Dental Crown Issues: Expert Answers to Common Concerns

Q: Dental Crown Issues: Expert Answers to Common Concerns

Hello： Since the current issue is only the fracture of the right central incisor, it is recommended to focus on reconstructing that tooth (simplifying the problem makes it easier to achieve the goal). <br>We can see if it is possible to reattach the post and crown; if not, I sugg

Braces issues

Hello Doctor: Over a year ago, I had issues with the metal crowns on two of my central incisors and the left lateral incisor bridge, which had black margins at the gums.
I went to the clinic to have them remade.
The right central incisor had not been crowned since I had a root canal at 18, and the doctor suggested that since I was already remaking the others, I should also do the right central incisor for aesthetic reasons, and assessed that a post was not necessary.
So, I ended up getting four crowns in total.
However, in April of this year, the crown on the right central incisor came off while I was brushing and flossing, and the tooth inside broke as well.
When I returned to the original doctor, he asked how this happened and mentioned that my tooth was fragile and that the occlusion was the reason for the break.
However, I had used the right central incisor without a crown for 25 years without any issues, and now, after getting a crown, it broke in just over a year.
The doctor initially said that if it broke, it would need to be remade with a post, but during my second visit, he stated that even with a post, he could guarantee it would break again in the future because the remaining tooth structure was not long enough, and he cited occlusion issues.
He suggested two options: 1.
Remake all four crowns, connecting the right central incisor with the three adjacent teeth to prevent future breaks.
2.
Alternatively, create a bridge between the lateral incisor and the canine, emphasizing that if neither option is pursued, if it breaks down to the root, the only solution would be an implant.

I have a few questions for you, Doctor:
Q1.
If a post is placed, will it still be prone to breaking so easily? Would it be better for me to avoid using the right central incisor when eating? My previous central incisor with a metal post never broke.

Q2.
I have already spent a considerable amount on the four crowns, and now, just over a year later, I am being told I need to redo them.
It's hard to accept, and I don't want to compromise healthy teeth for crowns.
Are these really the only two options?
Q3.
The doctor mentioned making a temporary denture for 3-6 months to observe the situation.
Is this necessary, or should I just proceed with the crowns directly? Thank you, Doctor.
I apologize for the many questions.

bai, 40~49 year old female. Ask Date: 2024/05/08

Dr. Lin Jiayong reply Dentistry

Hello: Since the current issue is only the fracture of the right central incisor, it is recommended to focus on reconstructing that tooth (simplifying the problem makes it easier to achieve the goal).
We can see if it is possible to reattach the post and crown; if not, I suggest considering an implant or an aesthetic removable partial denture for the missing tooth.
I do not recommend bridging to the right canine (if the canine has issues, it will only lead to more frustration).
Given that it has only been a little over a year, discuss the cost issues with your dentist.
If a consensus cannot be reached, you may consult the local dental association for assistance.
Until there is an agreement, I do not recommend hastily grinding down teeth or making temporary crowns.

Reply Date: 2024/05/08

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your dental crowns and the issues you've been experiencing. Dental crowns can be a complex topic, especially when complications arise. Let's address your questions systematically.

Q1: Will placing a post (core) prevent future fractures?
Placing a post can provide additional support to a tooth that has undergone root canal treatment, especially if there is significant loss of tooth structure. However, it does not guarantee that the tooth will not fracture in the future. The integrity of the remaining tooth structure, the quality of the crown, and the occlusion (bite) all play critical roles in the longevity of the restoration. If your dentist has indicated that your tooth is at risk due to its length and the occlusion, it may be wise to avoid putting excessive force on that tooth, such as biting hard foods. This precaution can help minimize the risk of further damage.

Q2: Are there only two options for treatment?
It can be frustrating to hear that you may need to redo the crowns after such a short period. While your dentist has suggested two options—replacing the crowns or creating a bridge—there may be other alternatives worth exploring. For instance, if the adjacent teeth are healthy, a less invasive approach could be to reinforce the existing crown with a more durable material or to consider a different type of crown that might better withstand your bite. It’s essential to have an open discussion with your dentist about your concerns, the costs involved, and the potential risks and benefits of each option. If you feel uncertain, seeking a second opinion from another dental professional could provide additional insights.

Q3: Is it necessary to have a temporary crown for 3-6 months?
The recommendation for a temporary crown for a few months is typically made to allow the dentist to assess how the tooth responds under functional conditions. This period can help determine if the tooth can withstand the forces of chewing without fracturing. However, if you feel confident about proceeding with a permanent crown and your dentist agrees, you may not need to wait that long. Discuss your concerns with your dentist; they can provide guidance based on your specific situation.

Additional Considerations:
1. Occlusion and Bite: It’s crucial to evaluate your bite and how your teeth come together. Misalignment can lead to excessive forces on certain teeth, increasing the risk of fractures. If your dentist has identified occlusal issues, addressing these may be necessary before proceeding with new crowns.

2. Material Choice: The material used for crowns can significantly affect their durability. Metal crowns are often more resilient than porcelain ones, especially in the back teeth where the forces of chewing are greatest. Discuss with your dentist the best material options for your specific needs.

3. Long-term Care: After any dental procedure, maintaining excellent oral hygiene is vital. Regular dental check-ups and cleanings can help catch any issues early before they become significant problems.

4. Patient Advocacy: If you feel that your concerns are not being adequately addressed, it’s important to advocate for yourself. Don’t hesitate to ask your dentist for detailed explanations of their recommendations and the rationale behind them.

In conclusion, navigating dental crown issues can be challenging, but with open communication with your dentist and possibly seeking a second opinion, you can find a solution that works best for you. Remember, your comfort and understanding of the treatment process are paramount. Thank you for your questions, and I hope this information helps clarify your concerns.

Best regards,
Doctor Q&A Teams

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