Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

July 17, 2015

I had an awful experience getting this CEREC crown

Filed under: Dental crowns — Tags: , , — mesasmiles @ 2:42 pm

Dr. Hall

I recently had a CEREC crown put in. I was told how great the CEREC was going to be, and that this was supposed to fit perfectly. But it didn’t seem to go that way.

I ended up spending about three hours in the dental chair. My dentist said she had to take a generic image from the database because my tooth was in such bad shape. And then the crown didn’t fit when it was made. I was watching the screen on the machine when she was making it, and I noticed a lot of red area. And then when she tried to put it on, it didn’t fit. She had to hand grind the sides and a lot off the top. It looked like it was sitting up really high and she had to grind it a lot. And then now it looks like it’s a little lower than the teeth next to it and doesn’t look like a natural tooth. It doesn’t have the bumps on it like my other teeth have, and seems a little wider on the outside at the base. Also it seems a little sensitive. I don’t know if that’s normal for a period of time or not. Its been almost a week. It just don’t feel strong. I wonder if it is not seated in properly.

Now when I went to the CEREC site, it looks like this was supposed to be a near perfect fit and would only take a few minutes to put in. And only minor modification if any. I also sen the image of how it looks when they take the image. My tooth looked identical to this, so Im a little concerned why she is saying it was because the tooth was in bad shape as to why they couldn’t fit it right or get a proper model of it. It looks from the site that they could make a copy of the top tooth to know how it would fit. But my dentist only took a image of the prepared tooth, so that doesn’t seem right.

So I want to know if my dentist did something wrong and is she trying to cover it up? and what about the sensitivity – why is that?
– Chad from Texas

Dear Chad,
You’re correct that something isn’t right with this crown. I can’t pin down from your description exactly why you had this bad experience, but you’re right that it shouldn’t have been this way.

The initial comment that your dentist made about having to take a generic image from the database because your tooth was in such bad shape–I’m not sure what to make of that. The CEREC crown system is made to deal with teeth that are in bad shape. Teeth that are in good shape don’t need crowns. The CEREC software asks the dentist to input which tooth is being crowned. For example, the dentist would program in that you need a crown on your upper left first molar. CEREC is set up to recognize how that tooth is supposed to look and gives the dentist a starting point for designing the crown. Then the images of the surrounding teeth and the opposing teeth should give her the information the machine needs to fit the crown perfectly onto your tooth and into your bite. Clearly, from all the grinding she did and what you are telling me about the shape looking funny and the tooth looking low, that didn’t happen. Why? One possibility is that she didn’t really know what she was doing. Another is that there was some problem that she didn’t tell you about such as that your gums were bleeding so badly that she wasn’t able to get good pictures of your prepared tooth.

There are a lot of things that can go wrong with a crown. In dental school, the first operative procedure your dentist was taught was how to do fillings. Only after she mastered that was she taught how to do a crown, because a high level of skill is required to do a crown and there are a lot of things that can go wrong. If the crown doesn’t fit the tooth perfectly all the way around, for example, the crown will have what is called an open margin–a gap through which decay can enter. Decay that gets into a tooth under a crown can ruin a tooth. If the bite isn’t designed correctly, it can lead to soreness in the tooth or TMJ problems. If the sides aren’t contoured correctly, it can lead to gum inflammation and gum disease. From the sounds of what you described, it seems like your dentist may have just sculpted the crown freehand in your mouth, which is a recipe for all kinds of trouble.

You mention sensitivity but you don’t say whether it is steady, increasing, or decreasing and whether that is sensitivity to cold, to sweets, to biting, or to something else. If it is steady and caused by either cold or food or air, my guess would be that is from an open margin. An open margin would probably mean the crown needs to be re-done.

You definitely want to get another dentist to look at this. And, assuming the crown has to be re-done, your dentist should pay for that. Don’t demand just a refund, but you want her to pay for the replacement crown and anything else that may be required to fix this, which may be more than what she charged you for this defective crown.

A couple of little tips on getting this second opinion–do not tell the second dentist any of this that you told me. Just tell the dentist you were questioning the crown and say that you don’t really want to say any more than that, and you want his or her opinion on the crown based alone on what he or she sees, not based on your story. Don’t give the name of your dentist. You want a blind second opinion. The more you say, the more you telegraph about the answer you’re expecting, and that can color the opinion you get. And you don’t want the dentist influenced by any friendship or animosity they may feel toward your dentist. If they press you for more information, say that you’ll be happy to share that after they tell you their opinion about what they see but not before. Oh, and be willing to pay for an x-ray so that the dentist can fully evaluate this.

Good luck,
Dr. Hall

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About David A. Hall

Dr. David 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 complete Internet marketing for dentists.

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