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Question:
Crown Endurance: I recently had my second permanent crown in four months put on by my general dentist.
The first permanent crown lasted approximately two months before the porcelain cracked on the crown and partially came off. A second crown (porcelain fused to gold again) was ordered and placed on my
previously root canal treated tooth (#18) approximately six weeks ago.
It now has a small hole in the porcelain (which is what happened to the first crown before the porcelain cracked off). I visited my dentist to make them aware of the hole in the porcelain and was told that "it was not a problem. Lots of people have holes in the porcelain of their crowns and as long as the hole did not get any larger not to worry about it."
My concern is that based on the research I have done, on average, a crown should last between ten and sixteen years. These crowns are not even lasting two months.
Questions:
1. Should I demand another new porcelain fused to gold crown be put on my tooth?
2. Is a hole in the porcelain of my crown truly ok or what other dental problems could it cause?
3. How common is a hole in the porcelain of a crown?
4. Is this recurring problem most likely due to the materials used to make the crown, the craftsmanship of the crown or the installation of the crown? ...Visitor from GA
Answer:
Some studies indicate as much as a 20% failure rate with porcelain on the second molar. It is a tooth that takes a disproportionate amount of stress and if you are like the rest of us, you grind your teeth at night and this contributes to the problem.
While all dentists want to be responsive to our patients' requests, and those requests are increasingly connected to porcelain and esthetic dentistry, there are some real limitations.
I recently reviewed the very limited literature on porcelain crown longevity rates and studies also show more of an average of 4 to 7 years for the longevity of a porcelain crown. If you have dental insurance, they will pay for a new crown after five years. That is what they consider a reasonable life expectancy and if your think about it, that industry is not known for their generosity!
In particular, it is the back half of tooth # 18 that takes the largest "hit" while under function. This is consistent with your experiences. A crack or hole in the porcelain does not affect the integrity of the fit at
the gum line or margin and does not limit the life expectancy of the crown-only the esthetic value.
I am not a big advocate of demanding anything. Calmly discussing your disappointment with the outcome rather than looking to blame the dentist or his lab for faulty workmanship. It was, after all, working when you left the office.
As long as the missing porcelain does not cause food impaction in that area and you are therefore able to keep the tooth clean, then you might consider riding it out with a wait and see attitude.
I suggest you have you dentist evaluate you for night time grinding and perhaps make a night guard. This diagnosis from my desk is only consistent with the literally almost 100% of people I see, and have seen in the last ten years, who are clenching and grinding their teeth at night.
The benefits for a night guard protect all you teeth and underlying gums and bone as well. Most patients have no idea they clench and grind their teeth at night unless they also suffer jaw pain in the morning and headaches as well. This phenomenon is stress related and cannot be controlled by Valium or repeating a mantra before bedtime.
If you are unhappy with your porcelain crown, I recommend you consider doing a gold crown on this tooth. Your problems will cease and your pocket book will appreciate the fact that this crown will last three times longer then a porcelain crown, No one is going to see it, so I recommend you option for function rather than esthetics. Good luck!
Editorial Staff
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