Can anyone here help?

I recently had new crowns put on #14 and #16 (#15 was done a few months
previously), and am having HORRIBLE bite problems that my family dentist
has (so far) been unable to correct - even after 5 or so adjustment visits.

Prior to having this most recent procedure, a previous Dentist put CEREC
crowns on all 3 teeth. 20+ (no exaggeration - literally twenty plus)
adjustments over a course of two years later, I gave up and went to my
old Dentist - who took the CERECs off of 14 and 16 and put traditional
crowns on them. (#15 was converted from a CEREC to a porcelain crown by
the Dentist that originally did the 3 CERECs. I was unhappy with the
result of #15 being converted over, as I had bad pulpitis afterward for
a couple of weeks, and there is a margin at the gumline that I didn't
expect - so, I got thoroughly disgusted with the original Dentist and
switched at that point).

I have a bite that tends to close in many different places naturally,
and I think this has contributed to the problem, as I think that the
molds that are made for the crown prep wind up offset, based on where I
close when they are being made. (If I close my mouth and "rest" my
front teeth on each other, my back teeth don't hit. If I close my mouth
on my back teeth, the front don't hit, etc. Should have had braces as a
kid, but we couldn't afford it at the time, and I'm living with the
results now, 30 years later). The reason I think this is that the
CERECs made by Dentist #1 were "long" on the back of the tooth. Crowns
made by Dentist #2 for #14 and #16 are WAY long on the "front" side of
the tooth. In fact, #14 feels unnaturally "large" in my mouth, and has
a very strange "curve" where the biting surface of the tooth feels
almost like a crescent as it goes from the back of my mouth to the
front. (It does not feel "right" at all to me).

Complicating all of this, I have adult periodontal disease, and pockets
5+mm in the area.

The symptoms I'm having are more gum-related. I feel pain in the gum
area above 14, 15 and 16. But the structure/shape of the teeth feels
'wrong' as well, and there are spots I can touch with my finger that
feel 'wrong' (pointy/jagged) and sensitive to the touch.

So, a couple of questions..

- What type of Dentist can I go to as a "bite Specialist"? I don't want
to go through the Braces or Invisalign at this point, and am just
looking for someone who can "fix" the bite by adjusting "properly"
(which neither Dentist seemed to be able to do).

- Can a traditional crown that is "wrong" (IMHO) be removed and re-done?
If so..what's involved?

- Is it normal/within reason to have 20+ adjustments from the first
Dentist and 5+ from the second to try to get this "right"? Seems like
BOTH dentists are doing a horrible job to me, and this shouldn't take
more than 1-2 visits, post-crown install.

I'm going on 3 years now with this problem and no-one has been able to
help so far. So, sorry for the long post..but I REALLY need help - this
is absolutely ruining my quality of life and takes HOURS a day away from
my focus with pain & discomfort.

PS: I'm located in the SE Michigan area.

Thanks..

- JS

Dear Jim,

You described a series of problems and from your post without examining
you it is impossible to diagnose your problem(s).
You want to have this problem corrected with just new crowns and that
is a serious limitation you are placing on the treating dr. In order to
solve your problem you may require other types of treatments regardless
of whether you like to pursue them or not.
For example from your symptoms you have described a possible root canal
situation, changing or adjusting the crown is not going to fix the
infected tooth which is sensitive to touch and does not fit right.
you really need somebody to examine everything and let them fix the
problem without telling them how you like them to fix your problem.
there are a lot of dentists able to fix your problem you just need to
find them.



