Has my upper left wisdom tooth drifted into malocclusion, since getting my 2nd molar crowned? Can this happen?

[ToothPatient]

My bite feels off and is painful.

I initially had a full gold crown put on my 2nd upper left molar. The contact points were very tight to the adjacent teeth, in fact initially we couldn't get floss in between, but this eventually corrected itself.

After a couple weeks, I noticed the bite touching early on what I thought was the inner slanted cusp of the crown.
Dentist changed the crown but the problem persists.

Whilst he was changing the crown I checked the bite, and the same early contact was happening, so I realized it wasn't on crown at all.

Using occlusive paper and an intra-oral camera at home, it's obvious the early contact is on the wisdom tooth behind it:

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Upper left wisdom tooth now.

This is an eccentric bite, but only slightly. In fact to avoid an uncomfortable catching, I have to tilt my head to the left when chewing.
Zirconia crown in the 2nd molar position.

Is it possible the gold crown with the tight contacts, pushed the wisdom tooth into malocclusion?

This was before removal, the full gold crown and its contact with the wisdom tooth in question.

If this is the case, what can be done about it?

I figured if the subsequent zirconia crown was fabricated a certain way, it would have allowed the wisdom tooth to drift back into its original position.

But I'm not sure given its contact now, could it even make it worse?

 

[ToothPatient]

This was the tooth prior to root canal treatment and crowning.

 

[Dr M]

Do you have a lower opposing wisdom tooth? It is highly unlikely that the gold crown could've pushed the wisdom into an malocclusion. However, there is a chance that the new crown, could've changed your bite altogether, due to different occlusal forces to what you were used to. Have you tried just adjusting the small contact spot on the wisdom?

 

[ToothPatient]

Do you have a lower opposing wisdom tooth?

Yes.

It is highly unlikely that the gold crown could've pushed the wisdom into an malocclusion. However, there is a chance that the new crown, could've changed your bite altogether, due to different occlusal forces to what you were used to. Have you tried just adjusting the small contact spot on the wisdom?

In what sense? The bite itself feels normal, except for that awkward contact on the wisdom tooth.

The crown is almost out of occlusion, just in occlusion enough to prevent over-eruption.

Prior to crowning, the RCT'd tooth was out of occlusion also and it was all good.

When I run my finger along that row of teeth on the left upper side (side with crown) and right upper, the buccal aspect, I get to the wisdom tooth on the affected side, and it clearly protrudes more buccally than the right side, where the right side is completely flush with those teeth in that row.

However, it's possible it was like this before, and I'm just more conscious of it now?

My main concern is that if the crown did cause a malocclusion on the wisdom tooth, that it could continue to worsen it and I may be left with an indefinite problem?

I guess the dentist may consider a small adjustment on the problematic portion of the wisdom tooth, but I personally would want to be certain that further drift wouldn't occur, after this gets done.

The dentist took impression scans prior to crowning (when there was no problem), and then again a few weeks ago when the crown was being replaced -- so perhaps he could compare them if I got in touch, and use that to find out whether any drift of that wisdom tooth did in fact happen?

 

[Dr M]

I think you are just more conscious of it now. Although drifting of teeth can also occur, it takes a long time before that can happen. It would not happen between the crown prep and placement visit.
If it bothers you that much, adjust the high spot on the wisdom and then make a retainer to sleep with at night or a bite-plate. This will prevent further movement of the teeth and will protect all the teeth from grinding forces as an added bonus.

 

[ToothPatient]

I think you are just more conscious of it now. Although drifting of teeth can also occur, it takes a long time before that can happen. It would not happen between the crown prep and placement visit.
If it bothers you that much, adjust the high spot on the wisdom and then make a retainer to sleep with at night or a bite-plate. This will prevent further movement of the teeth and will protect all the teeth from grinding forces as an added bonus.

Cheers, just for 100% clarity though, the timeline would have been 4 to 6 weeks after the placement of the gold crown........ it was about then I began to notice this "high point".

Based on that timeline, drift still wouldn't happen that quickly?

Today it actually bothered me less, just over two weeks out from having the replacement crown fitted.

For some reason if I retract my jaw it's less bothersome, I guess however the teeth meet when the mandible is slightly retracted.

If it settles by the time my review comes around (4 weeks from now), that would be ideal.

 

[Dr M]

If it settles, then no need for any adjustments. 4 to 6 weeks is quite a long time for a crown to be fitted, but I still don't believe it is enough time for significant drift to occur. At least you know you have options if it is still bothersome during the review.

 

[ToothPatient]

Would it ever be a case where the dentist (prosthodontist in this case), removes the crown, allows the affected tooth to drift back into place, then re-does the crown?

Whether that would even work or not, of course I've no idea.

