Please help - crown disaster

dentaldistress

Hi All,

Looking for some advice or similar experiences.

A tooth which I paid to have root canalled in June of this year broke in October (I was warned that it might fracture as they're always weaker once they've been root canalled, so that wasn't an issue as such).

I visited a dentist in the North to have the root canal done in June to save on the cost, but when it broke I didn't have the time to go back up, so I went to a nearby Dublin dentist who told me it needed to be crowned at a cost of €500.

I had my moulds done and a temporary crown fitted on my first visit and all went well. I had chosen a porcelain-over-metal crown so that my tooth would be as normal looking as possible as it's a pre molar and visible when I open my mouth.

When it came to fitting the crown a few weeks later, the dentist couldn't get it to fit my bite, so she drilled and drilled at it until she had gone through the porcelain covering and exposed the metal beneath. This left a visible black hole on the tooth. She also filed the tooth above it in an effort to make the crown fit.

I complained and demanded to see another dentist, who eventually agreed to replace the crown, but he inisisted that he could use the same mould. In the meantime I had to revisit him because of the pain I was experiencing in the crowned tooth - it hurt to bite down on it.

I went back today to have the new crown fitted, same problem again (naturally) with it not fitting my bite, and now he's telling me that my top tooth is the problem, that IT'S not fitting my mouth and he'll need to file away a chunk of its enamel for the crown to fit.

I can't understand why he won't make the crown to fit my bite, rather than having to file away at my bite to fit the crown. His argument is that this happens all the time and is totally normal and that it's a great crown.

Can anyone tell me if it's normal to have to extensively file both a crown and the surrounding teeth to make it fit? Or do i have the right to demand a new mould/refund so that I can go elsewhere?

Thanks.

georgieporgy

If you had come to me I would have charged you 800euro and the crown would have fitted perfectly. sometimes if the opposing tooth is overerrupted it is ok to grind it down a bit. Otherwise no.

If unhappy you could ask for a refund and vote with your feet. ( I hope the cheap root canal is ok...:eek:)

dentaldistress

The "cheap" root canal is perfect, thank you. You seem to imply that by trying to get cheap work done on my teeth, I'm getting dodgy jobs.

Firstly, €500 isn't cheap - I priced around before I got it done (as I always would) and the type of crown I wanted was €500 to €600 in all local dentists. I wouldn't have been prepared to pay anywhere near €800 for it - that would have swung my decision to go North of the border again.

I wish that the dentist in the North was more easily accessible, I got both better workmanship and quality from her than anyone can seem to offer me down here...

Oral Surgeon

Sorry to hear you are having issues op. I don't do crowns or root canals etc but;

dentaldistress wrote: »

Hi All,

Looking for some advice or similar experiences.

A tooth which I paid to have root canalled in June of this year broke in October (I was warned that it might fracture as they're always weaker once they've been root canalled, so that wasn't an issue as such).

I visited a dentist in the North to have the root canal done in June to save on the cost, but when it broke I didn't have the time to go back up, so I went to a nearby Dublin dentist who told me it needed to be crowned at a cost of €500.

A recurring story unfortunitly... €500 for a porcelain fused to metal crown seems too cheap but be of high quality...

dentaldistress wrote: »

When it came to fitting the crown a few weeks later, the dentist couldn't get it to fit my bite, so she drilled and drilled at it until she had gone through the porcelain covering and exposed the metal beneath. This left a visible black hole on the tooth. She also filed the tooth above it in an effort to make the crown fit.

I complained and demanded to see another dentist, who eventually agreed to replace the crown, but he inisisted that he could use the same mould.

A crown is a precision custom made item that should fit with little or no adjustment. Obvioulsy some tweaking is necessary sometimes but drilling to the point of perforation of the porcelain layer is not good- the problems could be in the tooth preparation, the impression or the lab that made the crown- impossible to say here...
As for adjusting the opposing tooth, again some tweaking is allowed but if there was a massive bite interference because the opposing tooth is in a strange position or angle- then the adjustments should be done before the crown is made...
As for using the same impression- if the tooth preparation and impressions are good and the problem is with the lab fabrication of the crown then that's ok but if not then you'll get another crown that doesn't fit...

dentaldistress wrote: »

In the meantime I had to revisit him because of the pain I was experiencing in the crowned tooth - it hurt to bite down on it.