Jim S wrote:

> Can anyone here help?
>
> I recently had new crowns put on #14 and #16 (#15 was done a few months
> previously), and am having HORRIBLE bite problems that my family dentist
> has (so far) been unable to correct - even after 5 or so adjustment visits.
>
> Prior to having this most recent procedure, a previous Dentist put CEREC
> crowns on all 3 teeth. 20+ (no exaggeration - literally twenty plus)
> adjustments over a course of two years later, I gave up and went to my
> old Dentist - who took the CERECs off of 14 and 16 and put traditional
> crowns on them. (#15 was converted from a CEREC to a porcelain crown by
> the Dentist that originally did the 3 CERECs. I was unhappy with the
> result of #15 being converted over, as I had bad pulpitis afterward for
> a couple of weeks, and there is a margin at the gumline that I didn't
> expect - so, I got thoroughly disgusted with the original Dentist and
> switched at that point).
>
> I have a bite that tends to close in many different places naturally,
> and I think this has contributed to the problem, as I think that the
> molds that are made for the crown prep wind up offset, based on where I
> close when they are being made. (If I close my mouth and "rest" my
> front teeth on each other, my back teeth don't hit. If I close my mouth
> on my back teeth, the front don't hit, etc. Should have had braces as a
> kid, but we couldn't afford it at the time, and I'm living with the
> results now, 30 years later). The reason I think this is that the
> CERECs made by Dentist #1 were "long" on the back of the tooth. Crowns
> made by Dentist #2 for #14 and #16 are WAY long on the "front" side of
> the tooth. In fact, #14 feels unnaturally "large" in my mouth, and has
> a very strange "curve" where the biting surface of the tooth feels
> almost like a crescent as it goes from the back of my mouth to the
> front. (It does not feel "right" at all to me).
>
> Complicating all of this, I have adult periodontal disease, and pockets
> 5+mm in the area.
>
> The symptoms I'm having are more gum-related. I feel pain in the gum
> area above 14, 15 and 16. But the structure/shape of the teeth feels
> 'wrong' as well, and there are spots I can touch with my finger that
> feel 'wrong' (pointy/jagged) and sensitive to the touch.
>
> So, a couple of questions..
>
> - What type of Dentist can I go to as a "bite Specialist"? I don't want
> to go through the Braces or Invisalign at this point, and am just
> looking for someone who can "fix" the bite by adjusting "properly"
> (which neither Dentist seemed to be able to do).
>
> - Can a traditional crown that is "wrong" (IMHO) be removed and re-done?
> If so..what's involved?
>
> - Is it normal/within reason to have 20+ adjustments from the first
> Dentist and 5+ from the second to try to get this "right"? Seems like
> BOTH dentists are doing a horrible job to me, and this shouldn't take
> more than 1-2 visits, post-crown install.
>
> I'm going on 3 years now with this problem and no-one has been able to
> help so far. So, sorry for the long post..but I REALLY need help - this
> is absolutely ruining my quality of life and takes HOURS a day away from
> my focus with pain & discomfort.
>
> PS: I'm located in the SE Michigan area.
>
> Thanks..
>
> - JS

Jim S wrote:

