DENTAL CARE

Q: Why Do I Need Two Crowns?

A: This question prompts another common discussion in my office. Whenever a crown is needed for a patient, I usually explain the various treatment choices before we begin. I explain this to my patient and we discuss which way to proceed. We talk together and come up with the most appropriate choice for that person in that situation at that time of their lives. What is appropriate for a 21 year old may not be the best choice for a 75 year old. Medications, life style and remaining teeth all may influence our approach. We can talk more about this and we have on previous occasions. Let’s leave that for another time. Right now let’s get back to our subject of two crowns. Once the patient and I determine that the proper treatment is a crown, an explanation then ensues. What are our goals and how I hope to accomplish them. As part of the process of crown fabrication there will be a time between the tooth shaping and the delivery of the final crown. This can take days or even weeks depending on the circumstances. The shaped tooth requires protection during this time period. In cases where the tooth may be sensitive, this cover will solve that issue. Even in cases where there is no sensitivity, a temporary crown is still necessary. Besides protecting the tooth, the temporary crown keeps the tooth in position so that it does not drift. Teeth are always trying to move and they need gentle restraint to keep this under control. The gentle restraint is accomplished in this case by the temporary crown.

Now we have established that we will make a crown to cover the tooth in the interim time between our first appointment which is the “preparation” appointment and our second appointment which is the “seating” appointment. This crown is made by the doctor and cemented or glued in a way that it will stay on for as long as it needs to be there, but comes off easily enough when it needs to be removed. Here is where the question comes into play. If I make a crown to cover the tooth while waiting for my lab to make a custom crown, why can’t this be the final crown? Why can’t I use this intermediate or temporary crown and make it permanent. Today we have very cosmetic and strong materials that we use for temporary crowns. These look great. So let us put away the temporary cement, which is weak by nature, and replace it with a stronger, more permanent cement.

One main answer to this is contours. It is much more difficult to create a crown with the proper shape vis-a-vis other teeth when working directly in the mouth. When we send an impression to the laboratory, a model of your mouth is created. This model is where all the work takes place. The model can be held, turned and looked at from various angles. The tooth can be viewed as if one was standing in the back of the mouth and looking forward. This allows us to create a shape that will be resistant to food trapping and allow chewing to function in the most efficient manner.

I saw a new patient this week who had a temporary crown on an implant. That temporary had been there long past it’s usefulness. As a result she had food sticking between it and the adjacent teeth. She came to me because she was in great pain. The sticking food caused decay on the teeth in front and behind the temporary crown. As a result of these inadequate contours of the temporary crown, she required two root canals and two crowns on these side teeth. Fortunately, she is now out of pain and doing well. However, all of this could have been avoided had she returned to her dentist to finish the case properly and not rely on the temporary crown as a final treatment.

The moral of the story is to try to establish and appropriate treatment, start the process and finish it in an orderly manner. Completion of planned work is vital for continual health in the mouth. If you are involved in some treatment, but for whatever reason, there has been a delay in completion, let me help you finish or come up with an alternate approach for you. Together, we can reach your goal of looking and feeling good. I can be contacted at 440.951.7856. Have a great week.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile 34586 Lakeshore Boulevard (¼ mile west of Route 91 on Lakeshore Blvd) Eastlake, Ohio 44095 440-951-7856 Severance Medical Arts, Suite 603 5 Severance Center Cleveland Heights, Ohio 44118 216-371-2333 www.jeffreygrossdds.com

Jeffrey Gross, DDS, FAGD