Finding it bothersome again today there's clearly a malocclusion, probably shaving it as you suggested could be one remedy.

 

[Dr M]

Any unnecessary drilling on a tooth, could potentially lead to nerve damage on that tooth. The only way that a tooth can drift back into position, is with some sort of orthodontic intervention. Drift is usually only one way passively.

 

[ToothPatient]

Any unnecessary drilling on a tooth, could potentially lead to nerve damage on that tooth. The only way that a tooth can drift back into position, is with some sort of orthodontic intervention. Drift is usually only one way passively.

Cheers. Just for clarity, the "Dahl Effect" and "drift", are they the same or is there some distinction?

I've read the Dahl effect can happen in a few weeks, but drift may take longer?

PS - if that high point on the wisdom tooth was adjusted, and I didn't wear that retainer at night, does that mean it could actually drift further, or go into malocclusion again?

 

[Dr M]

The Dahl effect is done where either a device or a dental filling, crown or restoration is used in order to create space in order for other teeth to over-erupt in time, in order to come into full contact again. This is done purposefully. Drift usually occurs naturally or passively, due to teeth moving into available space. This is not done purposefully, but is due to the natural movement of teeth.
In my opinion, the Dahl effect still takes more than a few weeks, sometimes even months.
If you don't wear the retainer at night, there is always a chance that drift can occur. This happens to all patients over a period of years.

 

[ToothPatient]

The Dahl effect is done where either a device or a dental filling, crown or restoration is used in order to create space in order for other teeth to over-erupt in time, in order to come into full contact again. This is done purposefully. Drift usually occurs naturally or passively, due to teeth moving into available space. This is not done purposefully, but is due to the natural movement of teeth.
In my opinion, the Dahl effect still takes more than a few weeks, sometimes even months.
If you don't wear the retainer at night, there is always a chance that drift can occur. This happens to all patients over a period of years.

And just for total clarity, that drift can even happen to the tooth in the lateral direction, toward the buccal side? Not just proximally/distally?

 

[Dr M]

It can happen in any direction

 

[MattKW]

That's a real rough gold crown that looks like he had to adjust it a lot but didn't bother polishing it up. I'm guessing that he continued to adjust it after cementing in place because it has a likely perforation where you can see the cement exposed (see image). Eventually the perforation will cause the cement to degrade and let the plaque get silently underneath.
Apart from the other issue you talk about above, I would have that crown removed, the preparation adjusted, and the crown remade. All adjustments should be done and checked for thickness before cementation.
I always try to get my patients to accept gold crowns for 2nd molars because they are more conservative than any other type, including zirconia, but you still have to do them right.

 

[ToothPatient]

That's a real rough gold crown that looks like he had to adjust it a lot but didn't bother polishing it up. I'm guessing that he continued to adjust it after cementing in place because it has a likely perforation where you can see the cement exposed (see image). Eventually the perforation will cause the cement to degrade and let the plaque get silently underneath.
Apart from the other issue you talk about above, I would have that crown removed, the preparation adjusted, and the crown remade. All adjustments should be done and checked for thickness before cementation.
I always try to get my patients to accept gold crowns for 2nd molars because they are more conservative than any other type, including zirconia, but you still have to do them right.

Yes there were lots of adjustments, but he replaced it with zirconia and if feels quite a bit better.

Certainly not "high" as prior.

This is the replacement and point of contact, stained.

All other teeth make good flush contact.

This is the wisdom tooth behind it that I thought may have drifted, but this is the straight bit position with some grinding around, and it stains on both sides of that cusp equally, so presumably that means it's unlikely that it drifted buccally?

 

[Dr M]

I do not think drifting occured. Most likely there was an issue with the previous crown, which was sorted out with all the adjustments made and now there is better contact, which is why it feels better.
You don't perhaps struggle with any grinding issues in general?

 

[ToothPatient]

I do not think drifting occured. Most likely there was an issue with the previous crown, which was sorted out with all the adjustments made and now there is better contact, which is why it feels better.
You don't perhaps struggle with any grinding issues in general?

No, though I had been intentionally clacking my teeth together to check the bite, then made a concerted efforted to stop that about three weeks ago.

I think that may have sensitized it slightly.

I still have an on-again off-again tingling/electrical sensation around the palatal/mesial gumline of the crown, which can be annoying. It could be discomfort/pain, depending on the intensity, but it comes and goes.

I'm not sure what to attribute that too.

Endo said to focus on good flossing.

But at a glance, does that contact point on the crown require reducing? Or is it minimally in occlusion as is?

All other teeth feel like they meet perfectly, nothing "high" in the bite.

I'm unsure if further reduction would alleviate that palatal/mesial gumline tingling/electrical feeling I mentioned.