A root canal treated tooth should not hurt. Pain to bite down on is either an indication that the root canal is failed/failing or that the bite on the temporary crown was too high and caused you to bite on that tooth too much.... or that there is some gum infection causing pain to bite on.
You should investigate this further as a painful root canal treated tooth probably shouldn't be crowned until symptomless...

dentaldistress wrote: »

I went back today to have the new crown fitted, same problem again (naturally) with it not fitting my bite, and now he's telling me that my top tooth is the problem, that IT'S not fitting my mouth and he'll need to file away a chunk of its enamel for the crown to fit.

There could be a few reasons for it not to fit your bite:
The crown may not be fitting the tooth properly and therefore is high and then banging into the upper tooth.
The crown may be fitting the tooth correctly but the lab technician made The crown too thick and therefore it hits the upper tooth
The crown may be fitting the tooth correctly but the dentist did not prepare enough tooth away and that leaves the lab technician without enough room to place metal and porcelain...
The crown may fit the tooth correctly and be prepared correctly and made to the correct thickness but the upper tooth if in a strange position or angle may be the problem- but again this should really be adjusted prior to the making of the crown...

So did you not have the crown fitted then? Is the temporary still on? Is it still painful to bite on??

dentaldistress wrote: »

I can't understand why he won't make the crown to fit my bite, rather than having to file away at my bite to fit the crown. His argument is that this happens all the time and is totally normal and that it's a great crown.

Can anyone tell me if it's normal to have to extensively file both a crown and the surrounding teeth to make it fit? Or do i have the right to demand a new mould/refund so that I can go elsewhere?

There's a load of possible reasons why this is not fitting. As stated above, bite adjustments may be necessary in many cases but major adjustments like you describe should not be needed as an afterthought.
It's hard for us to gauge how much adjustment you mean but if the porcelain is perforated- then no this is not good.

Don't really know your rights on this one but you should discuss this in your clinic....

Good luck,
OS

dentaldistress

Thanks for your reply, Oral Surgeon! Detail is appreciated.

As stated above, I did price around at the time and other dentists were offering the same price line for the crown I wanted. Had I seen a major discrepancy, I would have thought something was up.

Secondly, the dentist I'm currently seeing did an x ray to make sure that the root canal hadn't failed, and he said that the job was "impeccably done" - his words, not mine, so the root canal seems fine.

The pain didn't start until I had the initial permanent crown fitted - so, post root canal, and even after the break, and while wearing the temporary crown, there was no pain. Pain only occured after I'd had the first proper crown fitted. I presume (and was told) that the pain is coming from my bite being off. I realise that the root canalled tooth is "dead" so I assume that the pain I'm feeling is from the gum, which is agitated and bleeding a lot.

The dentist has fitted the new crown but has only temporarily glued it on - I have to go back to him next week. I can already feel that the bite is still way off, so I know he'll have to adjust it again, despite already filing it today (along with my top one).

I just wanted to check that if I go back next week and he wants to start filing at the top teeth again, I'm not crazy to let him do it, and that in some cases it's necessary (though I don't see why, if the crown was made properly in the first place).

Thanks again!!

eric hoone

Consumers should not price medical devices with the same criteria as other products.
A cheap crown will not tick all the boxes.
You are getting good service after the event, but the savings made on lab-costs at that price have caught up with everyone concerned.

dentaldistress

At what point was I supposed to realise that this was a cheap crown? I've already stated twice above that I priced around and they were all in the same range.

I should note that I've had trouble with dentists before who have charged "full whack" for their procedures (if this crown really was at cut price) and that's made no difference whatsoever.

