All-Ceramic Crown Redo and Veneers for Softer, More Feminine Front Teeth

Hello. I am Park Jonguk, DDS, MS of Dream Dental Clinic, and I have provided esthetic treatment in Apgujeong for 20 years.

Today, I would like to share a special case in which an all-ceramic crown redo and veneers were performed together.

One front tooth with a crown, and the others natural teeth

This patient was a woman, and of her 4 front teeth, one had an all-ceramic crown while the other 3 were natural teeth.

The problem was that the teeth looked too masculine and were dark.

The patient said, "I feel stressed because my teeth look bulky and masculine," and added, "I want brighter, more feminine-looking teeth."

The existing crown was dark in color and bulky in shape.

The 3 natural teeth were also dark, and their size and shape looked masculine.

We therefore decided to redo the 1 crown and place veneers on the 3 natural teeth, treating all 4 together.

Before treatment: masculine-looking, dark teeth

Figure 1 shows the teeth before treatment.

The overall tooth shade is dark.

The teeth look masculine because their shape is bulky and broad.

The existing crown also looks unnatural and does not blend with the surrounding teeth.

Although the patient was a woman, she was concerned that her teeth gave her a strong impression.

Designing a feminine appearance with a wax-up

Figures 2 and 3 show the detailed diagnostic wax-up process.

We redesigned the size and shape of the teeth to look feminine and refined.

We slightly reduced the tooth width and made the curves soft and elegant.

The tooth edges were also designed with rounded, feminine lines.

We planned a bright shade, but rather than making it simply white, we designed it to have translucency and depth.

After seeing the wax-up model, the patient was delighted and said, "At last, I can have feminine-looking teeth."

Crown removal and tooth reduction

Figure 4 shows the crown removal and tooth reduction process for the veneers.

We carefully removed the existing all-ceramic crown.

After the crown was removed, discoloration of the tooth became visible.

The tooth was darkly discolored, and the problem was that whitening was not possible because there was a post inside it.

When a post is present, conventional whitening does not improve the color.

The discoloration therefore had to be masked with a crown.

The other 3 natural teeth received minimal tooth reduction for veneers.

Using a microscope, we precisely reduced the front teeth by only about 0.3-0.5mm.

The adjacent tooth was treated with a no-prep approach.

Fabrication stage: the secret of shade matching

Figures 5, 6, and 7 show the fabricated veneers and all-ceramic crown.

There is an important point here.

Only the crown was fabricated in a slightly darker shade.

Why was that?

There is a reason.

When a veneer is bonded to a natural tooth, the color of the natural tooth shows through.

Because a veneer is thin (0.3-0.5mm), some of the underlying tooth color shows through.

Therefore, even if the veneer itself is made slightly brighter, once it is bonded to the tooth, its shade blends with the color underneath and appears natural.

A crown, however, is different.

Because a crown fully covers the tooth, the underlying tooth color does not show through.

A discolored tooth, especially one like the tooth in this case, must be masked completely.

The crown itself therefore needs to be made slightly darker so that its shade resembles that of the teeth with veneers.

This must be anticipated in advance, and the crown and veneers need to be fabricated in different shades.

This kind of detailed calculation produces a natural-looking result.

At less experienced clinics, this difference is often not anticipated, so the shades of the crown and veneers may not match.

This is expertise built through treating numerous cases over 20 years.

After treatment: brighter and more feminine

Figures 8, 9, and 10 show the teeth after treatment.

It is a truly remarkable change.

A bright, luminous shade

The formerly dark tooth shade became bright and luminous.

But the teeth are not simply white.

They retain translucency and look natural and beautiful.

The translucency at the tooth edges, subtle shade changes from the cervical area to the incisal edge, and depth that varies with the light were all reproduced.

A feminine shape

The formerly bulky tooth shapes became refined and elegant.

The tooth width was adjusted appropriately, and the curves are soft and feminine.

The tooth edges also form rounded, beautiful lines.

Perfect shade matching

Most importantly, the shades of the crown and veneers match perfectly.

It is impossible to tell which is the crown and which are the veneers.

The advance calculation to make the crown slightly darker proved exactly right.

The 4 teeth harmonize perfectly, as though they had always looked this way.

Patient satisfaction

When the patient looked in the mirror, she was delighted and said, "At last, I have a feminine smile."

She said, "Now that my teeth are brighter, my whole face looks brighter, and I look 10 years younger."

The secret to combining crowns and veneers

When crowns and veneers are treated together, shade calculation is extremely important.

Many people overlook this point.

Characteristics of veneers

Because veneers are thin, the color of the underlying teeth shows through.

The shade of a veneer itself therefore differs from its final shade.

Characteristics of crowns

Because a crown completely covers the tooth, the shade of the crown itself becomes the final shade.

The secret of shade adjustment

To achieve the same final shade, the crowns and veneers therefore need to be fabricated in different shades.

If this subtle difference is not calculated, the crown alone may appear noticeably brighter or darker.

This aspect requires experience and expertise.

The importance of manual buildup

This case was also fabricated by hand using a multilayer buildup (multi-layer stacking technique).

This technique builds up several layers of ceramic.

The dentin, enamel, and translucent layers are built up with different ceramics to reproduce the structure of a natural tooth.

This is necessary to achieve a natural, beautiful result while retaining translucency.

A single block used in a same-day approach cannot reproduce this complex shade calculation and translucency.

For feminine-looking teeth, shape matters

Will simply brightening the teeth make them look feminine?

No.

Shape is more important.

Tooth width, curves, proportions, and surface characteristics all contribute to a feminine appearance.

Bulky, broad teeth look masculine no matter how bright they are.

Refined, elegant curves, appropriate dimensions, and soft lines create a feminine appearance.

In this case as well, we completely redesigned not only the shade but also the shape to create a feminine appearance.

Treating teeth together can help even when only one tooth is a problem

Many people ask, "Only one tooth is a problem. Do the other teeth need treatment too?"

We could have redone just the 1 crown in this case.

However, the color and shape of the other 3 teeth were also unsatisfactory.

Treating all 4 together enabled us to achieve a much more beautiful result.

We could establish overall harmony and balance and also match the shades perfectly.

Esthetic treatment is about creating an overall smile, not treating an individual tooth in isolation.

Frequently Asked Questions (Q&A)

Q1. If a crown and veneers are placed together, will their shades mismatch?

A. With insufficient experience, the shades may not match. However, by accounting for the translucency of veneers and adjusting the crown shade, they can be matched perfectly. This is the difference experience makes.

Q2. Can a tooth with a post also be brightened?

A. When a post is present, conventional whitening will not work, but covering the tooth with an all-ceramic crown can make it perfectly bright. The discoloration can be masked completely, and the desired shade can be achieved.

Q3. Can masculine-looking teeth be changed to look feminine?

A. Yes, they can. By redesigning not only the shade but also the width, length, curves, and proportions of the teeth, feminine-looking teeth can be created. Shape design is extremely important.

This article is based on the clinical experience of a dentist who has provided esthetic treatment in Apgujeong for 20 years. He teaches all-ceramic crown and veneer techniques to dentists every month at Lamista Academy and has published Korea's first textbook on veneers.