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Do I need a crown
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Do I need a crown

My molar, upper right secound from the last, had its old worn amalgum filing removed one year ago and replaced with a new silver filing. This tooth developed a cracK and now one of the cusps have broken off below the gum line. I can see the filing and I am syprised by how much space it takes up. I do not like going to the densist, and I want to preserve my teeth and do what ever is the most long lasting work so I can avaid going back. I do go to my densist every 30months for cleaning and a check up. I do not carewhat the costs are because my irrational fear of dental work far exceeds what my dental bill would be. First question did we (my dentist and I ) make the correct choise in replacing the olg worn filling with another silver filling? would a porcelin filling have been better, less tooth structure removed ? Now with the one cust broken off, is the potentialy most long lasting solution to this molar a gold crown? Or is an inlay better? Or what would happen if I do nothing? I want to preserve my teeth with limiting the time I will have to have more work done in the future. I do not want to do just a patch job I want to have done whatever is best for my tooth with out any caring on costs. cost do not matter. I hope I explaind my sisuation well enough. Looking forward to your answers.
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14 Comments Post a Comment
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748543_tn?1371753642
Well , I have not had any silver amalgam in office ohh for at least 15 years.. I don't see the rational for changing one big silver filling with another one.. they end up cracking teeth..
Now, as what to do.. If your tooth has cracked, as you said, below the gum line you need to check couple of things first.. whether you need crown lenghtening or not and should you do a prophylactic root canal before the new crown.. because that is what you needed in the first place. If you don't mind Gold.. then that is the longest lasing restoration you could get, but make sure the job is done right, meaning no shortcuts with the gum line and/ or root canal, you don't want to get a crown and six months later need a root canal thru it and destroy the crown.
good luck.
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Avatar_n_tn
The one cust broke off my molar before the gum line not underneath it. Why do I need a root canal? The tooth feel fine.
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Avatar_n_tn
Also accourding to my dentist, he recomended another silver filing because the amount of tooth structure he would have to remove would be less then a ceramic filling and the new silver filing could last anither 30 years. I was never told that the silver filing could crack my mplar. If I was aware of that I would not have followed his recomendation. I would like to save my molar. What should I do? Get a another dentist to look at my molar? The piece that broke off is small, it was only one of the 4 cusps. Could I leave it alone or would the integrity of this molar be compromised and furthur damage will occur?
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Avatar_f_tn
your tooth could have cracked with a ceramic filling also. my dentist usually recommends a crown when my large fillings need replacing. sometimes teeth crack and others last another 20 years.  dont go for the do nothing option. the tooth is already damaged and will only get worse without some kind of action. the tooth should have a crown (gold is strongest) and be checked to see if a root canal is indicated. even if a root canal is not needed now you may need one in the future and if they do drill thru the crown it will not destroy it like the dr nassery claims. if you want to do the best for your teeth cleaning and exams are important. if you go every 6 months you will dramatically reduce more extensive dental procedures!
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748543_tn?1371753642
In your first post you clerly wrote " and now one of the cusps have broken off below the gum line"
If that was correct then you possibly need the gum repositiioning, if now that is not the case then you can just get the crown.
Now as for the expert opinion of Lynn...it is a known fact that silver amalgam expands and that is main cause of internal micro fractures in the dentin and enamel, these fractures are not readily obvious to the naked eye. However, a bit of magnification and you can see them all over.. if the tooth fractured now that means there are many other fracture lines in the body of the tooth.. and that means there is a great chance that bacteria can easily find their way to the nerve chamber, specially after tooth preparation for  a crown. Hence the recommenation for a root canal eventhough the tooth seems fine now.
As for Lynn suggesting that my "claim" about cutting through a crown does not destroy it.. well lets just say that is probably what her dentist told her when he/she had to do the root canal through her crown.. and since she is the expert here I guess she knows all..Little bit of knowledge can be dangerous.

