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Dentistry/Tooth fracture

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Question
Hi doctor,
I actually had a question about a patient who had a silver crown placed 5 years ago on #30. A month ago he had a small occlusal composite placed on opposing tooth, initially no problems. About a week ago, started feeling sensitivity on 30, but only to biting. Tooth not root canaled, but patient didn't complain and cold and hot sensitivity. Just to biting. Occlusion checked, and reduced on lingual cusps 30 where occlusion was heavy, but not in contact with opposing new composite at all. Told patient to let it heal for a week or so and we can reevaluate it if further pain experienced.
Radio graphically ok, crown fits well, pocket depth wnl,  only sensitive to biting, no vitality tests done.  Prior to dismissal patient stated he thinks previous  dentist placed crown because it was fractured tooth.
If patient returns, I'm wondering to remove crown-assess fracture. If nonrestable, extract and think implant since patient missing 31 and 32. If restorable, need a root canal and new crown, which still has questionable prognosis and may eventullay need extraction. What will u advise to do??
Thanks, :)

Answer
Hi,
There are two things that I might want to do:
1. As you know, there is static occlusion ie maximum intercuspation, and there is dynamic occlusion which is teeth contact on lateral excursions. I would use the 8-mm shim stock articulating paper to verify centric occlusion and make sure that there is no interference on lateral excursion ie no contact between 30 and the opposing tooth when chewing.
2. If that doesn't help then I would refer the patient to an endodontist for evaluation before removing the crown. If endodontist says that tooth needs a RCT then I would give the patient the option of doing RCT through existing crown specially since you mentioned that margins are OK. Otherwise if you remove crown and endodontist says no RCT is needed then patient might get upset for having to pay for a new crown. At the same time you want to explain to patient that crown might come off during RCT and in that case patient will need a crown anyway.

Hope this helps.

Regards,
M. Elsafi, DDS

Dentistry

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Mohamed Elsafi, DDS, MS, FACP

Expertise

I am a board-certified Maxillofacial Prosthodontist. I do head and neck prosthetic reconstruction for patients with congenital and acquired defects. This also includes trauma and cancer patients. I can answer questions about prosthetic rehabilitation of the head and neck area. I am also a board-certified prosthodontist and can answer questions about dental reconstruction including crowns, bridges, veneers, partial and complete dentures and implant restorations. I can also answer questions about TMJ problems. I can not answer about surgical reconstruction.

Experience

I am a board-certified prosthodontist and maxillofacial prosthodontist and have been practicing denitstry for over 15 years.

Organizations
American Academy of Maxillofacial Prosthetics. American College of Prosthodontists.

Education/Credentials
I received my dental degree from University of Southern California. I did my prosthodontics residency at University of Florida and my maxillofacial prosthetics fellowship at MD Anderson Cancer Center in Houston.

Awards and Honors
Chief Fellow at MD Anderson Cancer Center.

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