Off to the dentist, YET again!

[BiC]

Over the last couple years, I had 2 crown lengthening surgeries and 2 crowns. Well, this evening I broke off about 1/3 of a crown.

 

Thank God it doesn't hurt since I had a root canal on the tooth. BUT, I'm going to have FUN with them trying to remove the rest of the crown from my tooth since it is cemented on!

 

Did anybody ever go through this? What did they do to fix you up?

 

My guess is that they will simply drill the crown away, but I don't know. It figures this would happen at the start of a 4 day weekend!

 

Peace

[spiral light]

Originally posted by BiC:

Over the last couple years, I had 2 crown lengthening surgeries and 2 crowns. Well, this evening I broke off about 1/3 of a crown.

 

Thank God it doesn't hurt since I had a root canal on the tooth. BUT, I'm going to have FUN with them trying to remove the rest of the crown from my tooth since it is cemented on!

 

Did anybody ever go through this? What did they do to fix you up?

 

My guess is that they will simply drill the crown away, but I don't know. It figures this would happen at the start of a 4 day weekend!

 

Peace

Oy! I'd better watch myself, I have 2 new(ish) crowns that I don't to mess with. One thing I would do if I could turn back the clock is take better care of my teeth.

[Mudcat]

Don't be surprised if they are able to pop the rest of the crown right off, no fuss, no muss (and no pain either!).

 

I once had to have a crown reset and they were able pull it off with very little effort.

 

Good luck!

[Base]

Hey, at least you're in the UK (our dental rep is undeserved!)

 

I've been 5 times this year, due to a tooth crubling after not going for 10 years (ok, I'm still scared of them!!!), but it was relatively pain free, don't think it was anything as elaborate as you are having tho BiC!!!

[blurry6]

I actually sell Dental Supplies in my day job, so I happen to know a lot about dentistry and dental procedures,...since the tooth is not vital (no root),...pain will not be much of an issue unless they have to use a bur (drill) to remove what's left of the crown - even in that case they might 'try' to do it sans-anesthetic, but if you have some discomfort, they'll knock it out with a carpule or two to numb you up.

 

The latest dental adhesives are VERY strong - the failures occur more often in the crown breaking,...the tooth breaking,...and finally the adhesive.

 

Sounds like you have a porcelain crown or porcelain-fused-to-metal (PFM in dental lingo). Some of the newer crowns are quite good and come with a coping material already (procera, and lava being some of the newest and most widely accepted). However, while strong, they are more susceptable to cracking and breaking than the good ol' 'gold crown' which sucks aesthetically, but is hard to beat in terms of longevity and wear...

 

If the crown is going in on a back molar (posterior tooth) or somewhere it's hard to see I'd recommend going with a gold crown,...but if it's an anterior tooth (front tooth), you'll definately want to go with a nice lab-shaded porcelain type of a crown. if you do go porcelain, and you're a 'grinder' i.e. you grind your teeth in your sleep, you should have the Dr. talk to you about a night-guard,...kind of a pain, but worth it if you crack these puppies too often ($$$)...

[MadStrum]

Hey BiC,

 

Just went to the dentist, but not to do anything like what you described.

Removed a wisdom tooth, and the removal was pretty painless. It was after about 3-4 hours that I started having the chills.. and it hurt for 3-4 days afterwards.

 

Pier.

[Teahead]

I feel for you Bic! I smashed half off my front teeth when I was twelve years old. I've spent almost as much time in the dentists chair as I have in this computer seat!

 

My liking for sweet foods has done nothing to strengthen the rest of my teeth either, I have more fillings than I'd care to admit.

 

Just think how lucky you are this didn't happen tomorrow? When you wouldn't have gotten a dentist until Tuesday, because of the Bank Holiday.

 

Best wishes.

 

Tea.