The above theme that I've somehow gotten what was coming to me for trying to get a cheap job done is wearing thin. I asked for advice. If you have none, please refrain from jibes about skimping on costs. That was never my intention. The fact that spending a "mere" 500 euro is considered being cheap with my teeth is laughable and shows how ridiculous this country has gotten in terms of dental costs.

Dianthus

If the fit of the crown is otherwise good, and this is solely a spacing issue when you close your teeth together, something will have to change.
Options:
1- Create space by removing more porcelain from the crown(risking thin porcelain&/perforation through to the metal), or by removing enamel from the opposing tooth (destructive to healthy tooth)
2- Create space by modifying (further shortening) the underlying root treated tooth; this may not be feasible
3- Accept that there is currently insufficient space for BOTH metal& porcelain , decline any further adjustment of either tooth, and have a crown constructed with a metal biting surface.
However...if the temporary crown was comfortable,& in place for a few weeks without breaking, then it may well be that there IS sufficient space present for both the metal and the porcelain, but that there was some sort of distortion of the impression sent to the laboratory(as both dentists used the same impression for the crowns). So equally, it may be as simple as having a new impression taken?
At the moment, you're not happy, your tooth isn't happy, probably your dentist isn't happy either. Return, have a- calm!- chat, ask them to discuss the options with you. Good luck OP.

eric hoone

sorry dentaldistress, i realise that i wasn't very helpful there.
you've given a good account of problem and i agree you have only one of two options:
1) New crown
2) Allow dentist adjust existing crown and opposing tooth till it fits

dentaldistress

Thanks for the helpful reply Dianthus.

The fact that the temporary crown fitted perfectly and gave no pain/discomfort whatsoever for three weeks would lead me to believe that a MFP crown is possible in that location. It seems to me that the mess up was either at impression stage or in the lab. The dentist took a good look at my impressions after the first crown went so wrong and his evaluation was that it WAS possible to have a MPF crown in that location (this was another dentist, the person who effed up the first crown I refused to see again).

I have to admit that the new crown looks a lot better (the original one's colour was wrong, the second dentist saw this immediately) and it looks much more like the old tooth did than the first crown. My bite is still off, but I'm more hopeful now that with a little readjustment it will be much more comfortable than the next one.

Then again, the pain from the initial crown's bite being "off" didn't occur for a few days, so I might be in agony by Monday with it.

Thanks for all the advice, at least I know now what options to go through with the dentist.

Thanks for all the advice.

dentaldistress

Dianthus wrote: »

1- Create space by removing more porcelain from the crown(risking thin porcelain&/perforation through to the metal), or by removing enamel from the opposing tooth (destructive to healthy tooth)

Just one more question, Dianthus...Will filing the crown damage its durability/strength? He has promised that he won't leave me with a crown where they've had to drill all the way through the porcelain again, but I'm assuming that filing the crown heavily will affect the long term durability of the crown?

Oral Surgeon

dentaldistress wrote: »

Thanks for the helpful reply Dianthus.

The fact that the temporary crown fitted perfectly and gave no pain/discomfort whatsoever for three weeks would lead me to believe that a MFP crown is possible in that location. It seems to me that the mess up was either at impression stage or in the lab. The dentist took a good look at my impressions after the first crown went so wrong and his evaluation was that it WAS possible to have a MPF crown in that location (this was another dentist, the person who effed up the first crown I refused to see again).

I have to admit that the new crown looks a lot better (the original one's colour was wrong, the second dentist saw this immediately) and it looks much more like the old tooth did than the first crown. My bite is still off, but I'm more hopeful now that with a little readjustment it will be much more comfortable than the next one.

Then again, the pain from the initial crown's bite being "off" didn't occur for a few days, so I might be in agony by Monday with it.

Thanks for all the advice, at least I know now what options to go through with the dentist.

Thanks for all the advice.

If you have the second crown in place with temp cement and "the bite feels off" as you say, then it shouldn't require too much more adjustment as if the bite was very high- then it would be quite uncomfortable as you are putting all your biting force on one tooth...

So maybe a small adjustment may be ok but as said previously- a large adjustment is a little messy...