> Can anyone here help?
>
> I recently had new crowns put on #14 and #16 (#15 was done a few months
> previously), and am having HORRIBLE bite problems that my family dentist
> has (so far) been unable to correct - even after 5 or so adjustment visits.
>
> Prior to having this most recent procedure, a previous Dentist put CEREC
> crowns on all 3 teeth. 20+ (no exaggeration - literally twenty plus)
> adjustments over a course of two years later, I gave up and went to my
> old Dentist - who took the CERECs off of 14 and 16 and put traditional
> crowns on them. (#15 was converted from a CEREC to a porcelain crown by
> the Dentist that originally did the 3 CERECs. I was unhappy with the
> result of #15 being converted over, as I had bad pulpitis afterward for
> a couple of weeks, and there is a margin at the gumline that I didn't
> expect - so, I got thoroughly disgusted with the original Dentist and
> switched at that point).
>
> I have a bite that tends to close in many different places naturally,
> and I think this has contributed to the problem, as I think that the
> molds that are made for the crown prep wind up offset, based on where I
> close when they are being made. (If I close my mouth and "rest" my
> front teeth on each other, my back teeth don't hit. If I close my mouth
> on my back teeth, the front don't hit, etc. Should have had braces as a
> kid, but we couldn't afford it at the time, and I'm living with the
> results now, 30 years later). The reason I think this is that the
> CERECs made by Dentist #1 were "long" on the back of the tooth. Crowns
> made by Dentist #2 for #14 and #16 are WAY long on the "front" side of
> the tooth. In fact, #14 feels unnaturally "large" in my mouth, and has
> a very strange "curve" where the biting surface of the tooth feels
> almost like a crescent as it goes from the back of my mouth to the
> front. (It does not feel "right" at all to me).
>
> Complicating all of this, I have adult periodontal disease, and pockets
> 5+mm in the area.
>
> The symptoms I'm having are more gum-related. I feel pain in the gum
> area above 14, 15 and 16. But the structure/shape of the teeth feels
> 'wrong' as well, and there are spots I can touch with my finger that
> feel 'wrong' (pointy/jagged) and sensitive to the touch.
>
> So, a couple of questions..
>
> - What type of Dentist can I go to as a "bite Specialist"? I don't want
> to go through the Braces or Invisalign at this point, and am just
> looking for someone who can "fix" the bite by adjusting "properly"
> (which neither Dentist seemed to be able to do).
>
> - Can a traditional crown that is "wrong" (IMHO) be removed and re-done?
> If so..what's involved?
>
> - Is it normal/within reason to have 20+ adjustments from the first
> Dentist and 5+ from the second to try to get this "right"? Seems like
> BOTH dentists are doing a horrible job to me, and this shouldn't take
> more than 1-2 visits, post-crown install.
>
> I'm going on 3 years now with this problem and no-one has been able to
> help so far. So, sorry for the long post..but I REALLY need help - this
> is absolutely ruining my quality of life and takes HOURS a day away from
> my focus with pain & discomfort.
>
> PS: I'm located in the SE Michigan area.
>
> Thanks..
>
> - JS
>
>
>
>
>
>

It is difficult from this narrative to know where the problems lie.
Often, if there is even a subtle discrepency the bite in one part of the
mouth (the chances obviously increased by having 3 adjacent teeth
restored) there is a strong tendency for the patient to compensate and
develop an accommodated bite. It then becomes difficult to find an
ideal occlusion. Complicating this is that it seems from your
description your bite is not ideal to begin with.
Finally, the situation is not helped by your acknowledged periodontal
disease. You could go to a prosthodontist who would no doubt be able to
put you in some kind of a treatment appliance (probably acrylic) and
develop an improved bite. There would have to be very precise
communication as to what your requirements are as far as tooth
shape--this could be worked out in a provisional restoration. Lastly, I
would very strongly recommend that this be done in coordination with
periodontal treatment, or you could lose the whole ball of wax here. I
hear nothing in your description to convince me that the treatment was
"horrible", merely that your precise needs were not communicated to your
dentists. Everything else you describe seems to be fairly normal stuff
that can happen in a restorative case, coupled with an acute sensitivity
on your part to the contours of the restorations.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Mark & Steven Bornfeld wrote:

> Jim S wrote:
>

>
>
> It is difficult from this narrative to know where the problems lie.
> Often, if there is even a subtle discrepency the bite in one part of the
> mouth (the chances obviously increased by having 3 adjacent teeth
> restored) there is a strong tendency for the patient to compensate and
> develop an accommodated bite. It then becomes difficult to find an
> ideal occlusion. Complicating this is that it seems from your
> description your bite is not ideal to begin with.
> Finally, the situation is not helped by your acknowledged
> periodontal disease. You could go to a prosthodontist who would no
> doubt be able to put you in some kind of a treatment appliance (probably
> acrylic) and develop an improved bite. There would have to be very
> precise communication as to what your requirements are as far as tooth
> shape--this could be worked out in a provisional restoration. Lastly, I
> would very strongly recommend that this be done in coordination with
> periodontal treatment, or you could lose the whole ball of wax here. I
> hear nothing in your description to convince me that the treatment was
> "horrible", merely that your precise needs were not communicated to your
> dentists. Everything else you describe seems to be fairly normal stuff
> that can happen in a restorative case, coupled with an acute sensitivity
> on your part to the contours of the restorations.
>
> Steve
>

Steve - thanks much for the reply..

