When not to treat a patient. This woman was a very lovely, 30-something year-old who presented for what she believed would be a quick recementation of a single, upper lateral dental crown. Many crowns and root canals were recently completed by her local dentist near her home. She indicated that she had a good relationship with him.
There were many reasons why I chose not to treat this patient and instead recommended that she go back to her current dentist for care. 1) It appeared that the crown is completely seated on the post and core instead of being seated on a minimum of two millimeters of sound tooth structure. 2) The post preparation was short and should have been nearly double its length for strength and retention. 3) The post was prefabricated and not cast; this will also decrease its strength and retention.
I did not want to take out the loose crown and then find that I also had a loose post and core in my hand. Proper care might indicate a new, longer cast post and core, possible crown lengthening, and a new crown. Crown lengthening surgery could likely affect the crown margins on all the other new anterior crowns.
Once you touch it, you own the problem. Both the dentist and patient need to agree in advance what could happen, and what might need to be done, if an “easy” repair turns out to be quite a big problem. This philosophy is both fair and appropriate for the patient and will save a lot of young dentists from having a major, unexpected problem. All things considered it was not worth getting started. The patient was appreciative of my assessment and was happy to return to her dentist for the repair.
There were many reasons why I chose not to treat this patient and instead recommended that she go back to her current dentist for care. 1) It appeared that the crown is completely seated on the post and core instead of being seated on a minimum of two millimeters of sound tooth structure. 2) The post preparation was short and should have been nearly double its length for strength and retention. 3) The post was prefabricated and not cast; this will also decrease its strength and retention.
I did not want to take out the loose crown and then find that I also had a loose post and core in my hand. Proper care might indicate a new, longer cast post and core, possible crown lengthening, and a new crown. Crown lengthening surgery could likely affect the crown margins on all the other new anterior crowns.
Once you touch it, you own the problem. Both the dentist and patient need to agree in advance what could happen, and what might need to be done, if an “easy” repair turns out to be quite a big problem. This philosophy is both fair and appropriate for the patient and will save a lot of young dentists from having a major, unexpected problem. All things considered it was not worth getting started. The patient was appreciative of my assessment and was happy to return to her dentist for the repair.