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Mark Bornfeld
Mark Bornfeld, Dentist (DDS)
Category: Health
Satisfied Customers: 5721
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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What does a dentist do if my crown doesnt fit

Resolved Question:

I may have a crown that doesn't fit. I will determine that with my dentist. I am interested to know what is typically done if a crown doesn't fit, after all the adjustments possible have been made? How do they take off a crown that is permanently cemented to the remaining tooth underneath?
Submitted: 6 years ago.
Category: Health
Expert:  Family Physician replied 6 years ago.
When did you initially have this tooth crowned?
Customer: replied 6 years ago.
Reply to Family Physician's Post: The tooth was originally crowned in early June.
Expert:  Family Physician replied 6 years ago.
And you dentist said to wait?
Customer: replied 6 years ago.
Reply to Family Physician's Post: yes, I think he is good dentist, he said to wait.
Expert:  Family Physician replied 6 years ago.
At this point - if you are not having other problems, it may be reasonable to wait, however I don't see how waiting is going to help it tighten up.

I would like to have one of our dentists check your question - I will send them a PM to see if they can look at your question. I'm not sure if he is online at this moment - But I am confident that he will be with you ASAP.
Family Physician, Doctor (MD)
Category: Health
Satisfied Customers: 12566
Experience: Emergency Medicine and Family Practice for over 26 years
Family Physician and 6 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
Still interested to hear more about the procedure in the case I do need to have a permanent crown removed.... thanx
Customer: replied 6 years ago.
I thought I should mention that the tooth is still alive under the crown. I originally bit a pop corn kernal and cracked the tooth that may have had a crack in it. So, the broken part of the tooth was removed, impressions taken, and a temp made until the perm came it. The temp was fine... fit great. The perm seemed big. Had to make adjustments just to fit it in place to try it.I've been back twice for adjustments, but the gum remains very swollen on the upper outside of my rt jaw. It's a molar, 2nd from the back.

I've been going to this dentist for a long time, and am happy with his work so far. This just may have been a bad crown.

I'm very nervous about what they would have to do to fix it at this point. Things are so swollen how do they get a goo impression?

How do they even get it off when the orinal tooth is so ground down, and it is permanantly cemented there.

I feel like I may just need to have him pull it and get a bridge!! Anything to lessen the pain. I'm not much of a whiner, and it is really a problem. Advil does help- just not enough.

The way I left it with my dentist after the final possible adjustment is to wait 3 weeks. During that time, I am to floss hard, use listerine everyday, use hydrogen peroxide everyday. I think he is hoping this will lessen the swelling in the gum.

When he checked the bite he thought I was getting good contact, but he said it might have been high because the gum looked like it had been irritated for that reason. My teath do close, but it just doesn't feel right, almost too snug. If the bite is good it doesn't explain why my mouth is so irritated.

He said if things weren't better He might need to take off the crown, and warned me it wasn't easy to do. He also expressed a concern about starting over and getting good impresseions with my gums so swollen.

I should have asked him more questions. It hurts, but I want to be clear on wht the next steps are if the current plan of waiting doesn't work.

I don't want to loose this tooth, but I can't take this constant pain much longer.

Well- that's the whole 9 yards.

I should say my dentist did a back molar gold crown for me that fits perfectly, although it did take one adjustment. He has done a great jobe doing a fillingf on my front tooth that needs to look natural- and it is holding way longer than predicted. BotXXXXX XXXXXne, he seems to know what he is doing, but I just dont get all my questions answered, in poart because he is busy, and in part, I am embarrassed, and finally because I don't think of the right away.

Sorry for the long answer.... But I really need some help
Expert:  replied 6 years ago.
DearCustomer

It is unclear from your narrative whether your symptoms are a result of poor crown fit, or some unrelated problem. The parameters of good fit are well known by any competent dentist, and it is therefore a simple matter to determine if a crown fits prior to cementing it on a tooth. It makes no sense to cement a crown that fits poorly, since it is far easier to modify a crown prior to cementation; it can be returned to the dental laboratory to add contour or re-glaze the porcelain. In other words, either your dentist felt the crown was fitting well at the time he cemented it, or he simply dropped the ball and the crown didn't fit well, or there is a problem with the tooth that is unrelated to the crown.

If it turns out that there is something wrong with the crown, it is a simple matter to remove it, although it does require that the crown be destroyed and re-made. However, this would almost certainly be due to error by the dentist (he should not have cemented a crown that was deficient in some way), and the cost of replacement should be borne by the dentist.

