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Ask Joshua Bednar Your Own Question
Joshua Bednar
Joshua Bednar, Dentist (DDS or equivalent)
Category: Dental
Satisfied Customers: 2
Experience:  Oral & Maxillofacial Surgery Resident at Mayo Clinic
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I would prefer doing a paid phone consult, ASAP, if

Customer Question

I would prefer doing a paid phone consult, ASAP, if possible.  But, if not, I can also do a chat.  Please let me know either way. Thanks.

Jon

Submitted: 2 months ago.
Category: Dental
Expert:  JACUSTOMER-dgtzb6ku- replied 2 months ago.

Hello

This is Dr. Bonilla. I understand your concerns.

I can help you with the phone consult.

Customer: replied 2 months ago.

Dr. Bonilla,

Please OPT OUT of my DENTAL CROWN question, ASAP. I need to chat with a DENTAL CROWN EXPERT, ASAP and you have kept my question from being answered for 5 days. Thank you.

Jon

Expert:  Stewart Shernan replied 2 months ago.

Hello there,

I'd be happy to try to help you via online chat if you'd like. I have thirty+ years experience constructing crowns and delivering dental care in many areas.

What is your question ?

Dr Shernan

Customer: replied 2 months ago.
Relist: I still need help.
Expert:  Stewart Shernan replied 2 months ago.

Hello again -

If you'd like I'll try and answer your question. What do you wish to know ?

Dr Shernan

Customer: replied 2 months ago.
Relist: I still need help.
Expert:  Joshua Bednar replied 2 months ago.

Hello Jon,

I am happy to try and answer your question. I am unable to do a call, but I am happy to try and assist you over online chat.

Please let me know. Thanks.

Dr. Bednar

Customer: replied 2 months ago.

Hi, Dr. Bednar

Thank you very much for your very prompt response. I definitely have some new urgent dental questions to ask you.

First, I am a 66yo M who, approx six years ago, was diagnosed with at least two very rare and potentially very serious chronic medical conditions (including a blood disorder and bilateral posterior ethmoid sinusitis.) Additionally, I have persistant low IgM and am currently being evaluted by an allergist/ immunologist for likely immunodeficiency.

I was, therefore, advised to be very cautious regarding infectious diseases. And, in that regard, when I needed dental work, I chose to have it performed by a dental specialist-- who claimed to exercise a much higher level of care with his dental patients.

However, when, approx five yrs ago, he performed two e.Max crowns (#14 and #19) and a porcelain inlay (#15), I immediately after developed several seconds of "cold sensitivity" in that area of my mouth that continued for more than a year despite using Sensodyne toothpaste twice a day. And, upon thorough evalution by an endodontist, it was determined that the "cold sensitivity" was being caused by the inlay (apparently not fitting completely "right.")

Anyway, the dental specialist said that there was nothing to do about it, and, since I rarely drink cold beverages or eat cold food, I was able to forget about it...

..that is, until now. Because ten weeks ago, although it felt "fine," I let the dental specialist do a crown prep on #18 to replace a gold crown that he claimed had "stickiness" around the margin and likely had decay inside. And, due to my age and serious medical conditions, I decided that it would be better to do it "sooner than later."

However, although he promised to be able to at least temporarily cement on the permanent crown two weeks after the prep, as soon as he completed the prep (and I was getting out of the chair), I was told by the dental specialist's dental assistant, that the dental specialist had no openings for at least six weeks.

As a result, I wasn't able to return for 7 weeks to get my permanent gold crown and when he put it in my mouth, it was very "high." I wasn't surprised, because it seemed as if my teeth had shifted during those 7 weeks as a result of wearing a LOW temporary crown that entire time.

And, as I expected, while attempting to make the new gold crown fit, the prosthodontist perforated the top. And, then said that, rather than do a NEW impression, he was going to send it back to the lab to have it "soldered." I did speak with him again the following week to discuss that, and he claimed that he would be having a NEW crown made at the lab-- but, that it would be made from the then 8 week old impression. (He again refused my request that a NEW impression be made.)

And, now I'm scheduled to have that "new" gold crown (based on the initial 10 week old impression) cemented next Monday by the dental specialist.

MY KEY QUESTIONS:

1) Especially since the new gold crown is on my #18 tooth and is directly below my "problematic" #15 inlay, and also since it has now been TEN WEEKS since my crown prep and initial impression were made, and also since I had been wearing a LOW temporary crown for that entire time (and it felt as if my teeth had been "shifting"), and, the permanent gold crown made from that initial impression was "so high that he perforated the top while trying to make it fit," shouldn't the dental specialist be making a NEW impression now (instead of trying to permanently cement either a "remanufactured" gold crown" or NEW gold crown based on my initial impression)?

2) And, if so, is there some basic "rule of good dentistry" to which I can refer to get this dental specialist "do the right thing?"

3) If you were me, would you absolutely refuse to let him try to fit and then cement the "new" gold crown based on the 10 week old impression and instead DEMAND that the dental specialist either immediately make a NEW impression (to be sent to the lab for a NEW gold crown) or else choose to find another dentist who will do so?

4) In that regard, shouldn't the dental specialist, with his "higher level of care" claim, WANT to make a NEW impression to make sure that he gets the higher quality fit for the crown (that he quaranteed to me)?

My apologies for so much detail. But, in this case, I believe that it's critical for you to know.

Thanks in advance for your prompt response. Sincerely,

Jon

P.S. I realize that there is a possibility that a NEW gold crown based on the initial impression could be "made to fit." But, it would seem that, even if he were able to do so without perforating it again, he would again thin out the top of the gold crown to the point of weakening the structure-- which is not good dentistry-- and certainly not good specialty dentistry.

Expert:  Joshua Bednar replied 2 months ago.

Jon, I am sorry I did not answer sooner. Somehow I didn't see a notification that you replied to the message. Anyway, this is clearly a complex case and difficult to assess from a distance, but I think you have a couple options. Regarding a "rule of good dentistry", there is nothing of that nature. Dentistry is an autonomous profession and the licensed dentist will make recommendations that he believes is in your best interest. You, as a patient, also have the right to disagree with the dentist and to seek a second opinion elsewhere. I suspect that is what you are doing with your question on this forum. You question, however, would be best answered by a live, second opinion, with a local dentist or prosthodontist (crown specialist).

It is difficult to say if the treatment he is offering and suggesting is the best for you. Yes, your tooth could have shifted during the time but significant movement in that short period of time is unlikely. Unlikely, doesn't mean it didn't happen. The only way for me to be certain would be for me to exam you and your impression/dental cast. Therefore, if you want a second opinion and do not feel comfortable with the treatment offered by your dental specialist, I would seek out another specialist in your area. Specifically, a prosthodonist would have the most training and experience with dental crowns if you are looking for someone with the most training. I hope this helped answer your question. Please let me know if there is anything else I can do.

-Dr. Bednar

Expert:  Joshua Bednar replied 2 months ago.

I wish you the best.