Is it normal that Zirconia crown feels unnatural against tongue?

[Nan]

Except for slight curves, the occlusal surface feels undefined as opposed to my molar on opposite side which feels more indented/sharp/hollow.
As well when I look at the occlusal view of mouth the crown looks slightly wider than my molar on the opposite side.
Is this all how it should be?
Bite feels fine and crown doesn't bother me when I don't intentionally feel it, but the width seems odd to my eye.

Crown is Katana STML cemented onto left first maxillary molar.

Please see attached photos. (side/occlusal. Crown is on the right hand side of the photo)

 

[MattKW]

I see what you mean, but who's going to be looking that closely at your teeth? The main thing is that it fits and functions well.

 

[Nan]

I see what you mean, but who's going to be looking that closely at your teeth? The main thing is that it fits and functions well.

Would it be a bad idea to adjust and narrow it down on the sides (chairside in mouth)?

 

[Busybee]

Does it affect the way your mouth feels when you speak?

 

[Nan]

Does it affect the way your mouth feels when you speak?

No, not that I've noticed.
It is only bothersome when I feel it with my tongue - it feels different to my natural teeth (wider/shinier/unpronounced cusps)

 

[MattKW]

No, not that I've noticed.
It is only bothersome when I feel it with my tongue - it feels different to my natural teeth (wider/shinier/unpronounced cusps)

By the time you need a crown for a tooth, it's often been altered anyway from the multiple fillings. What does it really matter in the end? If you can eat and talk, and it doesn't look hideous, then you're fine. I've seen far worse-looking crowns than that which are going quite well, and the patient isn't even aware of their ugly crown.

 

[Busybee]

No, not that I've noticed.
It is only bothersome when I feel it with my tongue - it feels different to my natural teeth (wider/shinier/unpronounced cusps)

So are you bothered about the appearance at all or is it just the feel of it? Because if it's the latter you're likely to get used to that over time. The dentist could polish it a bit to make it feel more acceptable. A crown is a foreign object that's plonked in your mouth. Sometimes it feels very alien and can get about two to three months to get used to.

 

[MattKW]

Would it be a bad idea to adjust and narrow it down on the sides (chairside in mouth)?

It is best not to adjust ceramics in the mouth:

1. The ceramic might fracture,
2. You could drill through too far and expose the tooth structure,
3. You can't polish ceramics as well as a glazing in the lab.

If I have to adjust a lot of a ceramic crown, i send it back to the lab for reglazing.

 

[Busybee]

Funnily enough I don't think there's one ceramic restoration that I have not had adjusted by the dentist to ensure the bite is good. Every dentist has a different view of whether this is good/bad, but the tooth in the pic looks like a tank so don't think there's much chance of fracture.

 

[MattKW]

Funnily enough I don't think there's one ceramic restoration that I have not had adjusted by the dentist to ensure the bite is good. Every dentist has a different view of whether this is good/bad, but the tooth in the pic looks like a tank so don't think there's much chance of fracture.

A crown that doesn't need adjustment is highly desirable, and depends on the quality of the impression, the quality of the lab, and the way the teeth interdigitate. I probably get ~80% that need no adjustment. Once in a while it comes back way out of whack, but that's usually because the patient has a bite that's difficult to record.
If you try to adjust a tooth before cementation, then the remaining thickness can be measured with calipers. After it's been cemented, nobody knows how thick it is, and you can drill through without warning. It makes no difference if it looks like a tank, I wouldn't touch it.
Drilling of ceramic crowns can also lead to microfractures, which although may not cause the crown to break on the day of adjustment, it can be a cause of later fracture even years later. Reglazing is best practice for anything more than minor adjustments. It is often safer to make minor adjustment to the opposing natural teeth.

 

[Nan]

So are you bothered about the appearance at all or is it just the feel of it? Because if it's the latter you're likely to get used to that over time. The dentist could polish it a bit to make it feel more acceptable. A crown is a foreign object that's plonked in your mouth. Sometimes it feels very alien and can get about two to three months to get used to.