[BiC]

Originally posted by blurry6:

I actually sell Dental Supplies in my day job, so I happen to know a lot about dentistry and dental procedures,...since the tooth is not vital (no root),...pain will not be much of an issue unless they have to use a bur (drill) to remove what's left of the crown - even in that case they might 'try' to do it sans-anesthetic, but if you have some discomfort, they'll knock it out with a carpule or two to numb you up.

 

The latest dental adhesives are VERY strong - the failures occur more often in the crown breaking,...the tooth breaking,...and finally the adhesive.

 

Sounds like you have a porcelain crown or porcelain-fused-to-metal (PFM in dental lingo). Some of the newer crowns are quite good and come with a coping material already (procera, and lava being some of the newest and most widely accepted). However, while strong, they are more susceptable to cracking and breaking than the good ol' 'gold crown' which sucks aesthetically, but is hard to beat in terms of longevity and wear...

 

If the crown is going in on a back molar (posterior tooth) or somewhere it's hard to see I'd recommend going with a gold crown,...but if it's an anterior tooth (front tooth), you'll definately want to go with a nice lab-shaded porcelain type of a crown. if you do go porcelain, and you're a 'grinder' i.e. you grind your teeth in your sleep, you should have the Dr. talk to you about a night-guard,...kind of a pain, but worth it if you crack these puppies too often ($$$)...

Yes, It is a PFM crown. It's my upper left tooth, 3rd from the rear- including my wisdom. Of course as you know, the metal is on the inside. About 1/4 of the porcelain broke off. I have an appt. set up for Thursday. Here is what my dentist had to say,

 

My first impression over what you have described is that some of the porcelain has cleaved. As most of the strength comes from the metal substructure, the integrity of the crown will not be compromised. Let's get you in next week sometime to have a look.

We'll see how it goes!

 

Peace

[BiC]

Oh yeah, since I'm in the Air Force, all the work done is FREE .

 

Thank God, or I would be a broke puppy with everything I've been through!

[blurry6]

Yes, It is a PFM crown. It's my upper left tooth, 3rd from the rear- including my wisdom. Of course as you know, the metal is on the inside. About 1/4 of the porcelain broke off. I have an appt. set up for Thursday. Here is what my dentist had to say,

 

My first impression over what you have described is that some of the porcelain has cleaved. As most of the strength comes from the metal substructure, the integrity of the crown will not be compromised. Let's get you in next week sometime to have a look.

We'll see how it goes!

 

Peace [/QB]

If that's the case (small portion of porcelain has broken off), than he might be able to repair it without having to take off the original restoration - it's all a matter of 'how much' broke off. I wouldn't worry about it,...it should be entirely pain-free. My question is, how did you break it?

[BiC]

Originally posted by blurry6:

Yes, It is a PFM crown. It's my upper left tooth, 3rd from the rear- including my wisdom. Of course as you know, the metal is on the inside. About 1/4 of the porcelain broke off. I have an appt. set up for Thursday. Here is what my dentist had to say,

 

My first impression over what you have described is that some of the porcelain has cleaved. As most of the strength comes from the metal substructure, the integrity of the crown will not be compromised. Let's get you in next week sometime to have a look.

We'll see how it goes!

 

Peace

If that's the case (small portion of porcelain has broken off), than he might be able to repair it without having to take off the original restoration - it's all a matter of 'how much' broke off. I wouldn't worry about it,...it should be entirely pain-free. My question is, how did you break it?[/QB]

I was simply eating peanut butter crackers when it broke. But I swear there was already a "hairline" crack in it. I could feel it with my tongue, and thought it was a crack but wasn't for sure. Nothing big though, but just enough to tell it wasn't smooth. Now, it's gone. So, that tells me that's where it broke off.

 

If I knock on the tooth itself, there is some sensitivity. This has always been since I had the crown. I had always thought that was from my crown lengthening surgery- tender gum/bone. But sometimes I wonder if they performed a thorough root canal. I swear, I have those teeth that are in the 3% category with extra canals. I've had at least 4 root canals. Everytime the dentist commented on the "extra" canals.

