Dr. Hall,
My crown has fallen off 3 times. I have returned to him again and he says I need a gingivectomy to keep the crown secure by giving the crown more tooth area to bond the crown. This sounds extreme to me. Also the base of my tooth is blackened where I recall it was not when he placed the crown the last round. I’m holding the loose crown now and need to decide soon!
Please advise!
– Nancy from San Francisco
(See Dr. Hall’s answer below.)
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Dear Nancy,
The procedure is called crown lengthening—trimming the gum and maybe some of the bone to expose more of the tooth so that it can retain a crown. Sometimes that is necessary, and I had occasion to do that in my practice.
My problem with your situation is that your dentist should have known up front that crown lengthening would have been required to retain the crown. Coming to you after the crown has fallen off three times makes me not trust him. Did he not realize when he first prepared your tooth that crown lengthening would be required? Or is it that crown lengthening isn’t actually required in your situation and this is just an excuse he is giving you?
It is possible to do a crown on a short tooth and have it stay on without doing crown lengthening and without having any problem. But the tooth has to be carefully prepared with only a very slight taper and possibly cutting some grooves into the sides of the tooth. I have a blog post about crown retention form that you can read here. It cuts into the excuses that many dentists use to explain why their crown fell off. In over twenty years of practice, I never had one of my crowns fall off, because I always prepared them with a tight draw. Many dentists don’t like to prepare a crown with a tight draw because it is more demanding and even a slight error can mean that the crown won’t fit at all.
It is when a tooth is “bombed out” with most of the crown either broken off or eaten away by decay that crown lengthening is required.
Bottom line—I wouldn’t trust this dentist to try again and would get a second opinion. He’s clearly planning to do a new crown for you, so I’d have another more expert dentist do it. I don’t know what the blackening of your tooth is, but something doesn’t sound right about that either.
Oh, and I think your dentist should refund you AND the insurance company, if insurance was involved. If he doesn’t, I’d complain to the dental board and to the insurance company. A crown isn’t serviceable if it won’t stay on, so there should be no fee for it.
– Dr. Hall
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
I too have a crown that fell off for the third time. It is a porcelain crown, and I have never liked them. I much prefer the comfort of the gold. And none of my gold crowns have ever fallen off. This tooth is a molar on the top left, doesn’t really show. Previously, I had another crown fall off for the third time and she made a new one and it has stuck. I am convinced the adhesive process has changed for the worse. When replacing my crowns they keep using light cured material. Which doesn’t make any sense to me. I have asked if I could get good old-fashioned cement/adhesive. But the crown keeps falling off. unfortunately I have no way to know what type of adhesive they are using. Can you talk a little bit about adhesive options in today’s dental field?
Response by Dr. Hall:
It isn’t about the adhesive used, it is about the shape of the crown preparation.