Decay Under Crown | Patient Profile

Boulder, Colorado Dentist

Tooth #2 with PFM and Access Filling

Dee had just moved to town and was due for her cleaning.  She wanted to make sure that there were no problems with her teeth.  She chose to come to Adler Cosmetic & Family Dentistry at her daughter’s recommendation, who was one of Dr. Adler’s long time patients.

During Dr. Adler’s comprehensive exam using an interoral camera, he noted that tooth #2, her upper right molar, had a porcelain fused to metal crown, also known as a PFM, that was breaking down.  A composite filling in the top of the crown sealing an access opening showed that the tooth had had a root canal done after the crown had been placed.  The root canal was apparent in the x-ray but Dr. Adler also saw that there was decay on the distal or back side of the tooth under the crown.  He recommended that the existing crown be removed so the decay could be cleaned out and a new all porcelain crown be placed.

Once the crown was removed, Dr. Adler saw that the decay was more extensive.  The patient said that she had pain on the tooth which had originally prompted the placement of the PFM crown.  When pain had continued later after the crown was done, an access opening was drilled though the crown and a root canal was performed.

Tooth #2 After Crown Removed

Tooth #2 After Crown Removed

After the root canal, the tooth did not continue to bother her as much.  It was apparent that the decay under the crown was reason for the root canal but unfortunately for Dee, the problem was not completely resolved by it and the damage was done.  It is not uncommon to see decay develop underneath older crowns due to a breakdown in the seal or bond of the crown.  The more decay Dr. Adler removed the deeper it continued to go.  Dr. Adler used a tissue laser to remove excess tissue around the distal of the tooth that had partially grown into the cavity obscuring his view of the extent of the decay.  Once the tissue was removed, Dr. Adler realized that the decay did go below the gum line and that removing all of it would not leave enough tooth structure to support the crown enough insure that it would be successful.  The only other option was to remove the tooth.
Tooth #2 After Laser Used

Tooth #2 After Laser Used

Root canalled teeth can sometimes be tricky to extract since the tooth is more fragile and likely to break a part during the procedure.  Dr. Adler was able to successfully extract Dee’s tooth with no problems.  Sometimes a tooth can not be saved despite a doctor’s best efforts if the decay has gone too deep.  Dee is glad that the tooth no longer bothers her and that the decay was stopped in its tracts.  She is now considering replacing the tooth by placing an implant, not only to replace the tooth but also to help keep the bone from receding.  The implant acts like the roots of a natural tooth by supporting it and giving the bone something to attach to.  Based upon Dee’s most recent experience she is making double sure that all of her old crowns are in good condition and don’t need to be replaced.