Q: Dr. Crapo: When I was a child I lived in a small town without a dentist. We had to go twenty miles to see one. It wasn’t a pleasant experience so if we had a toothache we’d wait till it was killing us before saying anything to our parents. Most of the time the dentist would just take a look and say “it’s gotta come out”. By the time I was a teenager my baby molars and some of my permanent ones had been pulled. After I got married I seemed to lose a tooth every year or two, until I finally needed dentures. At first, they fit okay. As time went by I had more trouble, till at last I couldn’t wear the lower denture. It wasn’t long before the upper wouldn’t stay in. That’s when I investigated implants. I had two implants put in which wasn’t enough but the implant dentist said I needed to see someone who could graft a large amount of bone in both my upper and lower jaw before more implants went in. He referred me to a great surgeon who did it all. His friend then put in the teeth that are now in place. Everything has been great and I’ve had compliments from a few dentists at the quality of the work done by these two doctors. My problem is that I’ve chipped two of the front teeth and it looks unsightly. Do my teeth have to be remade in order to fix the problem? Will I be without my teeth? Can they be repaired right in my mouth or do you send them to the lab? I want a good job but I don’t know what to do. Will they chip again once they’re fixed?
A: Your current problem suggests that the implant “roots” are strong enough for the teeth that were put in, but the porcelain teeth are not strong enough to withstand the grinding you’re doing. Your situation is reminiscent of a gentleman I saw who was constantly breaking his front teeth including the porcelain teeth on a bridge I had made for him. It was terribly frustrating for both him and me, especially because he had a bad gag reflex and couldn’t wear a guard to protect his teeth.
Fortunately, a new material appeared and I was able to prepare over the porcelain, a veneer made from this newer material that is tougher and harder than porcelain. Fortunately, a very strong bond can be created between the remaining porcelain and this new material. It has been in place for five years without any chipping or breakage – we’re both pleased. The technique is done right in the mouth, requires no local anesthetic and matches your porcelain teeth beautifully.