However, conventional wisdom says that when you put a handpiece at 400K RPM to a crwon that was lutted in with cement, you will break the cement seal and the crown will start leaking anf will have recurrent decay in short time..that is of course regardless of the big hole on the top surface that now need sto be patched with a different material.. and the material of choice for a gold crown and now you have a great galvanic exchange of metals to leach out great amount of mercury into your system..
then again what do i know , only been doing this for 17 years.
all the best
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Avatar_n_tn
My molar cusp did not break off below the gum line. I am sure of that. I will get a gold cap/crown on that tooth. Is this a common procedure for dentists? Is there a speciality dentist for this or is it in the same catagory as filling a cavity? With a gold crown I read that the molar only need 1 mm of tooth has to be removed for the crown to fit and a gold crown needs the least amount of tooth material to be removed. Is this true? Is a gold crown the most long lasting? Why do you recomend a root canal? Can I just have the tooth shaved for the gold crown without a root canal? When my next silver filing wears our what do you recomend for a replacement? Thank you foe all your help.
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748543_tn?1371753642
If the tooth is not broken below the gum line then the crown is fine. A gold crown should be well within the skill set of a general dentist, however, if you want more expert skill you could see a prosthodontist.
As for the other matter, I am not recommending a root canal, I am merely mentioning that it should be discussed as a possibility, and shold be part any clinical judgment. When  you shave a tooth with a handpiece at the speed I have mentioned before and an average of 37lbs of air and water pressure you could easily push the bacteria throught the few millimiters of crack lines and tubules into the nerve chamber and cause irreversible pulpitis.
As for the reduction rate for gold crown, you are almost right, except for the bitting surface, that should be 1.5-2mm thick specially in molar area. Just make sure there is no silver left under it/
Good luck
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Avatar_dr_m_tn
Hi Larry,
I agree with Dr. Nassery here. The first thing I would do is to figure out why did you get the crack on this tooth? There are design issues with any type of a restoration or crown or filling that needs to be done. Unfortunately, the design issues are not taught or not as important to the dentists at a certain level. Not all dentists are created the same, so some they ONLY offer you a crown and see that as the only option. Some only do a certain type of Inlay/onlay ceramic or gold, etc. Each one of these restorations are great in a certain type of a situation. So the dentist needs to be well versed to be able to give you the best options and for them to be able to choose the right material and the right type of a restoration for you. If you are hesitant and do not like to go to a dentist, find someone who does sedation, and go more often so you can have more proactive treatment done, vs. reactive treatment which means more aggressive work, more costly and more work on you with not as good a prognosis.
I would look for someone who has this type of a training and does sedation dentistry.
http://www.top3dentists.com/pages/prosthodontal
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Avatar_n_tn
Hi Shervin:
The reason my molar cracked is because my old silver filling from 35 years ago was worn through. I aked my dentist what would he suggest as a replacement. The two items  i wanted were longivity and the least amount of tooth material that had to be removed. He told me a silver filing would be best. He said less tooth material to me removed and it would last long like the one he was replacing. So I said OK. After he was done repacing the old silver filing with a new silver filing I didnotice that this molar lookd gray. This molar was so thin in this area that the silver amalgum showed through. So much for less tooth material being removed. This filling was installed about 1 year ago. So bout two months ago this molar cracked and 1 week ago one of the cusp broke off. It was a cusp in the front, and it did not break off under the gum line. I can see what look like a large(to me large) silver filing behind where the cusp broke off. The silver filing takes up the whole area. I was told that I need a crown and that a gold crown need the least amount of tooth material to be removed. I now am not sure my dentist has the skills to do this work without making my tooth a spike (too much material removed) and covering it up with a gold crown. Should I be concerned? Are some dentists more skilled then others in the area of removing just the correct omunt of tooth material to fit a crown? Am I being to picky? Does it matter how much tooth material is removed because the crown will cover it up anyway? How much does the skill of the dentist and crown lab have on the longivity of the crown lasting a long time? I still have not done anything yet and I believeI have to so I can save this molar. Thanks to everyone for your input and help!!
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Avatar_n_tn
How important is is to remove the silver filling before the crown is installed? If the filling is removed what does the dentist have to put in the hole to fill it in befor the crown,or is the crown cast with the hole i my tooth once the filing is removed? Also if the filig is deep and the dentist removes it won't that increase my chances of needing a root canal? Is it better for me and my tooth to see a specialist for crowns?  Because of my obsevations of my dentist concering this tooth (see last posting) I am not sure if his skills are in my best intrest. Thank you for your continued help!!
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Avatar_n_tn
I forgot to add, and it took me a while to figure out, it is not that I am afraid of going to a dentist. I do go every three month for a check up and cleaning. It is just that I did not expect this molar to crack and a cusp piece break off. I believe ( and I could be wrong not  being a dentist) that if my dentist was more skilled when he removed my 35 year old filling he would have removed less tooth and I would not have seen grey under this molar whan he was done and subsequently this tooth would not have been structualy compromised (made thin) so it would not have cracked and finally broke off. I do not want to have  a less the skilled dentist shave my molar down and install a crown. I guess that is why I am having such an issue. I am overreacting, and is my analysis of my observations  of my dentist, concerning this molar, incorrect?
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Avatar_dr_m_tn
Hi Larry,
There are many different things that can go wrong with having dental work done and you are right on, that the more skilled dentist is required, even for something that might seem simple. Dentistry and dental materials have advanced over the past 15 years so much that most dentists are not up to date and they do not understand the engineering aspect of dentistry, the physics and the materials and they are limited to one type of restoration or one type of material. If all you have in your tool box is a hammer, everything is a nail to you! Also, I thought you had said every 30 months, that is why I mentioned about the fear issues. You seem to be on top of that however. As I had mentioned to you, find a highly qualified dentist, someone who can make the right determination, that they will not just jump in there and start drilling, but someone who can assess and figure out what is the right restoration and treatment plan for you, your tooth and they can look at the big picture and your whole mouth and person as opposed to a tooth walking into the office.
Keep me posted as to the progress of the case. Sometimes even venting out helps!
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Avatar_n_tn
Yeah, so my dentist has been doing this for nearly 40 years.  He shows me digital x-rays of my teeth and any decay BEFORE doing any dental work.  He's also shown me pictures of dental work he has done on past patients....  including composite fillings that he placed in the 1980s that are still in service.

I'm not sure why he wants me to have a crown put on a tooth that was filled by another dentist 3 months ago.  The filling is large, but there is no pain or leakage (there was some sensitivity after it was put in, but that has gone away).  I know the filling will probably not last forever, but I do wish I could wait at least a few months with getting a crown.  My husband will be graduating from grad school sometime within the next year, and hopefully, we will be able to afford dental insurance once he gets a job.  Also, I would like to wait and see if more info comes out about the all-zirconia crowns in the next year or so.

The one thing he has said is that he is absolutely certain the tooth does not need a root canal right now, and that, if I do need one in the future, drilling through a crown is usually not a problem.
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784382_tn?1376934640
get a new dentist.....they dont even teach how to do silver fillings anymore in fdental school, because there are such better ways to fill teeth now a days.

(dental student) =)
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