I dated a woman once who, as a girl, had broken a front tooth. The dentist told her that he could do one crown, but it might look funny, because it might not match the other tooth perfectly. If he did two crowns, however, he could guarantee a perfect match. So she let him do two.
But, as we know, when teeth are restored, that is rarely the end of their story. She later needed these crowns replaced, so she had that done. And, it turns out that she was a strong clencher. When she was in her fifties, she broke the teeth off at the gumline. Now they needed root canal treatments, crown lengthening, and posts to help hold the teeth in. That held for a couple of years, and then they broke off again. She had moved, so she went to another dentist who did more crown lengthening. The last I heard from her, she still had some problems with these front teeth and her dentist was talking to her about having implants in the front.
I am opposed to doing front teeth that way. And here is a suggestion for dentists who are inclined to cut corners and don’t want to spend that extra time to get that perfect match of a single crown on a front tooth but don’t want to risk what happened to this woman. When you need do a single front tooth, ask your patient this question: “There are two ways I can get these front teeth to match perfectly. One would be to do two crowns. Now I charge $1000 apiece for crowns, so that would be $2000. Or, I can do one crown, and have you keep coming back to the office until we get the shade perfect, but for all that extra work, I will need to charge you $2000 for that single crown. Which would you rather do?”
I’ll guarantee you that the overwhelming majority of patients will choose to pay double for the one crown than have you cut down a perfectly healthy tooth.
But it doesn’t need to be double. When I was practicing, I told people I would need to charge 50% extra for that perfect match of a single central incisor, and every single patient willingly agreed to the extra fee, and I didn’t have to threaten to do the second crown as an alternative. This enabled me to practice conservative dentistry and to be compensated adequately for my time.
And the way I handled those appointments was, I started with the crown prep appointment. Then, when the case was back from the lab, we did a “try-in.” This was scheduled mostly with the assistant, who would remove the temporary, try on the crown with try-in paste, look at the teeth with the patient, and form an opinion. I would then come into the operatory for about five minutes while I was waiting for someone to get numb or waiting for an impression to set or something else, assess the color, take any necessary photographs to assist the lab technician, and write the prescription for the tinting that was needed. We would not schedule the appointment for the crown seat until we had a successful try-in. This kept us from wasting chair time.