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Would you mind giving me your professional opinion about this onlay/crown, the one with the sticking up bit! It looks and feels bad to me. Is it ill-made and wrong? I call it my egg cup as it has no anatomy just what feels like a huge smooth hole where the cusp should be. It has never felt comfortable. The crown on the other side feels like part of my body.

Should my dentist have sent it back and complained to the lab rather than putting it in my mouth, hoping he’d get away with it? Sometimes I’ve thought about asking him to just take the wretched thing out but I’ve had so much dental work and dental negligence of late that I haven’t been able to face yet another scene with a dentist.

Sometimes the dentist who placed the crown has been quite frightening in the things he says and in his manner towards me. I feel anxious about the damage the crown might be doing to my other teeth, but I also feel terrified to confront him with the fact that I don’t think this crown is well made.

Since the crown was placed my mouth has never felt comfortable and sometimes I have quite severe pain that comes and goes. Could the ill-made crown be causing the pain? Also it has been in my mouth since early January, is it possible that it is damaging the opposing teeth? The dentist who placed the crown has adjusted the bite and it’s okay, the opposing tooth somehow fits inside the large smooth egg cup dip, and sort of skates around. The corner of the opposing tooth does catch on the lower part of the raised edge. When I lie on my side at night then the opposing tooth touches the high part of the raised lip sometimes. 

How bad is this? Maybe it’s not as bad as I think. I’m just desperate to save all my other healthy undamaged teeth and just limit the damage to the two first lower molars which have already been needlessly stolen from me because a dentist left the old fillings under the new ones when he replaced them. Both teeth developed stress fractures as a result. I have been made quite unwell physically and emotionally by the destruction of my healthy, lovely teeth, not to mention the huge expense of putting the damage right.

Best wishes, Katy

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Asked on 19/05/2009 12:00 am
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All new dentistry should fit in harmony with the other teeth and the way the jaw functioned before it was placed. However often, due to wear and habits such as tooth grinding and clenching, many of our patients have less than ideal function and something new with "push them over the edge" into a new way of chewing that is uncomfortable.
It is very easy to be confronted by a broken tooth and provide a crown without due consideration to the above because the situation appeared to be a straightforward one.
What is highlighted here is a situation where things were not as simple as expected and there has been a breakdown in communication and it may not be possible to overcome this without another change of dentist! Hopefully your own dentist will be receptive to your concerns and offer a solution.
I would suggest that one goes back to 1st principles, analyses the bite in relation to the motion of the jaw to see if the "high" cusp is actually interfering with the way the jaw would like to move or actually necessary to support the bite. It may well be that the only way to restore balance is to go beyond just putting things back to the way they were as the change in your bite has now made you aware of other previously unnoticed problems with the way your teeth function.

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 19/05/2009 12:00 am
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Factors to consider are:-

1. Everything made for the oral cavity is entering an ever-changing environment, as with everything but more so when we get older.
2. Anything made for the oral environment should be managed with trimming to establish it in harmony into its new home.
3. Management is key.
4. Anything you are unhappy with should be attended to by the practitioner who placed it.
5. It is a characteristic of the lingual cusps of the first molar to pierce the occlusal table above its abutment teeth.(stick up)
6. Looking at your photo, one is quite high and one is low.
7. What would be concerning, is that if this crown remains in dominant contact during opening and closing and more importantly from left to right excursion, then this tooth is deviating from its function and would need fine tuning. This function should be guided by your eye teeth unless it is planned as part of a treatment plan and/or there is no alternative (If this is now different due to the introduction of a new crown, then this should be adjusted by the clinician who placed it).
8. It is often a priority to keep whatever tooth structure left in order to maintain vitality of the remaining tooth. It would be considered good practice. If the occlusal anatomy is compromised, the assumption would be that as it is a gold crown it would not be expected to be aesthetic anyway. It has been considered for years to be the best long-term solution for the patient and their teeth due to strength and stability. An aesthetic compromise is considered acceptable. If you had made it clear that it was a gold crown ‘work of art ‘ that you wanted and it was not achieved then you should address this with your practitioner (patient education, who is responsible?)To be fair to some dentists this would be out of the ordinary. As we have a profession that was born in the NHS, some dentists are not used to patients who are willing to pay readily. To give some perspective, a gold crown in Europe from the best technician, could cost up to £800 if not more. You can get yellow gold crowns here from £60 (Gold is £16 a gram needing approximately 3 grams dependant on size)……the question would be…, how much gold is in it?
9. Pricing of laboratory fees quite often determines the level of skill a dentist would like access to for their patients. Unfortunately an expensive crown for the patient does not always mean a good laboratory, some dentists give there patients much more in other ways,(like surgery environment, higher level of skill, experience and equipment); this is why we need patient education.
10. It is easier for a dentist to see laboratory standards as it is easily scrutinised by our pricing .Dentists are educated as to what good quality is if we charge more, so we would have to be brave to increase our costs and often it is a reflection on skill and confidence to deliver top quality to the dentist. This is a good system for the patient as usually the price from a laboratory reflects the quality. But it does not always mean that if a dentist charges more that they are using a more expensive laboratory.

Take a look at the photos of a natural molar to see variation in cusp height.

Thank you for your other emails and I hope this helps.
 

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 19/05/2009 12:00 am