Crowns- cement visible & other issues

Ms White

Hi there,

I got crowns on my two front upper middle teeth. The day after getting them done I noticed a crack in one and a discolouration on it. Went back to dentist and she agreed it was "compromised" and they would replace it. I'm only getting around to going back this month. A few questions:

1) The cement on both crowns is actually visible at the gum and I can feel the "ridge" of it when I run my nail on it. Am I right in saying there should be NO cement at all visible on the front of the tooth?

2) She told me that there is no way to make the crowns sit exactly in line with the rest of my teeth (my teeth are straight and in good shape). Is this really true? I feel very conscious that the crowned teeth kinda stick out too much compared to the main line of my upper teeth.

3) Since getting the crowns done I have pain in one of them (the other had root canal done on it). When I went back and said this to the dentist she told me that the procedure of getting a crown can disturb the root, cause pain and if it doesn't settle down I might need root canal on it. Now she NEVER mentioned this to me BEFORE I agreed to get the crowns. Is that bad form?

So I am getting them replaced because of the crack but I'm just wondering should I ask about the cement not being visible this time and if she can actually file the teeth more so the actually sit in the "real line" of my teeth?

I just don't really know what is normal but I wasn't really happy with what has been done so far.

Appreciate any advice!

Oral Surgeon

Ms White wrote: »

Hi there,

I got crowns on my two front upper middle teeth. The day after getting them done I noticed a crack in one and a discolouration on it. Went back to dentist and she agreed it was "compromised" and they would replace it. I'm only getting around to going back this month. A few questions:

1) The cement on both crowns is actually visible at the gum and I can feel the "ridge" of it when I run my nail on it. Am I right in saying there should be NO cement at all visible on the front of the tooth?

2) She told me that there is no way to make the crowns sit exactly in line with the rest of my teeth (my teeth are straight and in good shape). Is this really true? I feel very conscious that the crowned teeth kinda stick out too much compared to the main line of my upper teeth.

3) Since getting the crowns done I have pain in one of them (the other had root canal done on it). When I went back and said this to the dentist she told me that the procedure of getting a crown can disturb the root, cause pain and if it doesn't settle down I might need root canal on it. Now she NEVER mentioned this to me BEFORE I agreed to get the crowns. Is that bad form?

So I am getting them replaced because of the crack but I'm just wondering should I ask about the cement not being visible this time and if she can actually file the teeth more so the actually sit in the "real line" of my teeth?

I just don't really know what is normal but I wasn't really happy with what has been done so far.

Appreciate any advice!

First off, a crown should not break in a day so it's good that they plan to replace it... Unfortunitely it is going to be made at a different time to the other crown so not as easy to match...

No cement should be visible, end of story. Long term recession or gum disease may cause the crown root margin to become visible but the crown should not begin life like this.

The crown to root junction should be imperceptible to a sharp probe so you feeling it with your fingernail is not good. A ledge like this allows leakage, decay, teeth to become dead, gum problems... And looks bad...

If the crowns look bulky and you are feeling this ledge and a crown has broken and cement is showing, it sounds like your dentist may not have prepared enough tooth away both at the margin of the tooth/root gum area and off the lip side if the tooth. The lab technician needs to build a thickness of porcelain to give the crown strength so maybe this space was lacking.
Did you approve the crowns prior to cementation??

Crown prepared teeth are at increased risk of nerve and pulp problems, this should have been mentioned. Similarly, root canal treated teeth with poorly fitting crowns are at increased risk of re-infection.

Possibly your specific situation is tricky and your teeth are angled so your dentist has a tough job in changing the angulations of the crowns and this can lead to compromises but still bottom line is that crowns should fit, have no visible cement and look like teeth and not.bulky crowns....

Os

Ms White

Thanks for the comprehensive reply!

First of all the dentist agreed to replace both crowns if I wish because as you have said, it would be hard for them to now replace just one AND get it to match the exisiting one perfectly. The reason I got two in the first place and not one was for this very reason: they told me it would look better to get a matching pair considering how noticable these particular two teeth are. I plan on getting both replaced for this reason.

I don't believe the crown broke after it was put in, I think the crack was there all along but I only noticed it the day after. Same with the discolouration.

To answer your question, yes I did agree to the crowns before they were cememted in but to be honest I really don't think I was in my full mind if you know what I mean. I had never had crowns fitted before,didn't really know what I should be looking out for e.g how in line they should be with my other teeth, cracks, discolouration etc and trusted the dentist and the dental nurse when they said they thought they looked great. Remember that the patient is drugged with anesthetic at this time and I was a bit shaken by the very unpleasant procedure of getting the temporary crowns removed just before having to evaluate how good these looked. So all in all it's kinda hard to really critique them when you are feeling so rough!!

I'm glad to hear the cement thing seems all wrong- I really felt this couldn't be right but at least now when I go back I can be more sure of myself in saying that I want the new ones done with absolutely no cememnt on the front of the tooth.

As for them sticking out a bit I suppose all I can do is ask her if it is possible to prep the tooth a bit more so that they sit back a little and look more in line with my other teeth.

One last question: she told me that for a natural look, the front middle teeth should be the same lenght as the eye teeth. So I went along with that because she told me like it was some sort of rule. But add in the fact that the middle teeth are now sitting forward slightly I think they appear to be LONGER than the eye teeth. I feel the crowns look a bit "horsey" due to the appearance of them looking "long". Would I be right to suggest that really they should actually be shorter but because they are slightly forward they will have the appearance of being the same lenght as the eye teeth rather than longer??

I'm not sure if I explained that too well!

btkm8unsl0w5r4

Dont worry about the technical aspects of the crowns, its not for a patient to worry about them, you have only to decide if you like them or not. Be fussy at the try in as its much fairer on the dentist to change things at that stage, the dentist will now be having to pay for a remake of the crowns.

Ms White

You are right, the time to be very very fussy is at the beginning.

Bear in mind now that I am going back to get these redone, not for asthetic reasons, but because there is a fundamental flaw in them. I'm simply taking this opportunity to improve on them asthetically as I feel maybe I wasn't fussy enough in the beginning and I kinda trusted the dentist too much when she said they looked good.

In a way it is a blessing in disguise that there is something wrong with them as it is giving me another chance at improving the look of them.

Lesson learned though and I hope anyone who is going for crowns for the first time reads this: be very very very fussy and take lots of time to scrutinise them before they are cemented in. And don't feel bad about saying you simply want them remade if the first version are not right for you.

Oral Surgeon

Your temporary crowns should be the shape and size that you are happy with. The margin should also be just at or below the gum line so not visible to you.... Sure the colour and texture will be different...

The temporary stage is a good time to get these things right, not when the expensive crowns have been made.....

btkm8unsl0w5r4

Please also remember your going to get what you pay for, a "value" crown is not look as good as a 3000 euro one, be realistic that if you have gone for maximum low cost then expectations have to be realistic, it is unfair to expect a dentist charging 600 for a crown to get the same results as one charging 2-3 times as much.