dental_trouble

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During 1998 I had several crowns placed:

Three unit bridge on upper incisors (7-9).
Two unit bridge on Lower left first and second molars (18-19).
Crown on lower right first molar (30).
Crown on upper left second molar (15).
Crown on upper left first biscupid (11).

(I hope I got the numbers correctly)

The dentist cemented the crowns temporarily, when I asked him about
permanent cement he said not to worry and that he will leave them
cemented temporarily unless there are problems.

I've been to the dentist several times since then, each time I asked
about the temporary crowns and told not to worry.

On February 2002, the crown on tooth 15 fell during sleep (I probably
swallowed it) and I came back. He then permanently cemented the bridge
on 18-19 and the crowns on 11 and 30.

A month ago the crown on tooth 11 fell and I decided to switch
dentists.
I was sent to do a full mouth series x-rays and went to two different
dentists (for second opinion).

The full mouth series:
http://www32.brinkster.com/dentaltrouble/

Both dentists said that tooth 11 is beyond all hope and that tooth 18
has significant decay present and needs to be treated.

The bridge was cut, the crown on 18 was removed and the dentist
decided to extract. It had significant decay under the crown in
addition to the decay seen in the x-ray.

My questions are:

1. Is it normal for crowns to fail so miserably after such a short
time after permanent cementation?

2. Is it reasonable to keep a crown temporarily cemented for so long ?

3. Should I worry about the other crowns present, especially on teeth
19 and 30 ? What should the dentist do ?

4. How can it be prevented on future crowns.

x-rays:
http://www32.brinkster.com/dentaltrouble/
Click on the thumbnail for a larger version.

Thanks in advance.

steven bornfeld

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No, it is not normal. Naturally, it is tempting to blame the
dentistry, and I can't rule out poor fit of the restorations based upon
the x-rays. But your (by the way excellent, and well-scanned) x-reays
demonstrate that you have an unusual susceptability to decay.

Not in my book. There are reasons to keep crowns or bridges in
temporary cement for some time, such as where the teeth are symptomatic
and the health of the nerve is suspect. I feel this should be for a
finite period of time. Temporary cements are somewhat soluble, and
leaving bridges/crowns in with temporary cement for an extended period
of time can lead to washout of the cement and recurrent decay. In a
patient with your obvious decay tendencies, I feel this is a mistake.
There are dentists who feel differently and I respect their opinions.
But if the bridge is in temporarily IMO it MUST be removed every few
months, examined closely for decay, and recemented.
BTW, it is tooth #12, not 11 (your upper L first premolar, fourth from
the front) that is hopeless, not #11. If given the choice, you're hurt
less by losing this tooth than you would have by losing #11.


#19 looks in the PA film to have decay on the distal. I'm not sure
about #30 either--the margin doesn't look too great. I would carefully
check the margins of both crowns with the crowns in place with an
explorer, then remove them and carefully check for decay. If the
margins are OK and there's not decay, I'd cement them with a good
permanent cement. I think there's a substantial chance you have
problems there too, I'm afraid.
You also have an amalgam overhang on #2, possible caries on #3 and 4
(tough call--should be checked clinically or re-x-rayed), possible decay
on #6, 7, 8, 9, 13, 14, 15, 23, and gross caries on #32 (which probably should be extracted).

These all should be evaluated. You should be on a caries prevention
program, incorporating evaluating and optimizing your diet and oral
hygiene. You should also ask your dentist about using a fluoride gel
such as Prevident 2000.
I am sorry to have to deliver possible additional bad news. Perhaps
you have discussed these issues already with your dentist.
Thanks for making the scans available. They are better than the
general run of x-rays I see posted here.
Good luck, Steve

dentaleducation

this is a comment meant as a genuine question, not as a derision of
dental pratice.

You said "As should the tooth under it, as long as the cement


Why do I spend hours doing everything I can to achieve a marginal
integrity of microns when we 'rely on the cement to seal the
gap'?...surely there should be NO GAP to seal if we have all done our
job right?

Mark
Dental technician
London UK

dr steve

Research shows specific limitations on how well a human or a machine can
fabricate a prosthesis and to what accuracy the marginal gap can be made.
If you work an extra 30 minutes on a case and deliver a crown with an 80
micron gap, that would be much better than the 1.2 mm gap I saw on crowns
delivered when I was in dental school. Cements can seal a 200 micron gap
very well and last a l-o-n-g time. A 1.0 mm gap, would have most cements
disappearing until the crown falls off or decay sets in. The extra time to
reduce the gap increases the quality and lengthens the life of the
restoration.

But,,,, really,,,,, do dentists still use dies? Don't tell me they still
use impression material too? <g>

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Stephen Mancuso, D.D.S.
Troy, Michigan, USA
DrSteve@Mancuso.d.d.s.com
{remove first 3 dots for email}
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This posting is intended for informational or conversational purposes only.
Always seek the opinion of a licensed dental professional before acting on
the advice or opinion expressed here. Only a dentist who has examined you
in person can diagnose your problems and make decisions which will affect
your health.
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Please ignore j..d...
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