On Thursday, March 24, I am to get a permanent crown glued on a bottom left side tooth—the last tooth on that left side. I’ve been having problems with the temporary crowns. The first temporary came off 30 hours after being placed. I went back to the dentist office and it was glued on again, which lasted 2 hours. I went back the next day and another temp was made of a white material and it felt fine. But the next day a piece of the temp came off and the day after that, a Saturday, another piece came off. On Sunday night the rest of the temp came off. I did no abuse of any kind and chewed on the unaffected side. I am so afraid the permanent crown won’t stay on and I will inhale it into my lungs. The impression for the crown had to be redone because the first one wasn’t useable, said the dental lab.
(See Dr. Hall’s answer below.)
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The two problems your dentist has had with this crown—getting the impression right and getting the temporary crown to stay on—would make me a very nervous patient. If I were in your shoes, I would cancel this crown and find another dentist to finish the procedure.
It isn’t uncommon to have a temporary crown come off. They are made to be temporary and to come off when that is needed. But to have that happen three times suggests to me a problem with competence. Yes, it could be that everything is okay with the crown preparation, but I would want to have another dentist look at this. I have another post where I address crown retention form and why a crown would tend to fall off. If a crown preparation is excessively tapered or short, the tooth would also have a problem retaining a temporary crown, and I’m worried that this may be what is happening to you. Having the third temporary fall apart further undermines my confidence in your dentist.
And then you throw in this extra point that the dental lab told your dentist that the first impression he or she sent them wasn’t usable, which heightens my suspicions even further. Yes, it is not unusual for a dentist to have problems with an impression for a crown. Sometimes there are fluids that seep up around the tooth that contaminate the impression. There are ways to control those fluids, but sometimes they can be difficult to control. Usually you would expect the dentist to catch those mistakes by examining the impression, but occasionally the mistake escapes the notice of the dentist and the laboratory has to discover it. If that had been the only thing to go wrong, as the patient I would be a little leery but not necessarily worried yet. But combined with the temporary crown issues, this totally worries me. You really need to have another dentist give you a second opinion.
Can you switch dentists in the middle of a crown procedure? Absolutely. The dentist has an ethical obligation to assist you in transferring the case to another dentist, if that’s what you want to do. In your case, if there is a problem with the crown preparation by the first dentist, the new dentist may have to do some extra work. If that were the case and I were the patient and I had already paid the first dentist for the crown, I would demand a complete refund. But you can work out those details with your new dentist. The important thing is to get this crown done right. Yes, you could aspirate a loose crown into your lungs. More likely you could swallow it. Either way, it’s a risky thing to have a crown that won’t stay on.
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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.