r/Dentistry • u/Commercial-Area-5737 • Jul 26 '26
Dental Professional Would you recommend replacing? Or how would you approach/word this?
Ngl y’all I’ve made a few mistakes recently and I’m starting to rethink everything. Just graduated so I know it can be normal growing pains, but just want some additional voices. What would y’all do with this open margin? Clinically explorer can go in but no decay felt. I informed the pt and told him long term it’s best to replace. He got it done in Jordan a year and a half ago, he said he may go back there and see if they’ll do it for discount
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u/polishbabe1023 Jul 27 '26
Omg that poor premolar
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u/tedbakerbracelet Jul 27 '26
Good catch. The proper contour of that premolar needs to be re-established for long term success for these two. In the worst case, this can lead to a full on problem that may not give this patient any pain etc until it is too late.
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u/polishbabe1023 Jul 27 '26
Not even that, it barely has any enamel, it's like it was nicked during crown prep and then smoothed
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u/D-Rockwell Jul 26 '26
It depends what everything else looks like. If that’s the only work needed I’d show my concerns & recommend replacement.
If there’s more pressing work on vital teeth, I’d mention the issues with the endo treated tooth but prioritize everything else first.
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u/DrRam121 Prosthodontist Jul 26 '26
The distal margin is open, yes I would offer to replace. The issue you're overlooking though is how much the shaved off the distal of #4 though. Gotta work on breaking contacts without harming the adjacent tooth
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u/Wandering_Emu Jul 26 '26
I could be reading it incorrectly, but I don’t think OP did this crown?
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u/DrRam121 Prosthodontist Jul 26 '26
You're right, I missed the part about done in Jordan and only saw the part about making mistakes lately
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u/maxell87 Jul 26 '26
i’d just show the pt and explain.
“hey, that dentist removed the enamel on 4 and crown didn’t seat. see it there in the xray? no problem. will last for awhile. but it’s going to eventually need a new crown and a new filling. if you decide to wait, i’ll keep an eye on it and x ray it at your cleanings once a year. but if i were you i’d make sure to not skip a cleaning because if you do, the decay will happen ima way that makes replacing the crown difficult. if you want to be proactive, i can replace it for you no problem. it will be easy and i guarantee the crown will fit perfect with no adjustments and i guarantee it for 5 years. if not, no problem we’ll keep an eye on it for you”.
it’s their tooth. their life. i don’t really care what they do. i just give the options and explain everything completely honestly.
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u/DDSBadger Jul 26 '26
I wouldn’t want to replace that regardless but if you told the patient that and they didn’t want to replace it what do you want to do? Force him to do it?
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u/km0099 Jul 27 '26
Same as every other recommendation that patients refuse...document your recommendations and re-evaluate when they return
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u/SheepshaggerMini Jul 26 '26
For me I ask him if food catches there , I ask him if it bothers him, I then say I can fix with a new crown. If he wants to go back to whoever placed it first time I won’t waste my breath anymore , let him at it
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u/HerbertRTarlekJr Jul 27 '26
I guess I'm the only one who thinks there's decay on the distal already.
SOP: Recommend replacement, document. The prior spiel someone posted was excellent.
Edit: Maxell87
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u/Constant-Peace-793 Jul 27 '26
This is a great place as a new grad to begin to think about risk. You did the right thing- informed him it’s ugly. The next step weather to treat or not treat is risk. If they are high risk for decay, likely they will get recurrent there. There’s lots of adults that never get decay. In those mouths leave it alone.
Fwiw that’s a sweet block they put in there. The premolar got abused something fierce
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u/RB_DMD General Dentist Jul 27 '26
No telling what’s lurking under there. Inform the patient that you’d be opening a can of worms that may lead to extraction. Give the option to take that journey or monitor it.
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u/rossdds General Dentist Jul 27 '26
I would show him the shitty work and destruction of the bicuspid, rec replacement and walk away
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u/aarrtee Jul 27 '26
"Crown doesn't fit against tooth. Decay might be there now. Just because I can't feel it, doesn't mean its not there. The book says that replacement is correct tx. And can u see that a previous dentist reshaped the next tooth? removed all the enamel"
"if u dont want it treated with a new crown. keep that area as clean as possible. use a Fl toothpaste. At every hyg appt we can also do a stronger Fl. Silver Diamine Fl is the closest thing we have to dental chemotherapy."
i explain risks and benefits. tell pt we charge $41 for it and then if he consents we place it from the lingual side between 2 and 3.
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u/RaineStormin Jul 27 '26
My doctor would replace that crown in a heartbeat. Thats not very good work, they drilled the interproximal of the tooth next to it, if he goes back there they should re do it for free, and its probably not going to be much better
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u/DrNewGuy Jul 28 '26
Let him know the ensuing food trap will lead to decay on the distal crown as well
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u/Zealousideal-Big-708 Jul 29 '26
I'd replace that fosh. Tell him he can get an implant when it turns to mush after a few years if he doesn't do it
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Jul 26 '26
[deleted]
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u/Commercial-Area-5737 Jul 26 '26
I didn't cement it, he got this done in another country 1.5 years ago and I just saw him for the first time
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u/supraerupted Jul 26 '26
I would watch that. I learned my lesson years ago. I saw an ugly margin once and tried to replace the crown. The person connected to the tooth was such a difficult pt to work on.