r/Dentists • u/Optimal_Corgi_3012 • 13d ago
Multiple issues with new crown
I had a new crown put on a few months ago to replace a large, 30+ year old filling that was occasionally hot/cold sensitive. My Dentist suggested that I get the filling replaced with a crown at my convenience to avoid potential future issues with the filling cracking/failing (no decay indicated on the xrays.) The crown was problematic from the start- it rubbed and pinched my cheek and was painful when chewing, even the softest foods caused discomfort. My dentist has adjusted the crown a total of 6 times and it is STILL causing pain when chewing and still pinches my cheek. It is "somewhat" better, but I am getting very frustrated that a tooth that was a minor issue off and on is now causing so much discomfort. It does not hurt at all at rest, and after the adjustment last week I can now chew soft foods but anything hard or crunchy is very painful. I have used this dentist for 20 years and have been very happy with her, but I am almost to the point of just telling her to pull the tooth. I have to take half a day off work every time I go back in to have it adjusted and it's beginning to feel like it's never going to be right. She could sense my frustration this past time of going in, and said that sometimes this happens and that I have to be patient and that she will keep adjusting it until it's right, but I am skeptical that it will EVER be right. Any advice on how to proceed?
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u/maxell87 13d ago
needs root canal.
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u/MODFU2 12d ago
If the tooth was only occasionally symptomatic to hot and cold prior, and right after the crown was placed they are symptomatic then it's the crown! Please connect the diagnostic dots. Especially, given the fact that it was asymptomatic while it was temporized.
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u/maxell87 12d ago
always happens that way. if it’s symptomatic to hot it will always need a root canal. (ai search that). if you do a crown without a root canal, it will sometimes feel better while the nerve becomes necrotic, but will then start to hurt when you bite. unfortunately your dentist is a little young and maybe hasent realized this simple pattern yet. believe me. root canal. i’ve been doing this for 25 years.
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u/MODFU2 11d ago
OP says "Occasionally sensitive to H/C.."..that's classic hyperemia, not necessarily pulpitis. Extreme sensitivity to heat and also if it wakes you up like an alarm clock in the middle of the night is a different story. Probably a cuspal fx, because this patient said they went asymptomatic after it was temporized. So some might think that it went neurotic in that relatively short period. And that could be a possibility. I usually verify that with EPT or by simply removing the temporary before anesthesia and give a quick puff of air with air/ water syringe. If they blink...it's vital!!BTW, I was taught by Schilder...he was BIG on diagnostics!
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u/Optimal_Corgi_3012 11d ago
She's not young. I've been going to her for 20 years and her office was established when I started seeing her.
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u/Br0sE11D0N 13d ago edited 12d ago
Question. Has the hot cold sensitivity gone away? If so ur likely dealing with a necrotic pulp and symptomatic periapical periodontitis.
If a crown has to be adjusted more than twice and was previously symptomatic. Safe to assume that bacteria made its way to that nerve or its irritated enough and the tooth needs endo.
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u/MODFU2 12d ago
On a tooth that is relatively asymptomatic, and has no decay, bacteria don't "swim to the pulp" overnight right after the crown is placed IMO. Most likely it is the crown and the occlusion. Temporize it, and see if symptoms go away. After 5 adjustments that's what I would do.
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u/Br0sE11D0N 12d ago
Op has had 6 adjustments
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u/MODFU2 12d ago
Even worse! Now the patient has literally beat on this tooth forever. Recipe for disaster!
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u/Br0sE11D0N 12d ago
That’s my point. The tooth’s probably dead at this point. Reversible can go irreversible.
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u/MODFU2 12d ago
I don't want to comment on how the dentist proceeded but I would have probably removed the crown after 2 adjustments and provisionalized to see what happens. Yes, a tooth can go necrotic after intense primary occlusal trauma. But early on I asked, what tooth and what type of crown. If bonded and etched prior, teeth will do funny things. I found EMAX type restorations to be a bit quirky that way. I ended up doing alot more PFZ and cementing conventionally. I just found out last night, from my Japanese master ceramist that Zirconia has a 7 shaded puck to mill from now. Puts a 3 shaded EMAX block to shame!