OS

Big_G

You ask people to refrain from jibes about getting a cheap crown, and I'll ask you to refrain from jibes about crap dentistry in the republic. Your personal experience notwithstanding, many people on here charge more for crowns than €500. Her where I am in Queensland the average fee for a crown is $1300. That's about €1000. Fitzgeme uses labs I think who charge about €500 for a crown, that's just a lab fee. However I've done good PFM crowns and even cerecs in the past for €500 and I've never cut the porcelain off down to metal. If I get that far it's an automatic remake and I do my trimming before the crown is cemented. And if I trim a lot the crown goes back for a reglaze in the lab.

The main reason that this crown is bad is because you've gotten the same result the second time as you did the first. The second dentist hasn't correctly identified the issue which led to the fit problems in the first place and even used the same impression! If I had to do a remake, I would first identify the likely cause (OS mentioned some above) and change whatever needed to be changed to get a better result. This does not appear to have happened based on what you are telling us. However, we do not and cannot know exactly what is going on without being witness to it. Sometimes teeth are at their preparation limit and there simply isnt an appropriate amount of room for restoration. I have seen this before especially in patients with class II div II jaw relationships especially with complete overbite, that is a concept that is a bit gobbledygook but the dentists here will know what I am talking about.

Just because a temporary crown works does not mean a permanent crown will work in the same situation (despite the dogma that we are taught in dental school). I have seen some thin temps that have lasted ages where a permanent crown just won't fit snow vice versa.

My advice is not to pay more, just don't make cost your priority. The only other advice I can give you is if you've exhausted your options and are still unhappy go somewhere else.

dentaldistress

Big_G wrote: »

You ask people to refrain from jibes about getting a cheap crown, and I'll ask you to refrain from jibes about crap dentistry in the republic.

I'm relating my experiences.

I have had bad after bad experience with dentists in the Republic (fillings that fall out and have to be repeatedly replaced, second opinions that completely contradict the first, an unnecessarily traumatic extraction etc). This is all after shelling out hundreds of euro (in case you think it's because I paid a tenner). I had a great experience in the North, for half the price. And before anyone insinuates that Northern dentists do cheap and inferior jobs, my boss lives in the North, has done all his life, and recommends dentists who he's used now for 40 years. So it's not me going a mile across the border for some dodgy Dan I've never heard of to do a root canal for fifty quid.

I'm sorry if that upsets you, but that's the truth.

I didn't come on here to ask about how much I should have paid for a crown. I came on to ask for advice on a solution. Instead I get numerous comments about how if I was willing to shell out a few hundred more euros I wouldn't be in this position. That's not necessarily true. There's an inherent smugness in some posts here suggesting that they automatically put my misfortune down to trying to skimp on costs.

If I think dental costs in the Republic are absolutely staggeringly overblown, I'll say so. I'm entitled to that opinion. And I'm not the only person with it. Hence people travelling across the border in their droves (happy customers, at that, I have friends who haven't attended a dentist down here in years).

Anyway, this isn't the debate and I'm sick of having it. Thanks for the actual advice.

btkm8unsl0w5r4

Don't know what is going on here it is all gone a bit weird, however OP
1. Your crown should fit without drilling the opposing teeth.
2. If the crown does not fit its not your problem, its the dentists problem. Its a technical fault either with the laboratory or the dentists preparation or impressions.
3. Sometime you do need to adjust the opposite tooth or filling, this however is explained in advance and should be minimal.
4. It is a fact that 500 euro is on the cheaper side for crowns (even in the North using NHS standard laboratory work), again however you should expect it to fit properly without much adjustment. Fit is a basic requirement of all crowns (to the prepared tooth and the bite). A lot of adjustment to a crown is a good sign it doesn't fit properly.
5. If you are not confident/happy in the work provided ask for your money back and go elsewhere. (where that is is up to you)
6. Pain is not a good sign in a root treated tooth. If it persists I would look into it. The root canal may have failed. I certainly would not have a crown permanently cemented onto it until your sure. I remember this tooth (you posted under a different user name) was tender after to root canal was done for quite some time, so your not being entirely honest with us