opinion (or quote)? If in doubt get a second or even third opinion. Also, do the prices that dentist's charge for this type work vary much from dentist to dentist or is it pretty much typical? We're trying to determine if it's worth getting a second opinion. Thanks! >Also, do the prices that dentist's charge for this type work vary much >from dentist to dentist or is it pretty much typical? We're trying to >determine if it's worth getting a second opinion. > >Thanks! When in doubt, it is always worth getting a second opinion. And sometimes a third or fourth. My Suburban Detroit office charge $1K for a single crown (no work needed under the crown). The Northern Michigan office I am at charges $685 for the same thing. NYC and LA charge a lot more. Rural Kentucky is probably a bit less. > Also, do the prices that dentist's charge for this type work vary much > from dentist to dentist or is it pretty much typical? We're trying to > determine if it's worth getting a second opinion. > > Thanks! > My Suburban Detroit office charge $1K for a single crown (no work needed > under the crown). The Northern Michigan office I am at charges $685 for the > same thing. > > NYC and LA charge a lot more. Rural Kentucky is probably a bit less. Time to raise my fees, I guess. Steve >> Also, do the prices that dentist's charge for this type work vary much >> from dentist to dentist or is it pretty much typical? We're trying to >> determine if it's worth getting a second opinion. >> >> Thanks! TFO causing recession,,,,,,,,,,, needs an NTI >> My girlfriend has several crowns on her front teeth that were done >> some time ago. They are metal lined crowns and have started showing [quoted text clipped - 25 lines] > > Steve |
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