Crown Issues - two months later...

[BlakeVic]

Hello,

I'm 41 and have a history of grinding. Two months ago, I received a zirconia / layered with porcelain crown on #19. During the following six weeks I had strained muscles in my back, limited range of motion in my neck, headaches, tooth pain/sensitivity to hot/cold and chewing as well as jaw alignment issues. Eventually, my bite guard broke in the exact spot that the crown was placed. At that point, the dentist determined the crown was too high and drilled it down.

1. After adjustment the surface of the crown felt like sandpaper and is now whiter than before. The dentist went back and polished the surface but I'm still concerned that the porcelain layer was drilled. Can adjusting a crown this way affect the appearance? Also, I clench and grind. Will the altered surface impact my opposing teeth?

2. I still cannot chew or drink hot, cold fluids without pain. Also, in the last couple of weeks, I've developed a dull, cold aching sensation in the crowned tooth. The dentist says it could take six months for the sensitivity to settle. He's also said it's possible I have an infection but has declined to prescribe medication because he says there are no other signs. He does not think I need a root canal. We have a follow up in a couple of weeks to see if the adjustment fixes the pain. But, if the pain and sensitivity persist what could be the problem?

The two months of the crown being too high threw my bite off. The dentist wants to drill my other teeth to balance. I do not want my other teeth manipulated until we determine what is going on with the crowned tooth. I've considered going to a new dentist and starting this process over. I have consulted other dentists and been told I may need a root canal, new crown, Invisalign...

In addition to the questions above, does anyone have thoughts, recommendations on how I should move forward with this situation?

Thank you.

 

[Dr M]

1) Adjusting the crown definitely affects the porcelain layer. If it is not rough, it should not affect the occlusion with your other teeth. Getting the bite correct is more important.

2) The pain could be related to a lot of things. Difficult to say without an x-ray. If the pain does not subside, a root canal would be the next step. This can be done through the crown, but there is also a chance that the crown would need to be replaced.

 

[BlakeVic]

1) Adjusting the crown definitely affects the porcelain layer. If it is not rough, it should not affect the occlusion with your other teeth. Getting the bite correct is more important.

2) The pain could be related to a lot of things. Difficult to say without an x-ray. If the pain does not subside, a root canal would be the next step. This can be done through the crown, but there is also a chance that the crown would need to be replaced.

Hello Dr. M. Thank you.

I've provided some prepped, crowned X-rays and a photo of original tooth. A few follow up questions, please:

1. The surface of my crowned tooth is visibly whiter. I'm assuming this is because of the drilling. My understanding is that the porcelain is used to match color. Is that correct? Is it common practice to drill this type of crown or should it have been replaced?

2. Regarding my original tooth, there was zero pain to chewing, sensitivity to liquids. I had a dull ache and occasional sensitivity to air (breathing) for six weeks leading up to the crown. I was told the divot was too large to fill and that my grinding could eventually crack the tooth. In the last couple of weeks a dull and cold ache has returned, chewing issues persist and sensitivity to cold almost feels like it's getting worse. The dentist keeps telling me the X-rays look good and sensitivity could last six months. He has mentioned the possibility of infection but says there are no other signs. I'm aware that grinding can extend and complicate the healing process but I grind at night and wear a custom fitted guard. Do you have any additional thoughts?

3. I had braces when I was younger. Prior to this crown the dentist described my bite as "perfect". He now wants to drill my molars (opposite the crown) to try and balance my bite. Is that a good idea? I declined with hopes that after the adjustment my bite will settle (the crown was too high for two months before adjustment). If my bite doesn't settle, would ortho treatment balance it? I'd be more open to something like Invisalign as opposed to drilling my healthy teeth.

Thanks again.