Two Newly Crowned Teeth moved laterally 2 hours after perm cementing, then wedged & became motionless.

[Cattina]

Hi all, I've had conflicting info on this new development. Insights appreciated! Earlier this week permanently cemented crowns (2) with RelyX-Ultimate on two teeth #12 and #13 were placed. and crowns two hours later moved laterally sideways when I took a bite (not real hard) on a snack. A definite "slide" was felt and thereafter the two crowns could be gently "wiggled." Reported to Dentist (prosthodontist) and appointment made for 3 days later. Meanwhile on following day (day 2) I kept previously scheduled quarterly cleaning appointment. Experienced hygienist reviewed situation first by xray. Crown margins looked ok but large chunk of cement seen adjacent to #13 and removed, other small pieces. Very inflamed where removed. Hygienist and period doc (it's a perio practice) noted movement and cement chunk removed and no other problems seen on other teeth. by the end of the next day, (day 3) the two crowns mysteriously stopped moving and seemed tightly and uncomfortably "wedged" somewhere different...I had pain on eating for the first time 3rd day. On 4th day was my appointment with the restorative dentist. He did not offer a bite adjustment (to my surprise) but it was decided to remove crowns. Since one of teeth is RCT (#13) and fragile, they were sectioned off successfully. Doctor however had thought they looked ok, and I'm not sure he believed they had moved...can't be sure. So I'm wondering if 1) anyone has ever seen this "looseness & movement" and then "no movement." Two things were suggested: 1) The crowns may have somehow moved into place. But alternatively 2) once a seal is broken (the cement) it is no longer dependable and decay can enter. 3) aggressive prep I had on this area a year earlier by the general dentist who referred me may have jeopardized the b biologic margin perhaps necessitating special accommodations for future crown cementing. So I've heard it alll, or is there more? The "moving-not moving crowns experience is particularly weird. Like having a car problem, going to mechanic and it looks normal...thanks for any insights! Xrays attached.

 

[Dr M]

I would also consider a CBCT of the root canal tooth. Any movement, might also be an indication that the tooth with the metal post, might have cracked. I would rule out any cracks on the root canal treated tooth before new crowns were placed. Any specific reason why the two teeth were connected to each other? What did the prosthodontist say?

 

[Cattina]

Thank you Dr M for your reply. I actually already did have a CBCT on the root canal tooth shortly before the crowns were cemented, so that is an excellent suggestion. To answer your other question (whether 12 and 13 should be splinted together for the bridge. My pre ious bridge which lasted 30 years did have them together. We initially tried that, But 12 came loose and 13 didn't and it was very painful having that situation, Because of the fragility of 13, it was decided to have two separate crowns instead. so that if 13 fails, it will not also affect 12. #14 is an implant with sinus graft. On a different note, I have since learned that RelyX Ultimate, like most current cements only fully sets within 24-48 hours. So the definitive movement I felt when biting sideways two hours after COULD have happened. and then moved again when the (dangerous) cement was removed from the implant area (#14) the following day. So from what I've been told, when the crowns resettled, an occlusal adjustment possibly could have solved the whole situation. I'm not sure why it wasn't suggested, but since the movement could have jeopardized the seal, perhaps removal was the safer option, However I'm now faced with going through a 4th prep before final crowns on a fragile tooth. So as you can imagine I am concerned. Quite honestly, there seems like a good amount of tooth structure but a perio consult as to that area is probably a good idea before yet another prep. Although I'd think a prosthodontist could make that call. I'd really like to keep tooth #13 as long as possible if I can. The tests (CBCT) have not confirmed a fracture (though sometimes they are hard to see). It doesn't hurt, it's just tender and the ligament is reactive. Am I correct that the RelyX really can take 24-48 hours to settle and that explains the movement0-no movement mystery?) FYI in general I have no other existent problems, though I do have a lot of bridgework from previous problems. I'm "religious" with hygiene now. I use a water pic daily, a night guard and probably should get some fluoride trays. Any other suggestions very helpful as right now I'm back in "temps" on tooth 13 and 12, affixed with fixodent - not a bad situation since I can clean teeth carefully at night before replacing the temp crowns.Any insights about the "crown movement-not movement and paths forward of course appreciated. Thanks again, much appreciated.

 

[Dr M]

Cement can take a while to set, so there is definitely a chance that this, with the combination of the excess cement, could have lead to the movement you have felt. I am sure however that a prosthodontist will be able to determine if there is still enough healthy tooth structure left, and if the tooth has been prepped previously, not a lot, or even no additional prep work should be required. This time around, just be careful not to bite too hard on those teeth until 24 hours have passed and avoid flossing . Also take your night guard with , when the final crowns are cemented in order to ensure that there is no interference between the crowns and the night guard.