Old Crown Replacement: Fixing the Bad - Ugly - Leaking
Longevity of Restorative Ceramics
Dental crowns, a popular restorative component for replacing teeth, under ideal conditions can last for many many years. Failure can occur early in some instances due to the how the crowns are implemented, as in standard bridgework. Because of the characteristics of normal bridge structures, and especially in long spans, crowns can fail every few years.
Individual tooth restorations incorporating porcelain crowns should have much longer years of service and endurance. A crown that fails in this type of treatment may falter because of cementation issues, leakage, underlying decay, underlying tooth sensitivity, inadequate build up of the existing tooth, improper post installation (if used), implant device failure (if used), contamination of or improperly prepared bonding services, extraordinary bite and occlusal forces and many more.
Product failures are rare, but still occur. These problems usually center on poor color characteristics and failures in porcelain to metal fusion (where occlusal - physical forces are not responsible).
Diagnosing Crown Failure Dynamics
Skill, substantial experience, creativity and raw talent are required for diagnosing the cause of failure and how to remedy it... permanently. Doctors who rely heavily on the use of articulators are best able to diagnose, understand and manage the bite problems and resulting unbalanced forces that can destroy what was once very good dentistry.
Most importantly, porcelain restoration components are subject to the same wear and tear issues as normal teeth. Furthermore, since ceramic teeth are structurally less resiliant than natural teeth, they can cause uneven wear on opposing natural teeth.
Our patient, as can be seen in the 2nd preop (before) photo, provides evidence of different types of crown failures.
Her gums were bleeding, some crowns were poorly contoured, color consistency was failing, leakage (bacteria seeping through bonding at the margins) and were causing uneven wear on her mandibular (lower jaw) teeth.
A thorough examination of the patient's dentition and in depth study of the occlual relationships led to the recommendation of twelve (12) new all porcelain crowns.
Critical Articulation Analysis
The use of an articular and diagnostic wax ups enabled the dentist and the patient to create the needed components that recreated the normal dental function the patient was lacking, as well has providing a modeling basis for obtaining the precise cosmetic result the patient wanted ... without mistakes.
Our last 2 postop pictures dramatize the impact that normally sized and shaped restorations can have on a smile.
The patient's bite has been opened, her upper jaw structure now provides adequate support for her upper lip movement and lastly, smiling appears to be natural rather than a conscious effort (compare to before pictures).
Gum Reshaping - Ginvigal Tissue Contouring
For final cosmetic treatment that puts the finishing touch on major full arch restorative treatments is gum shaping and recontouring. The before photos reflect an uneven and unflattering gum line. A soft tissue laser was used for reshaping the gingival tissue according to the patient's specifiications.
Replacement of porcelain restorations, considering the rapid advancements being made in products and specialized treatment techniques provide wonderful opportunities for people seeking natural and healthy smiles that can endure for many many years.
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