What are you suggesting I do in regards to conveying "precise
communication as to requirements for tooth shape"? I've worked with 2
separate dentists now, over the course of nearly 3 years trying to do
exactly that - I've gone to both for "adjustments" and have showed them
exactly where I think the problem is, by indicating the area of the
tooth (14, 15 or 16 all at different times) that I think is "hitting"
hard on the teeth below it. They confirm this with contact
(articulation?) paper, see the blue dots, and grind away. It feels
"fine" for anywhere from a couple of days to a couple of weeks, then
starts acting up again. This makes me wonder if my teeth are shifting,
or if I just am then getting used to the "new" fit and my bite somehow
compensates. Not being in the Dental field myself, I have no idea - I
just know it's not "right" and causes me pain.

Also not sure I follow you on my "precise needs not being communicated
to my Dentist", as I think that they were. Dentist #1 recommended doing
all 3 teeth at once as they had "deep carries" and he sold me on the
benefits of CEREC. Obviously, this probably wasn't the best treatment
overall, as it created the original fit problem. (Doing one at a time
and getting the bite right probably would have been far better). To me,
my "precise needs" were for the teeth to be restored and the fit to work
in such a way as it doesn't cause me pain and discomfort. Seems pretty
simple to me. What other "precise needs" should I have conveyed?

When I mention to friends that I've been suffering through this for 3
years now, I get lots of people suggesting legal action. (Not that this
is of interest to me - I just want my bite to be "normal" again). Yet,
your post almost implies that somehow *I'm* at fault here? Not sure I
agree, as having a "wrong" bite that hits hard and causes me pain for *3
long, suffering years* now seems highly abnormal - especially as I've
made over 2 DOZEN separate trips to 2 separate Dentists to try to get it
"right" and yet NO-ONE seems able to accomplish that. In my thinking,
ONE visit (two or three MAX) should fix it - not 24+.

Where am I going wrong here? I'm a tech guy by trade and not a Dentist,
but it sure seems like something is VERY wrong with this situation and
the treatment that I've received. This makes me question the
quality/skill of the Dentists that I've used (sorry to be blunt &
somewhat accusatory, but what else can one logically conclude here?)
But, that aside - I just want to "fix it" and move on..

Thanks for the help..

Jim

> Where am I going wrong here? I'm a tech guy by trade and not a Dentist,
> but it sure seems like something is VERY wrong with this situation and
> the treatment that I've received. This makes me question the
> quality/skill of the Dentists that I've used (sorry to be blunt &
> somewhat accusatory, but what else can one logically conclude here?)
> But, that aside - I just want to "fix it" and move on..
>
> Thanks for the help..
>
> Jim

Like others have said, there is no way to diagnose your problem over
the internet.

However.....

I see lots of patients who have problems with clenching and they are
totally unaware. Throw in a few full coverage restorations at once
and the whole system that was *barely* coping, is thrown into complete
chaos.

Futher 'corrections' are being made while the system is still
malfunctioning and are unlikely to be successful.

*Usually* an NTI appliance will calm the nerves and muscles down to
let the dentist see where the teeth are actually hitting and make
adjustments as necessary. Sometimes there are really no adjustments
needed and just the NTI alone calms the storm.

JME,
D

Perhaps an endodontist may help you. Did they really put a crown on #16?

Le Huart wrote:

> Perhaps an endodontist may help you. Did they really put a crown on #16?

Yep..they really did put a crown on #16..CEREC originally (Dentist #1).
Replaced with traditional, porcelain crown by Dentist #2.

Would an endo help if I'm primarily having gum pain? The teeth don't
hurt like a traditional toothache, but are just sensitive on the
"points" at the bottom of the tooth that seem to hit. The rest of the
tooth is fine in terms of being relatively pain-free - it's just these
"stalagmites" hanging down (that seem unnaturally shaped) that are
sensitive, and the gum pain above it..

If the crowns were placed too far under the gums, between the teeth, you
may have a "biological width" problem. This can cause gingival
irritation but is usually unnoticable by the patient. There are two
options, gum surgery to reposition the biological width and keep the
existing crowns or gum surgery and new crowns. I'd still check with nan
endodontist for pulpal nerve damage, but if it is as you describe, see a
periodontist who does not work with (for0 theseb dentits.