Re: Did I get a sloppy crown prep?
From: Bill (dentaldoc_at_hotmail.com)
Date: 12/31/04
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Date: 30 Dec 2004 17:02:02 -0800
Patrick wrote:
> Hello folks,
>
> I am a male in my late 40's in good general health. I have about a
> half-dozen fillings and an old crown on a lower molar. Recently a
> corner broke off another molar.
>
> I had the crown prep about a week ago, and the crown is supposed to
be
> ready early next week. I am not very familiar with the dentist,
> and I worry that I might be getting a sloppy job.
>
> I'm trying to include the relevant facts--sorry if this is
long-winded.
>
> The broken tooth had a big filling for about 30 years. It has given
> some pain in the past several years, mostly when chewing. I was
chewing
> a steak some months ago when the inner front corner broke off. The
> dentinal surface of the shard is an ovoid about 4.5mm high and 5.5mm
> wide. The shard is about 2.5mm at its thickest. The exposed
dentinal
> surface of the tooth extended about 1mm to 2mm below the gum line.
>
> Before the prep, the dentist said my gums were healthy. He showed me
> the X-rays, which seem to be of good quality, and he said he didn't
see
> anything wrong with the root. I pressed him a bit to mention any
> possible complications. He only mentioned that the fracture surface
was
> partly below the gum line but acted like that wasn't much of a
problem.
> We determined to use a porcelain-covered metal crown.
>
> Maybe it's not justified, but I'm having some worry related to the
> doctor's demeanor, the appearance of the plastic impression, and the
fit
> of the temporary.
>
> Making small talk while waiting for the novocaine to work, he seemed
> something like depressed or apathetic. Really it seemed like he
didn't
> put much care into prepping the tooth. It seemed like he was working
at
> arm's length, as if he was barely looking. He was about to go in
again
> when I stopped him to spit. Then he didn't go in again after all, as
if
> he didn't want to go to the trouble.
>
> He showed me the impressions when they were done. When he held them
up,
> I could see light through the plastic where the prepped molar had
almost
> touched the opposing tooth. He pointed that out and said he would
have
> to adjust the opposing tooth (which has a medium-size filling in the
> center). He also mentioned that the impression showed the fracture
> line. I am thinking he didn't remove enough dentin.
>
> With a penlight and a pair of strong reading glasses I see two
irregular
> 4mm holes in the anodized surface of the aluminum temporary. In the
> holes I see white material, presumably either dentin or cement. The
> white areas are each about 2mm in diameter. I can't get floss
between
> the temporary and its neighbor. Maybe the question is whether there
is
> just a poor temporary fit or not enough dentin was removed.
>
> I was thinking I might tell the dentist I am uneasy and take the
crown
> and the models to another dentist to check before setting the crown.
It's not likely he would just let you have something you haven't fullly
paid for, just to take to a different dentist. Would the criteria for
selecting the second dentist be any different, or any better, than
those used in selecting the first dentist? The first dentist could be
insulted by your evident lack of trust. The second dentist generally
would not be eager to open a can of worms which wasn't his problem in
the first place.
You said that you weren't very familiar with this dentist. How did you
select him to perform the crown preparation?
It can be helpful to let a dentist know that you selected him based
upon his longstanding reputation for careful, meticulous dental
treatment. Of course, tell him this only if it is true.
If he has any reason to suspect that you paid no particular care in
selecting a dentist, then human nature (unfortunately) may come into
play here. I don't know the particulars of this situation, but I
suppose it's possible that the degree of care he put into the crown
preparation may reflect what he feels about the degree of care you put
into selecting him as your dentist in the first place.
Guard against letting an insurance company select your dentist.
Nobody on this newsgroup can see the tooth in question, so it's
impossible to judge accurately the parameters of the crown preparation.
I always recommend developing a personal relationship with your own
dentist over time, so this type of question can be discussed and
resolved with him directly.
Good luck to you. Let us know what you decide.
Best regards,
- dentaldoc
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