Dr. Hall,
I recently had a crown replaced on an upper molar (second molar from the back) due to the first crown breaking after several years. I needed it done quickly, so I went to a new dentist who used CEREC to make a same-day crown.
The crown feels like a wad of bubble gum stuck to my tooth. There was a large “bubble” that stuck out into my mouth and was rubbing my tongue. When I went back, she could see that it was misshapen, and she filed it down some. It STILL feels too big. It rubs my tongue when I talk, and I think I’m biting my tongue in my sleep. Should I go back and have more filed away? I have had upwards of 10 crowns, so I’m not just unused to the feeling of a crown in my mouth. I also thought that with CEREC, the computer would make the crown fit really well. I’m not sure how to proceed. Thank you.
– Renee from Utah
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Renee,
How is it you keep ending up with these dentists who don’t seem they know what they’re doing? My first question would be about the crown that broke. Crowns aren’t supposed to break, even after several years. They are supposed to be super-strong and are put on the tooth to keep IT from breaking.
But anyway, about this replacement crown. I would insist that this crown feel right to you. Besides feeling bulky or misshapen, it needs to be shaped so that you don’t bite your tongue in your sleep. Persistent tongue biting, lip biting, or cheek biting is a serious problem that in some cases can lead to the growth of a tumor. Proper overlap between the upper and lower teeth should prevent this. A properly shaped crown should not feel noticeable in the slightest.
With CEREC crowns, the dentist can scan the tooth before it is prepared for a crown and use the shape of the existing tooth as a guide in directing the CEREC machine in how to shape the tooth. Since the old crown had broken, she didn’t have that to go by. But then the CEREC software is fairly easy to direct so that the tooth is shaped properly. I’m just guessing based on what you’re telling me, and my guess is that your dentist didn’t know how to work the software to shape the crown without the original tooth or old crown to guide her.
If I were you, I would ask the dentist to take this crown off and start over again. Shaping a crown freehand after it is cemented is an arduous job and is next to impossible to do. That’s the reason crowns are made outside of the mouth, either in a laboratory or in a CEREC machine and then placed on the tooth after its shaping is finished. For example, one serious limitation is that she isn’t going to be able to shape it between the teeth at all. Another is that it is going to be quite difficult to shape it right at the gumline. Trying to shape it there, unless you have a dentist with uncommon skill, would result in either overcontouring or gouging the tooth. Overcountouring in these two locations will lead to food trapping and gum disease.
Based on your experience so far, I would have a hard time trusting your dentist with shaping the crown with the CEREC software, so I would ask your dentist to have the crown made by a dental laboratory. I hate sounding so tough on her, but you’re going to end up with problems with this tooth unless this crown can be made right.
To illustrate the problem with having an overcontoured crown, here is a photograph courtesy of the dentalcaseoftheday.com website submitted by Dr. Arthur Volker, a dentist in Queens, NY. This patient had this overcontoured crown for 7 years and presented to Dr. Volker complaining of constant bleeding of the gums around this crown. You can see from the purple color of the gums around the crown that there is gum disease here. Renee, I’m visualizing the crown you’re describing to me is worse than this one.
Good luck.
Dr. Hall
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