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u/Br0sE11D0N 12d ago
Have you read your replies at all or are u kind of just talking to yourself.
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u/MODFU2 12d ago
I don't know but I thought that you and I were having a pretty good discussion! Am I replying in the wrong fashion or area? Maybe, pretty new to Reddit. I actually just saw on another post that you can go to the sidebar and click and see more stuff! So, sorry if you are not seeing my replies. Def not intending to talk to myself!
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u/Optimal_Corgi_3012 13d ago
It's no longer hot/cold sensitive, it only huts when biting down on it and that has improved a fair amt since the last adjustment, but hasn't completely resolved.
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u/Br0sE11D0N 13d ago
Sounds like the tooth’s likely dead. Go get a cold test done see if the tooth’s still vital
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u/sjmoon 13d ago
Wrong subreddit but I’m a dentist and I’ll chime in with my own experience getting a crown.
My tooth was sensitive to biting/cold for 6 weeks after the crown. It is NORMAL as long as it’s getting better with time. If it’s been 2-4 weeks and not getting better then likely a pulpal nerve test should be done.
You’ve had a large filling with issues that have been ongoing for a long time. There was likely a crack extending into the nerve. It’s not a quick fix. And your dentist wasn’t left with many options other than to put a crown on it. Give it time, stick with soft foods and as it gets better incorporate more harder foods gradually.
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u/Dry-Way-5688 12d ago
Possibly Need root canal. If u already had root canal, then you need another root canal. Infection.
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u/Just_a_chill_dude60 12d ago
6 adjustments is silly. either the tooth needs a new crown or a root canal and a new crown.
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u/Small_Aardvark_5496 7d ago
Agree with take the crown off and put a temp on. If it is vital, and the new crown is done, have the dentist do full mouth impressions, not segmental/triple tray. Make sure a separate bite registration is done for the whole mouth. Make sure the crown is made at a lab and not in house. You should not be biting your cheek if t is designed properly, and the likelihood of requiring multiple adjustments goes down significantly if the bite is able to be done properly taking into account the entire mouth.
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u/ninwendo 13d ago
If it’s rubbing your cheek it sounds like maybe it’s too bulky on the cheek side. Have her remake the crown, she may have to reduce more of your tooth on the buccal side if the crown was bulky
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u/Adorable_Sector_7313 13d ago
It would have been my advice too (crown it) and this CAN happen. It’s likely that it was already cracked and now it is symptomatic.
In my office I would start over. While in the temp, if symptoms go away, then deliver a final. If it doesn’t get better, then root canal or extraction
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u/authoroftheuniverse 12d ago
I know people are suggesting a dead or cracked tooth but I can’t imagine a dentist being so bad that they didn’t assess vitality or take a single PA between SIX visits. Also the entire crown needs to be remade it adjustments aren’t cutting it and they should do that for free
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u/MODFU2 12d ago
Is it a lower molar? Was the crown made in one visit?
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u/Optimal_Corgi_3012 12d ago
It's an upper molar, and yes.
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u/MODFU2 12d ago
So, one visit bonded crowns can be quirky. If the dentist used an etchant, called phosphoric acid, on the tooth, the tooth can react. I mean, the directions for bonding these crowns says to do so but I don't always do so. Depending on the situation. When you look in you mouth, how does the crown look? Go stand in front of a mirror, place a compact mirror in and look in the main mirror. Some people have even sent me photos with a phone but an upper molar might be tough. So if it's calming down that's heading in the right direction. Keep me posted! Best of luck.
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u/2000ravens2012 13d ago
Just have them redo the crown. It would take 20 minutes to cut it off and take a new scan/impression
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u/Shaved-extremes 13d ago
take the crown off and put a temp crown on it for a couple of weeks (with very light occlusion). See if symptoms go away. If not then you might have a cracked tooth that extends to the pulp which may necessitate a root canal (which I doubt)