Dear Dr Reitz: I just had some dental work done on my two front teeth - a veneer and crown. The dentist, in an effort to make the teeth even at the bottom, used a motorized dental file.
The problem is she doesn't have a steady hand and the teeth are somewhat jagged. While the average person can't tell, I can, and it is somewhat disconcerting. I paid a nice piece of change already, and I would like a more perfect look. Are there manual dental files available to gently file the teeth to remove the jagged edges? I don't want a dentist to use a motorized file, since it might make it worse. Or should I leave well enough alone? - B.R.
Dear B. R.: Without knowing what material was used to make your crown and veneer it is difficult to determine why the edges are jagged after the first adjustment. Porcelain crowns and veneers can be fabricated using various ceramic systems, each with a different hardness. Veneers are thin and gain strength from the underlying tooth, therefore they were traditionally made from feldspathic porcelain. Because crowns replace more of the original tooth, if feldspathic porcelain is used, a core of metal or zirconia is necessary to provide adequate strength.
Many dentists have switched to the newer lithium disilicate porcelain (trade name Emax) for both veneers and crowns. The lithium disilicate makes a harder veneer, however it can't be made as thin as feldspathic porcelain, therefore requiring more tooth reduction. Lithium disilicate also appears to be an ideal material for single crowns that does not require the underlying metal or zirconia.
Lithium disilicate is twice as hard as feldspathic porcelain, and I find it's less prone to chipping when adjusted. But being harder also makes it more difficult to adjust after being cemented onto the tooth.
One of my hobbies is building acoustic guitars, and there are times an electric tool would be too aggressive for the delicate modifications that are necessary. In those instances I rely on hand files and hand chisels.
But, unlike woodworking tools, powered dental drills are precision instruments and can very accurately make adjustments. There are special rubber wheels made to adjust porcelain that are used on rotary motorized dental drills. Just like sandpaper they are made in different grits, which affects how quickly porcelain is removed.
If the jagged appearance of your front restorations is a concern I would suggest you allow the dentist to make slight adjustments using a fine porcelain polishing wheel.
The Dentist's Chair appears Saturdays. The column is written by John Reitz, DDS, and does not represent the opinion of the Pennsylvania State Dental Board. Dr Reitz answers questions from readers. E-mail them via his website at reitzdds.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610.