Hidden Decay and Crown in One Day

Hannah's Teeth Before
Hannah’s Teeth Before

Hannah, a college student in Boulder, Colorado, first came to Adler Cosmetic & Family Dentistry because she was experiencing cold sensitivity and pain while chewing on one of her lower left teeth.  During the emergency exam, we took a digital x-ray of the area and used the Diagnodent, a painless laser that helps detect decay beneath the hard enamel layer.  Tooth #19 (first front molar on the lower left) was determined to be the cause of the pain.  Hannah had a stainless steel crown on tooth #19.  She had worn holes in the top surface.  Stainless steel crowns are commonly placed on young children’s teeth but they do not last permanently.  It was also noted that tooth #18 had a dark stain on the top back surface and the Diagnodent got a reading that indicated the presence of decay.  It was determined that the old stainless steel crown on #19 needed to be replaced with an all porcelain Cerec crown and that tooth #18 needed a composite resin (white) filling.

Decay Exposed Once Crown Was Removed

Decay Exposed Once Crown Was Removed

 Only when the old stainless steel crown had been removed to prepare the tooth for the crown was the extent of the decay apparent.  Decay underneath the crown had destroyed most of the tooth structure.  Dr. Adler removed the visible decay and used decay indicator, a liquid dye that indicates areas of decay, to insure that all the remaining decay was then removed.  Tooth #19 was then prepared for the crown by shaping the remaining tooth into the best shape for supporting the crown.  In Hannah’s case, some of the tissue around the tooth needed to be cleaned with a laser due to the inflammation caused by the stainless steel crown.  Optical impressions were taken using the high-tech Cerec camera which then allowed Dr. Adler to custom shape the crown to fix Hannah’s tooth and bite.  The Cerec machine then fabricated the crown from a solid block of porcelain while Dr. Adler did Hannah’s filling on tooth #18. 

 The decay was similarly removed from the top back surface of tooth #18.  Once the area was disinfected and cleaned the composite resin was then chemically bonded to the tooth.  The filling was then adjusted to Hannah’s bite.  The composite is matched to the color of the tooth so once the filling is done it is hard to spot.  By the time the doctor was finished with the filling, the Cerec

  Hannah's New Crown

Hannah’s New Crown and Filling

machine was done milling the crown for tooth #19.  The crown was fitted on the tooth before any cement was added to insure a proper fit.  The tooth was then disinfected and cleaned.  Using very strong clear cement, the crown was then chemically bonded to the tooth.  In just one appointment, Hannah was able to leave with two much healthier and better looking teeth.


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