6 crowns in 6 weeks!

[cagrim]

My 16 year old son has a broken top front tooth. We decided to get a crown because the bonding didn't really match, and it looked terrible. In the last six weeks, he has broken 5 temporary crowns and one porcelain crown. The cement will not adhere the tooth to his existing tooth for more than a day or two. It continually comes loose. I am convinced it is not anything he is intentionally doing. No chewing on ice or candy or pen caps. After 15+ trips to the dentist, he is being extremely careful. We think he might be clenching his teeth in his sleep. In the middle of all of this he ended up needing a root canal on the tooth. Our dentist is out of ideas -- everything she tries either comes loose, or breaks, or both. She is now having a Procera crown made. She said she has tried every cement she has to keep the crowns attached--nothing works. Help! Any suggestions for a permanent solution?

[Jerome Bogin, D.D.S.]

I am not sure if the temp does not stay on that the Procera will be any better. At some point  you might consider getting another opinion.

[cttakemoto]

Possible causes of crowns coming off:  Too much taper of underlying tooth structure, possible overcutting of the top of the underlying tooth making it too short to hold onto, unusual occlusion (how teeth come together), or inadequate reduction of the temporary crown or porcelain crown.  

Long term solution may include a one or a combination of the following:
extrusion( to gain more length of the tooth above the gumline, possible crown lengthening (gum surgery to expose more tooth to hold crown on)  sraightening the taper for more retention, and possible use of a cement like Panavia to hold on the crown.

[scottma]

To:cagrim
      I agree with cttakemoto. 2 points added. Check out occlusion. Reduction of occlusal force may help retention and less chance of crown broken. However, there must be enough reduction of tooth for fabrication of porcelain crown. Splinting of anterior crowns. However, gum problems may develop later on.
Regards

[cagrim]

Thanks for your comment.  My son had another temp made yesterday and it's already come out today.  The two dentists that have worked on him are convinced his bite is fine.  I really think, at this point, there's a problem with the cement.  Nothing seems to hold.  Both dentists said they've each done dozens of crowns this month alone, and none have even come loose.  He's the only one coming in every other day.  We have to find a way to keep this temp in his mouth in one piece until the permanent tooth is ready in 3 weeks.  

[scottma]

Dear cagrim:
       Your son's condition is extremely rare. However, if your son's were my patient, I would use polycarboxylate or zinc phosphate cement. Although these cements are for final cementation, it's still quite easy to remove the temporary crowns.

[cagrim]

If this tooth refuses to adhere with any cement, what other options are there?  Also, what type of dentist should I go to for a second opinion?  A pediatric dentist?  A cosmetic dentist?

[Dondree]

WOW!  The same exact thing has happened to me.  I am so upset!  I have been to the dentist every other week for the last year.  I get my crown cemented in place and a day later, it comes loose.  It finally came to the point, under no approval from me, where the dentist cut away my gum, put the crown on, used a silver type object to attach it to my other tooth and put a filling type matter behind my tooth, on the roof of my mouth.  I was almost positive that it would stay but less than a week later it became loose.  I am online trying to see if the dental work has anything to do with the fact that I have started having nose bleeds everyday.  It is very interesting to see that I am not alone and most likely not alone in pain!