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Repair Small Hole in Gold Crown or Completely Replace?
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Questions in the Dental Health forum are answered by Dr. Jerome Tsang. Topics covered include bridges, cavities, crowns, and x-rays.

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Repair Small Hole in Gold Crown or Completely Replace?

In an exam yesterday my dentist characterized one porcelain crown on an upper back molar as not being the best size and shape-- he felt it was too large-- my gaps were 1's and 2's mostly but 4's around this porcelain crown-- anyway, this porcelain upper crown meets up to a bottom molar that has a full gold crown.  My dentist said it's not usually best practice to design porcelain to bear down on gold because porcelain is harder and will damage the gold.  He showed me two spots on this lower gold crown.  One is just scarred and not punctured yet but the other is a small hole, and he showed me with a mirror as he extracted food/debris from this hole.  I asked about the possibility of just filling the small hole and he said he used to consider a filling like this as an economical option but prefers not to because of the certainty that bacteria would be trapped beneath the filling and jeopardizes the entire tooth.  He doesn't really like the upper porcelain crown (wrong shape he says) but he suggests leaving the upper crown as is, removing the gold crown on the bottom molar and replacing with a new porcelain crown.  About $1300.  Does this sound like good judgment?  Thank you.
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Sounds like a difficult decision.  It sounds like there are problems with both crowns but I would be more concerned with the gold crown as well if there is a fracture or breakage of the crown.  Bacteria could potentially leak through the crown and damage the tooth underneath.  Filling the hole is an option but I agree that it would not be the best solution and I think that it could potentially have problems later on, especially if the filling breaks and you're back to where you started.  
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Jerome Tsang, DDSBlank
Irvine Modern Dentistry
Irvine, CA
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