Dentistry/Poorly Fitted Permanent Crown
QUESTION: I went to my dentist because a piece of a tooth broke lower left not from trauma but I think it had a filling that fell out and the tooth decayed under it. I think it was the back of 19. After a lot of backstory I won't go into, they started work on 19 and 18. I don't know why anything was done to 18 in retrospect unless the decay was across both teeth. Also, I had no pain in either tooth and no trouble eating. Just wanted to get the hole fixed.
Anyway, they did a root canal on 19 because of how deep the hole was and repaired and filled it and 18 just got a filling I think and a temporary crown was put on. The temp fit perfectly against the tooth but was a tiny bit high. I couldn't tell at the time since I was so numb but it was such a small difference that once all of my swelling and everything went down from the work two days later, it was fine and I was able to eat on the left side without any pain and it didn't feel like I even had any work done, just like it was my regular teeth.
I came in two weeks later to get the permanent for 18. Metal with porcelain. He couldn't get the crown to stay on the tooth. It felt almost like it was too big or shallow and had no way to grip my tooth. He would sit it on the tooth and press down on it as hard as possible and it would just fall right off.
I voiced my concern that something was wrong with the crown because I've never had a crown that didn't fit the tooth properly. He just kept saying the fit was perfect even though he couldn't get it to stay on. He decided to cement it so he could work on it which bothered me because I thought maybe the crown needed to be redone but he said no, it was fine.
He went to put it on again after doing some work on the tooth and when I bit down, I felt a crunch like there was a potato chip underneath the crown. He said it was fine and I said no, it wasn't, and he lifted it up and said there was maybe some debris under it but it's gone now.
After cementing it, he asked how it felt. I told him it was extremely high because normally all of my teeth touch snuggly and flat when I bite down but now 18 was the only one touching. I also said that in addition to the bite feeling too high, the bottom of the crown just didn't feel right on my tooth. He said again that the fit was fine but adjusted the top.
After two adjustments, I said it still felt wrong, too high and almost crooked, but at least closer since now some of my teeth were slightly grazing each other again and he said he wouldn't adjust it anymore because it looks fine to him and nothing is showing on the paper so wait a few days for everything to settle down.
This was a Friday and they're not open on weekends. I went home and noticed that he'd already taken off some of the porcelain which bugged me since the adjustments still weren't right. I tried to eat later that night and it was horrible. I couldn't chew on the right side because 18 was so high, it would smash against the upper teeth every time I bit down and cause pain and I couldn't eat on the left side because 18 didn't feel comfortable when I bit down on it and it kept my right side from touching enough.
18 was so high that sometimes even when I was talking, it would bang or graze against the upper teeth and hurt. After a weekend of this with me trying my best to keep my teeth apart, I started to get a lot of tenderness in 18 and I recognize it as the kind I've had when a tooth's root was inflamed. I started worrying that this poor fit and trauma was injuring the root which was healthy before even after getting the temp.
I had to go out of town that week so I only ate liquid and mushy foods I didn't have to chew and made an appointment when I came back the following Monday but my dentist could only see me that Friday so this is now two weeks since having the permanent crown put in. The tenderness was still there but not as bad since I stopped doing any chewing.
I told him what's been happening and that I still felt the crown wasn't fitted right to my tooth and he said again that the fit was fine. I said I was concerned about injury to my root and he said there wouldn't be and didn't even do an x-ray. I said could he at least fix the height and he said at first it was fine but then I insisted so he made some more adjustments. The bite felt a lot better but the fit still felt wrong. He then put the permanent crown on 19 and said that all the pain I was feeling on 18 was probably just me having sore gums or something.
As usual I still couldn't eat on 18 and there was still the bad tenderness and the feeling almost like 18 had a space or something between it and the underlying tooth whenever I tried to bite down on it. I also noticed that the crown on the opposite side same tooth feels smooth at the gumline but this one on 18 feels like it's sticking out really far like it's too wide in addition to being high or crooked or something.
I made another appointment with him to look at it again because I didn't yet have another dentist to go to and the pain was getting worse. The tenderness to the touch itself had finally gone away to where it was only a little noticeable but the overall pain had spread down into my jaw and up into my ear and I was afraid 18 was now infected from this messed up crown.