 

Furthermore, this crown is NOT seated firmly if you know what I mean. I can feel the edge of it on the inside of the tooth. My other crown is smooth/flush with my gum line all around. This one is not. It's as it I can get a grip on it with my fingernail, and pop it off. I don't think that's a good thing and will bring it to my dentist's attention on thursday, along with the sensitivity I am still experiencing.

 

Peace

[blurry6]

I was simply eating peanut butter crackers when it broke. But I swear there was already a "hairline" crack in it. I could feel it with my tongue, and thought it was a crack but wasn't for sure. Nothing big though, but just enough to tell it wasn't smooth. Now, it's gone. So, that tells me that's where it broke off.

 

If I knock on the tooth itself, there is some sensitivity. This has always been since I had the crown. I had always thought that was from my crown lengthening surgery- tender gum/bone. But sometimes I wonder if they performed a thorough root canal. I swear, I have those teeth that are in the 3% category with extra canals. I've had at least 4 root canals. Everytime the dentist commented on the "extra" canals.

 

Furthermore, this crown is NOT seated firmly if you know what I mean. I can feel the edge of it on the inside of the tooth. My other crown is smooth/flush with my gum line all around. This one is not. It's as it I can get a grip on it with my fingernail, and pop it off. I don't think that's a good thing and will bring it to my dentist's attention on thursday, along with the sensitivity I am still experiencing.

 

Peace [/QB]

I don't like to say this, but it kinda sounds like you have a shitty dentist,...Did 'this' Dentist do your root canal treatment, or were you refered to an endodontist (specialist),...? If your current dentist did the work (many of them do these procedures and most are quite adept at it, but many are not), I would make him aware of your concerns that this tooth remains sensitive, to this day.

 

The edge you describe on the crown that's bugging you is called an 'overhang' in dental lingo and is a hallmark of bad craftsmanship . Sounds like either he, or the lab, did a shoddy job of making sure the margin (the interface between the tooth and restoration) was accurate - ultimately, it's the dentists responsibility to insure the margin is tight. You should definately make the dentist aware of this, and that you're disatisfied with the restoration. If need be, you should have him do it again - for FREE! You paid for a quality restoration and that's what you want.

 

To show that you're not an uninformed clod, use phrases like, "I'm having touble with this crown you did, I don't think the 'margin' on this crown is accurate and I can feel the 'overhang' - what can you do about it?" Chances are, he'll want to go in with a bur and tighten it up so you won't have any more trouble - the easy solution. If this doesn't work for you, he OWES you a quality restoration with tight margins. It might require another crown procedure, but if I were you, I don't know if I'd let him do it, you might want to look into getting another dentist do the restoration and having the 1st guy pay for it...they hate doing this, but it happens more often than you think.

 

Unfortunately, all Dentist's aren't created equal. Some are truly gifted and very detail oriented types who demand perfection - GREAT dentists. Others have hands like hooves, and could care less whether their work is seen by other dentists, as long as their patient isn't complaining and they pay their bill - Shitty dentists.

[blurry6]

I have those teeth that are in the 3% category with extra canals. I've had at least 4 root canals. Everytime the dentist commented on the "extra" canals.

this isn't as uncommon as a lot of people think. In fact, 'extra canals' are pretty common. However, these extra canals DO make the endodontic procedure more tricky and are often beyond the capabilites of the 'general dentist' who dabbles in doing endodontics. The good dentist will know when to say something is beyond his capabilites and refer the patient to a specialist.

[BiC]

Thanx for your comments Blurry6! Unfortunately, because I'm in the military, I don't have much of a choice in choosing a dentist. All my dental work is free. I also wonder if the sensitivity is associated with my surgery since bone had to be cut away. I think I would be able to tell better if the crown was off my tooth.

 

I will definitely take your advice and use the lingo you gave.

 

If it were you, would you request that they drill the crown away, since they obviously cannot pop it off because of the cement?

 

Since changing dentists is not an option, how would you approach this?

