Decay under a Dental Crown – Patient Case Study

Dental crowns are an effective way to repair a damaged tooth. But like all dental restorations, crowns aren’t meant to last forever. Eventually they will need to be replaced for a variety of reasons. In some instances, this is due to tooth decay that develops under the crown. When this occurs, you will need to work with a highly skilled and experienced dentist who can accurately diagnose the issue and customize your treatment plan accordingly.

Decay under dental crown

During his career, Dr. Adler has helped numerous patients with decay under a dental crown. The correct course of action will depend on the nature and extent of the decay beneath the crown. In this blog post, we’re going to present a case study of Dee in order to illustrate how Dr. Adler approached this problem when the decay was so extensive that it required a tooth extraction.



Dee’s Story

Molar Tooth with Dental Crown and Access Dental Filling Dee had recently moved to Boulder and visited our office for an initial cleaning and dental exam. Dee’s daughter had been a long time patient of Dr. Adler’s, and she recommended that her mother choose Adler Advanced Dentistry for her oral health needs.


Dr. Adler performed a comprehensive exam that included imagery of her teeth using an intraoral camera. These images showed that tooth #2, her upper right molar, had a porcelain-fused-to-metal (PFM) crown that was breaking down. X-rays showed that a root canal was performed on the tooth after the dental crown had been placed. Dr. Adler noticed that there was decay on the distal (back) side of the tooth, underneath the crown. He recommended removing the existing crown in order to clean out the decay, and then placing a new all-porcelain crown once the tooth had been restored to proper health.


Ongoing Pain from a Poor Prior Dental Result

However, once he removed the crown, Dr. Adler noticed that the decay was much more extensive than was indicated on the x-ray. Dee told him she had been experiencing pain on the tooth, and the PFM crown was initially placed on the tooth to address this pain. However, the pain persisted after the crown was placed, prompting her old dentist to perform a root canal.


Molar Tooth after Dental Crown is Removed After the root canal had been performed, Dee experienced less pain. However, the procedure had not completely resolved the underlying issue causing her pain. It is common for decay to develop underneath older dental crowns due to a breakdown in the seal or bond of the crown, and this is what happened to Dee.


Dr. Adler continued removing decay only to find that it extended deep into Dee’s tooth. There was some excess tissue around the back of the tooth that had partially grown into the cavity, making it difficult for Dr. Adler to evaluate the extent of the decay. Once he used a soft tissue laser to remove this excess tissue, he saw that the decay extended beneath the gum line. As a result, removing all of the decay wouldn’t leave enough remaining natural tooth structure to support a new dental crown. Therefore, the best course of action was to remove the decayed tooth.


Extraction of the Decayed Tooth

Extracting a tooth after a root canal is performed can be challenging because the tooth becomes more fragile, increasing the chances of it breaking apart during the extraction procedure. However, Dr. Adler was able to perform the extraction without any issues.


Molar tooth after laser removed excess tissue and decay After the extraction, Dee’s pain went away for good due to the fact that decay was no longer spreading beneath her gum line. Dr. Adler recommended using a dental implant to replace the extracted tooth since this treatment option will also prevent her bone from receding. Dental implants are the only tooth replacement option that replaces the root as well as the tooth, which is why it eliminates any future bone deterioration.


Based on this experience, Dee has asked Dr. Adler to examine all of her old crowns in order to make sure they are in good condition and don’t need to be replaced.


If you’re experiencing pain in a tooth with a dental crown, please contact Adler Advanced Dentistry using the form on this page or call today to schedule an appointment. We serve patients in the Boulder, Colorado area.


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