When I saw him, I expressed to him again all of my concerns and again, he didn't do an x-ray and wouldn't consider that the crown was wrong. He just kept saying it was normal to have pain and said he'd just adjust the height of 18 and 19 again and that if it didn't feel better, come back. I told him I didn't want to keep coming back indefinitely, I wanted him to address and fix what's wrong now before it gets any worse. He just kept saying that it was probably just because the tooth is in a tight area or because I have sensitive gums or who knows what.
I was so upset, I left. I found a new dentist I haven't gone too yet but I heard good things about so will make an appointment but meanwhile I'm still having the jaw and ear pain and the 18 crown still hurts and feels crooked and just generally ill-fitted. I maxed out my insurance at this dentist this year with all the problems with their different dentists screwing up and me having to go back a million times so these two crowns, I paid for out of pocket.
I don't know how long it'll be before I can get in to see this new dentist and I refuse to go back to my old one for anything. In the meantime, my question is, what could be wrong with the crown that's caused all of this trouble on a tooth that felt fine and was healthy according to x-rays before he put it in?
I'm afraid that his shoddy work and failure to take proper steps to make sure everything was fine are responsible for injuring my root and causing problems with my jaw or an infection (I'm on a short course of antbiotics just in case) and I think they should refund me for the 18 crown but suspect they won't do it.
How do I ask for a reimbursement, what would I need to prove? Should I wait until my new dentist examines me first so I can have proof of the second opinion if she confirms that a bad job was done? And if they won't give it to me, how would I file a complaint against them without needing it to be a legal battle that I have no money for?
Beyond that, if my crown needs to be redone (which I feel it should be), how easy will that be? Is it hard to take off a permanent crown and will they really have to do a lot of prep work on the tooth again or can they just clean it and do another impression? I've never had a problem like this with any of my crowns and I hate that it was supposed to make things better but all it did was make everything worse. Thanks!
ANSWER: i am sorry to hear about all of these problems. it all sounds like the bite was off from the beginning and never quite adjusted correctly. that would explain all of the pain you had. you need to get into the new dentist ASAP and get this finally adjusted.
if you need the crown redone, it is not that difficult to get them off, particularly if they are a porcelain fused to gold crown. some of the new all ceramic crowns are tougher to get off, but they too can be removed. if a new crown is done, then you will need to ask the first dentist for a refund. this can be difficult. you need to do it very nicely and in a non-threatening manner. the dentist will be defensive. but you can tell him/her that you let him/her try numerous times to correct the problem and you had no choice but to get a second opinion. see what kind of reaction you get.
you have had other work done and know that this is a fluke occurrence. i cannot explain all of what took place without being there to see things in person, but it seems that you are on the right track to get it all corrected. good luck
jeff dalin, dds
---------- FOLLOW-UP ----------
QUESTION: Thank you so much for the reply, Jeff! So all of this could have just been caused by the bite? Is there any chance that the crown itself wasn't right regardless of the bite? Because it never felt right with how it was sitting on my tooth, not just with how it met the one above it.
I didn't think at the time that he did the impression well but didn't think anything of it until the crown came back and it wouldn't fit on my tooth at all. The temp fit perfectly so my first thought was that a new impression needed to be taken and the crown remade which I've heard isn't that uncommon but he said it was perfect.
If it wasn't perfect, could that explain why it wouldn't stay on my tooth and why it never felt like it was actually connected to my tooth even after he cemented it?
Also, I stumbled across someone who had a similar problem with their permanent crown and the sensation they described reminded me a little of mine and he also got a second opinion and his new dentist said the crown should have been remade because there was no mechanical retention. What is mechanical retention?
Thank you again, that's my last question :)
retention is accomplished by the shape of the preparation. you try to retain as much height as you can and you try to keep the walls as parallel as you can. sometimes you are dealing with short teeth and tight bites so you end up with very short preparations. this is not unusual at all. in these cases you rely more heavily on the bonding ability of the cement that you use.
there is no way for me to determine how this crown fits or why things were done in the way they were done. the new dentist you are seeing might be able to give you a better answer.
i hope this information helps...good luck
jeff dalin, dds