 

Maybe x-rays will reveal if the tooth is still alive. Man, I hate the thought of going through this whole thing again. But, I'm a pretty tough patient since I've also been through reconstructive jaw surgery when I was a kid about 20 years ago.

 

Peace

[blurry6]

If it were you, would you request that they drill the crown away, since they obviously cannot pop it off because of the cement?

 

Since changing dentists is not an option, how would you approach this?

 

Maybe x-rays will reveal if the tooth is still alive. Man, I hate the thought of going through this whole thing again. But, I'm a pretty tough patient since I've also been through reconstructive jaw surgery when I was a kid about 20 years ago.

 

Ahhhhh,...you're in the military,...that makes a LOT of things clearer. I don't mean to imply that all dentists in the military are hacks, far from it, but the constraints with which the military allows them to perform procedures, or use newer materials IS an issue - they are wont to use 'proven' (read: older) types of procedures and materials.

 

This IS an interesting situation. Seeing how you're in the Military, and don't have the options a private citizen would have, I'm not sure what you can and can't do,...I guess the logical course of action would be to go to your Dr., make him aware of all your concerns (endo still sensitive, margin not tight etc.), and allow him the oppurtunity to address it. If he blows you off, or gives what YOU feel is a bullshit answer, you should try to find 'someone' there you can take this issue to: your C.O., his C.O., - someone that can address it, or grant you the option of seeing another dentist.

 

If it's something that you've been dealing with for a while, it's not likely to just go away - at some point it will need to be addressed.

 

As to allowing the Dr. to use a drill to adjust the current margin - yeah, I'd let him try it. These 'adjustments' are the norm, and usually take place when the crown is first seated,...but it sounds like your Dr. either didn't see the overhang (does he wear 'loopes' (little binocular-like eyeglasses) when he works), or doesn't really care. The danger with these adjustments is if they're too severe (require him to take off a LOT of the porcelain) it can weaken the restoration to the point of breaking (something you're already familiar with) and having to redo the restoration from scratch - if that's even possible.

 

Clinically, just knowing what I know about your current dental health, the worst case scenario is that he'll have to pull the tooth altogether and put in a 'bridge' (restoration that spans the missing tooth and both ends are cemented to the adjacent teeth) to allow you to keep at least the 'function' of having a tooth there. While a bridge is often required to address a restoration, in this case it's a total 'hack' solution - you should have been given a quality endodontic procedure and crown to begin with,...now the same idiot is going to be pulling this tooth out, and is going to have to drill on the adjacent (healthy) teeth to prepare them for a bridge placement. This is a viable solution, and will probably work out, but it is removing a LOT of healthy tooth structure and this, above all things, is the main concern of a quality dentist - cause no pain, and keep as much of the original tooth as possible.

 

If the Dr. starts talking about doing a 'bridge' on this tooth, it means he's screwed up and is unwilling to admit he botched the endo. This is when you should actively seek another, quality dentist. How you go about that within the Military, I don't know, but you should probably keep a diary of all the procedures and conversations you've had up to date with this Dr. so that when you do go to ask for assistance from your C.O. or his C.O. you have a documented record of all the that has taken place up to date. Whomever that may be, will need this kind of info. to be able to make it happen for you. You should definately let it be known that you are COMPLETELY unsatisfied with this Dr.'s abilities, and request to have another Dr. take over.

 

The ideal restoration in a case where the tooth needs to be removed (extracted) altogether is to put in an 'implant' (metal post that is drilled into and fixed to the bone) in the extraction-site. These are pretty common in the private sector, but I'm unsure as their use in the Military.

 

This guy's a hack,...find someone else, however that can be done. Best of luck. Let me know if you need anymore info.

 

blurry6

[Mike Gug]

Good luck BiC.

 

When I saw this post's title I immediately thought of how much I hate it when I have to pay a $350 co-pay. Of course when I write out that check, the first thing that runs through my head is, "CRAP!, I could be buying a (insert guitar or gear here) instead!!!"