Slightly bothered with both. I'm happy with the side view, but looking at it from the occlusal view it seems almost out of place due its width. And when I feel it with my tongue it is slightly outward on both sides.
I'm just wondering if it's normal for monolithic zirconia (Katana STML in my case) to be like that?

 

[MattKW]

You are overly concerned. Forget it and you'll get used to it. End of thread.

 

[Busybee]

Slightly bothered with both. I'm happy with the side view, but looking at it from the occlusal view it seems almost out of place due its width. And when I feel it with my tongue it is slightly outward on both sides.
I'm just wondering if it's normal for monolithic zirconia (Katana STML in my case) to be like that?

Give it a couple of months. If you are feeling really miserable after that go back to your dentist. They are best placed to judge what can be done.

 

[Busybee]

Reglazing is best practice for anything more than minor adjustments. It is often safer to make minor adjustment to the opposing natural teeth.

Which is why it's a good idea to let patients trying a ceramic restoration in even if it's just prior to cementing in while in the dentist's chair. After all you can't stick the patient in the oven with it once it's on permanently.

 

[MattKW]

Which is why it's a good idea to let patients trying a ceramic restoration in even if it's just prior to cementing in while in the dentist's chair. After all you can't stick the patient in the oven with it once it's on permanently.

As per previous posts, this idea entails certain risks. This crown is not bad based only on the photos (not professional quality photos, no idea what was there before, no photos of models before/after), and the OP is unduly concerned. Rather than create further uncertainty, why not let the matter settle?

 

[Busybee]

That's what I've done. But there is definitely more official governance required on what is deemed to be a satisfactory restoration. Comparing it to worst case doesn't make it aesthetically acceptable. I'm not sure whether there even are any guidelines or rules for ensuring a restoration fits with the rest of the teeth and feels normal to the patient. If you check this forum there are many such posts. It cannot be that so many people are simply unduly concerned. There are problems in variation and quality of restorations and it seems that patients have no control and little recourse when so much seems subjective.

 

[MattKW]

That's what I've done. ..

These fora attract certain people that perhaps don't have that good relationship with their dentist, so it skews the representation of what's really happening. A better guide would come from statistics gathered from the Dental Boards and dental Associations, and insurers; these are often published.
There is no way of quantifying aesthetics, apart from comparing the work done to that of our peers. For example, I would expect the quality to be acceptable at a lower level in a 3rd world country. I would expect that a specialist prosthodontist will be judged against that of other prosthodontists, not against general dentists.

 

[honestdoc]

In the US, work done by general dentists are judged equally against those by specialists such as prosthodontics, endodontics, surgery, etc. Unfortunately, it seems that patients take advantage of dentists with the over-abundance of attorneys in this country. An unrelated legal case involved a dentist and a non-compliant periodontal patient. Pt missed a lot of appointments and treatments and later sued the dentist for lost teeth. Complete documentation were provided including perio charting, thorough chart notes, and treatment plans. However, the jury found in favor of the patient because the dentist "did not adequately prove to the patient of his deteriorating periodontal condition."

I don't like to work on cosmetic cases very often. It is very frustrating when patients get dissatisfied after your best attempt through mock ups, lab work, fittings, etc. I've encountered numerous dissatisfied denture cases after a lot of hard work. Luckily I usually ask the proper questions before I take cases on and will refer or not treat as appropriate.

 

[MattKW]

In the US, work done by general dentists are judged equally against those by specialists such as prosthodontics, endodontics, surgery, etc. .

Yes, it seems that the legal system in US is chaotic at times. In recent times, there was that unusual case involving talcum powder and ovarian cancer.

 

[Busybee]

But Honestdoc would you say that

Yes, it seems that the legal system in US is chaotic at times. In recent times, there was that unusual case involving talcum powder and ovarian cancer.

An interesting case. The main factor was asbestos which the manufacturer was aware might be present.