Expert: Lawrence Spindel DDS, www.lspindeldds.com - 11/21/2008

Question
Hi,

I just got  a crown on my back molar after a root canal.  The process was
grueling and more painful than the root canal I got a week and a half earlier.  
It took a while to get the crown to fit on the peg they made.  Once they stuck
it on, I couldn't bite down completely. They had to drill/sand away the crown
to fix my bite.

My question has to do with the way the crown looks.  It looks like a white box
in the back of my mouth.  There are no bumps and grooves that would make
it look like a natural molar.  Is this normal?  I got the impression that my
dentist was new to crowns.  His assistant was giving him advice as to what
another doctor does.  Did he sand away the aesthetic part of my crown?  I'm
relatively disappointed in the look because it was expensive.  If it is normal, I
can learn to live with it.  Is a smooth, white box a normal representation of a
crown for a molar?

Answer
Dear Shannon.

In my practice, when I get a new patient who needs a crown, it is not at all uncommon for them to complain that they do not like the way there previous crowns look and they ask me the same question you asked.  I explain that I can make them an aesthetic looking crown.

I accomplish this by carefully preparing the tooth and impressioning the tooth for the crown. The dentist must give a lab sufficient room and the proper shape in order for the lab to fabricate an aesthetic crown.He also must choose a good dental laboratory to make it(Porcelain crowns can vary in their naturalness from lab to lab.  When fitting the crown, sometimes the anatomy is ground off, but the crown can be polished and recarved by either the dentist chair side  or by if the dentist desires he has the option of returning the crown to the lab for recarving and glazing.

If your dentist did have to do a lot of adjustments to allow you to properly close your mouth, he may have ground away much of the 'occlusal anatomy' that the laboratory made for the crown. This would not have much to do with how long the crown will last and the aesthetics of back crowns usually are not as important as in the anterior section of the mouth.  If food is not getting stuck between the crown and adjacent teeth and the tooth is comfortable, I would not suggest you ask your dentist to redo this crown.

There is nothing wrong with mentioning at some point to your dentist that you are not entirely happy with the result. In this discussion it might be helpful if you could explain what about the crown you do not like and then see what he has to say.  However, If you do mention your unhappiness, he may offer to redo it and then you will have to decide if you want to go through the process again!

Good Luck and I hope I have explained the process to your satisfaction and please feel free to contact me again with future dental questions.