Dental Crown Complications: Root Damage and Treatment Options

The root structure of the first molar on the right side of the mandible is damaged with a cavity?

Hello Dr.
Lin, I would like to ask you: 1.
After a ceramic crown is placed, should the dentist use temporary cement for adhesion during the trial fitting, and then arrange for permanent cementation in the short term to prevent damage from food debris and bacterial erosion? 2.
I had a crown replacement for my lower right first molar completed in July 2021, but the dentist did not permanently cement it.
The dentist also did not schedule regular follow-ups, which led to inflammation, fever, and swelling in my entire lower jaw by November.
An X-ray examination revealed a large cavity in the tooth root that could not be filled, and there was apical inflammation with a defect in the gum.
Since then, it has been a nightmare; every time I eat, I have to clean immediately, or else I experience inflammation, bleeding, fever, and swelling.
I have taken countless anti-inflammatory and pain relief medications, and to this day, using an interdental brush causes sharp pain that leads to depression.
3.
Given the dentist's negligence that resulted in this situation, is there no way to salvage it? Thank you, Dr.
Lin, for taking the time to understand my situation.
I appreciate it.

Zhong Xiaojie, 60~69 year old female. Ask Date: 2022/05/09

Dr. Lin Jiayong reply Dentistry

Hello, if you previously used temporary adhesive, it is recommended to remove the dentures first, allowing your teeth to rest and recover without function.
This will facilitate subsequent treatments (such as periodontal surgery or apical retrofilling, etc.).
It is advised not to worry excessively and to return for regular check-ups.

Reply Date: 2022/05/09

More Info

Hello! Thank you for your questions regarding dental crown complications, particularly concerning root damage and treatment options. Let's break down your concerns and provide a comprehensive understanding of the situation.

1. Temporary Adhesive and Permanent Cementation: After a dental crown is placed, it is common for dentists to use a temporary adhesive during the trial phase. This allows for adjustments and ensures that the crown fits properly before permanent cementation. However, once the crown is confirmed to fit well, it is crucial for the dentist to schedule a follow-up appointment to permanently bond the crown using a stronger adhesive. This step is essential to prevent food particles and bacteria from infiltrating the space between the crown and the tooth, which can lead to decay and other complications.

2. Consequences of Delayed Cementation: In your case, it seems that the crown on your lower first molar was not permanently cemented, which unfortunately led to significant complications. The presence of a large cavity in the root, as well as inflammation and infection, indicates that bacteria likely entered through the unsealed margins of the crown. This situation can lead to a condition known as apical periodontitis, where the root tip becomes inflamed, often resulting in pain, swelling, and the formation of abscesses. The fact that you are experiencing systemic symptoms like fever and persistent pain suggests that the infection may be severe.

3. Treatment Options: Given the extent of the damage you described, the treatment options may be limited. If the root has a significant cavity that cannot be restored, and if there is ongoing infection, the tooth may need to be extracted. Following extraction, dental implants or bridges can be considered as replacements. However, if the tooth can be salvaged, options such as retreatment of the root canal or apicoectomy (surgical removal of the root tip) may be viable, depending on the specific circumstances and the dentist's assessment.

4. Impact of Dentist's Oversight: It is unfortunate that the oversight in not cementing the crown led to such complications. While it is difficult to assign blame, it is essential to communicate with your dentist about your concerns. If you feel that your dentist did not provide adequate care, you may want to seek a second opinion from another dental professional. They can evaluate the current state of your tooth and recommend the best course of action.

5. Preventive Measures: Moving forward, it is crucial to maintain regular dental check-ups, especially after significant dental work. This allows for early detection of any issues that may arise. Additionally, practicing good oral hygiene, including brushing and flossing regularly, can help prevent complications related to crowns and root canals.

In conclusion, while the situation you are facing is challenging, there are still options available. It is essential to consult with a qualified dental professional who can provide a thorough examination and discuss the best treatment plan tailored to your needs. Remember, your oral health is paramount, and addressing these issues promptly can help prevent further complications. Thank you for your inquiry, and I hope this information helps you navigate your dental concerns effectively.

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