However, before any attempt to replace the crown, the cause of your symptoms should be explored. The swelling of your gums could represent infection of the pulp (nerve) of the tooth, or could be the result of periodontal (gum) disease. In other words, additional efforts to address your symptoms should not be random or uninformed, but should be preceded by an identification of the problem. If your dentist cannot perform this determination himself, he should refer you to a specialist (an endodontist or periodontist) for this purpose.

Hope this helps...
Mark Bornfeld, Dentist (DDS)
Category: Health
Satisfied Customers: 5721
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
Mark Bornfeld and 6 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
Thanks for the answer, I am re-listing because I realized I had an additional clarification question.

How long should I wait to see if the gum recovers? Does 3 weeks seem reasonable? Also, if the crown is removed, and the tooth does not require a root canal, is the solution just a new crown? Or, might I need a bridge or a different solution? Any clarification is appreciated.

As you suggest, I believe my dentist is unsure what is causing the swelling. It might not be the crown. However, I've never had gum swelling before and it is right above the tooth with the new crown. It seems to me to be unlikely that it is an entirely independant problem, but I guess one can't know for sure.

My dentist used what looked like carbon paper to determine if the bite was ok. I am glad to hear it is fairly simple for a dentist to tell if the bite is ok. He said it was closing on the other teeth on that side, not just the crowned tooth. However, it's been two months since originally set and it doesn't feel right. I can close my teeth, but it feels like sometimes it's sliding into place, or just too snug.

I believe my dentist wants me to spend 3 weeks focused on healing the gum, as though it were an independant problem. If it isn't better than I go back, and he will investigate further. He said he would cover any additional costs.

I do believe he thought the crown was a fit when he cemented it. I am suspicious that it didn't come back from the lab in as good of a fit as usual. It was too large to even set on my remianing tooth when he started, so he was drilling on it for a while before I tried it on. The appointment took twice as long as scheduled, and my mouth was quite sore from trying it on by the end. However, when he cemented the crown, I could close my mouth, and it didn't feel especially high. I had every expectation that once my mouth recovered from the process it would be fine. Unfortunately it isn't going very well.

My one previous crown, did not take nearly as much time to have put on when it cam back from the lab.

I am mostly glad to hear that getting the crown off is not very very difficult, even if it does destroy the crown. I will also consider going to a specialist if I want a second oppinion, or I am not confident that my dentist's plan to find the root cause of the swelling makes sense.

Thanks again for any additional information you can provide.
Expert:  replied 6 years ago.
DearCustomer

Although waiting three weeks to see if matters improve isn't likely to make things worse, I'm somewhat dubious whether it will make a difference in the situation after two months.

As to what treatment is appropriate-- that is a more difficult question to answer, even if you eliminate the need for root canal therapy as a possibility. The symptoms you describe could arise from a wide variety of causes-- some of them trivial, and some more serious. For example, something as simple as closing a space between the crown and the adjacent tooth may solve the problem by eliminating a food impaction area. Another thing that may be relevant is that some patients are sensitive to the metal used under ceramic to metal crowns, if a base metal alloy was used. I have sometimes seen an improvement in gum condition by switching to a semi-precious or high noble alloy. On the other hand, severe gum disease or a fractured root may make salvage of the tooth impractical or impossible. What needs to be done is a careful assessment of the tooth, which will hopefully lead the way to a diagnosis. Simply re-making the crown in the hope that it will set things right would be unwise, since there would be no assurances that the same problem wouldn't follow.

That being said, your description that the bite feels like it's sometimes "sliding into place" is a clear indication that you have what is called a lateral excursive prematurity, which put more simply means that the bite is definitely not "right". This is something that should be included among the possibilities considered.

It is true that dental laboratories vary in the quality of the product they deliver, and this will certainly affect the amount of time needed to get the crown to fit properly. However, the botXXXXX XXXXXne is that the dentist needs to get the crown into a state that is worthy of serving his patient, regardless of the accuracy of the crown as delivered by the lab. When a crown is cemented, that constitutes the dentist's stamp of approval, and it is his fault if it comes up short in the quality department-- not the lab's fault.

I wish your dentist well in finding a solution, and wish for you the patience to see the process through to its conclusion.
Mark Bornfeld, Dentist (DDS)
Category: Health
Satisfied Customers: 5721
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
Mark Bornfeld and 6 other Health Specialists are ready to help you

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