Horrible bite problems after crowns - need help!!

Discussion in 'Dental Archive' started by Jim S, Dec 28, 2006.

  1. Jim S

    Jim S Guest

    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, Dec 28, 2006
    #1
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  2. 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:
     
    Alexander Vasserman DDS, Dec 28, 2006
    #2
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  3. 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

    --
    Mark & Steven Bornfeld DDS
    http://www.dentaltwins.com
    Brooklyn, NY
    718-258-5001
     
    Mark & Steven Bornfeld, Dec 28, 2006
    #3
  4. Jim S

    Jim S Guest

    Mark & Steven Bornfeld wrote:
    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
     
    Jim S, Dec 28, 2006
    #4
  5. Jim S

    Dartos Guest

    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
     
    Dartos, Dec 28, 2006
    #5
  6. Jim S

    Le Huart Guest

    Perhaps an endodontist may help you. Did they really put a crown on #16?
     
    Le Huart, Dec 28, 2006
    #6
  7. Jim S

    Jim S Guest

    Le Huart wrote:
    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..
     
    Jim S, Dec 28, 2006
    #7
  8. Jim S

    Le Huart Guest

    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.
     
    Le Huart, Dec 29, 2006
    #8
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