Problem with E4D ceramic crown

Discussion in 'Dental Restoration' started by Ms. Tessie, Dec 4, 2010.

  1. Ms. Tessie

    Ms. Tessie

    Dec 4, 2010
    I've recently had a E4D (D4D?) ceramic crown placed on my number 30 molar, which had a crack in it. The process involved removing an amalgam filling from childhood that my dentist described as being average in size.

    For aesthetic reasons, I did want a tooth-colored crown. In terms of booking appointments, my dentist seems to have originally planned for me to get a traditional porcelain fused to metal crown, but when he went to do the prep, he said he could do the ceramic crown and offered to finish the job that day. I couldn't stay because of work commitments, so he fitted me with a temporary crown that I wore for two weeks without any symptoms whatsoever, except for some sensitivity when I drank a cold beverage.

    When it came time to cement the permanent crown in, after we tested the bite, even though I had been injected with some novocaine, the initial bonding process was extremely painful; I suffered through it in the interests of time, and the tooth has been achy off and on ever since. The dentist requested that I return a week later for him to finalize the bonding process, which, to be honest, left me feeling as though I was walking around for a week with some small part of the prepared tooth exposed. The sensitivity I've been experiencing ever since has been far more extreme than with the temp crown.

    My questions:
    1) Is this normal for a dentist to have you come back to finish the bonding?
    2) How long should I live with this sensitivity before exploring with my dentist the possibility that maybe something went wrong during the bonding process? I've had the crown for about a month now.
    3) How would we figure out if something went wrong with the bonding?
    4) How often do patients have reactions to the bonding? I found one article online that said 16% of CEREC patients had sensitivity from the bonding, but I've found other articles that say that CEREC cuts down on post-operative sensitivity.
    5) Is it possible that some folks are just allergic to or more sensitive to the bonding process?
    6) What are my alternatives besides a root canal? Would it be reasonable to request a traditional porcelain-fused to metal crown after a certain amount of time? I've consulted with an endo, and he says it's too early to consider a root canal. Frankly, I'd be pretty upset if I had to get a root canal based on how nicely the tooth behaved with the temporary crown.
    7) Should I commit to a course of anti-inflammatories to help the tooth settle down? I've taken Ibuprofren occasionally. Taking Alleve is more effective at letting me forget about the tooth entirely for a while, but then the tooth acts up again. Initially, right after the procedure, I had one or two nights where I would wake up to the tooth hurting, but I'm not at that point now. The bite has been checked and it's apparently not an issue, and I'm not chewing on that side of my mouth anyway at this point.

    I suspect that something has gone amiss with the bonding, and I'd like to explore this with my dentist in a diplomatic and positive way.
    Thanks for your help in assessing my situation.
    Kind regards,
    Ms. Tessie
    Ms. Tessie, Dec 4, 2010
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  2. Ms. Tessie

    Jim Shunk DMD

    Feb 25, 2011

    If the bonding is causing the sensitivity, then it would seem logical that the chemical closest to the tooth is irritating the nerve. There are lots of different ways to bond a restoration to the tooth so you would need more information on what the bonding material is. Of course does that matter, because your tooth hurts! Go back and let them know your tooth hurts.
    Take care,
    J Shunk DMD
    Jim Shunk DMD, Feb 25, 2011
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