Zirconium crowns - are they the best solution for my problem?


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Hi, I am turning to this forum for piece of advice about my current dental situation.

I am 33 years old. I have had not very strong enamel since I can remember, and recently I have been experiencing some sensitivity in my upper central incisors. Couple of months ago one of my fillings fell off from one of them and my dentists replaced it, but since then they have become even more sensitive. I had an appointment couple of days ago and my dentists explained that it’s probably due to the fact, that both incisors are very thin and worn out, meaning the nerve is starting to get exposed more and more (attached photos). I strongly suspect this abrasion is the consequence of my particular “bite type”, because my bottom incisors always slide against my lingual side of upper incisors. Otherwise I do not have problems with griding my teeth in my sleep or anything like that.

Currently this is not an urgent matter, but I am starting to feel some discomfort due to sensitivity. My dentist recommended zirconium crowns would be a best solution and wants to implement them as soon as possible. I believe he mentioned being made with computer assisted modelling and they also measure the colour shade beforehand, so they match very good with other teeth. Considering it is an important health issue for me, the price tag is not that high (250 eur per piece, because the rest is covered by health insurance).

I unfortunately lost some confidence in my dentist, since he made some bad decisions in past years regarding my other dental issues – that is the reason I would like to get a second opinion from good people of this forum. Is there even an alternative on the long run or is this the only reasonable way to proceed?

I really appreciate all the answers,

Best regards
 

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honestdoc

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Do you have images of your lower front teeth? The way you're biting can strongly impact the success of any restorations. There are some considerations because there is no right or wrong answers. The questions are, how esthetic do you want, how strong the crowns need to be (E-max vs Zirconia), how much space do you have when your teeth come together. When any dentist prep your teeth for a crown, your teeth may feel more sensitive especially with cold substances. I do see a lot of incisal wear and I believe you may need a custom bite guard.
 
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Do you have images of your lower front teeth? The way you're biting can strongly impact the success of any restorations. There are some considerations because there is no right or wrong answers. The questions are, how esthetic do you want, how strong the crowns need to be (E-max vs Zirconia), how much space do you have when your teeth come together. When any dentist prep your teeth for a crown, your teeth may feel more sensitive especially with cold substances. I do see a lot of incisal wear and I believe you may need a custom bite guard.

Thank you for your reply. I really appreciate your answer. I am leaning towards to getting a second opinion at another dentist in my local area since you pointed out that there is no simple answer to my question.

Thank you for the occlusal guard suggestion. I will certainly give it a shot since it could help against further wearing down of my teeth. I must say that I don’t have a tendency to grind my teeth because of stress, also my partner says I do not do that at night. But I believe I am very susceptible to acid erosion. Couple of months ago I was drinking some wine at a wedding and my teeth hurt for almost two weeks after the event when I was brushing them (and I use Curaprox ultra soft).

I am adding pictures of my bottom teeth and bite.

What do you think about composite bonding and regular use of fluoride varnish like Colgate Duraphat? After thinking a bit I think I would like to try out some alternatives before going for the crowns.
 

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honestdoc

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Sorry for the late reply. I was out of town tending to my sick father. Composites are a great option. They are less traumatic (less drilling than crowns). However, they are not as strong and they can wear and stain quickly. In the US, the clear bite guard materials are not available due to Covid Pandemic. I'm not sure about Europe. Once available, have your teeth restored and custom fabricate one to minimize further wear/damage.
 
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Sorry for the late reply. I was out of town tending to my sick father. Composites are a great option. They are less traumatic (less drilling than crowns). However, they are not as strong and they can wear and stain quickly. In the US, the clear bite guard materials are not available due to Covid Pandemic. I'm not sure about Europe. Once available, have your teeth restored and custom fabricate one to minimize further wear/damage.

No need to apologize. Hope everything is ok.

I appreciate your input. I am leaning towards option with composite, at least for now. I can still go for crowns later I believe. I found this case study where they used this approach instead of crowns (https://www.dentistrytoday.com/rest...aesthetic-bonding-augmentation-not-amputation).

Thank you again for your insight,
Best regards,
 

honestdoc

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Wise choice. Composites are usually the first choice due to their conservative nature. You can always get crowns later. Also consider available bite guards to minimize wear.
 
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MattKW

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Rebuild is definitely the way to go in this case. Crowns would be quite risky and may lead to nerve death. In the link you provide, they have placed palatal veneers after drilling back some tooth structure. I wouldn't advise this removal of precious tooth structure.
Instead, composite build-ups will require no damage to your teeth at all. I used to do this with softened composite fillings (warm them up), but some new flowables (e.g. G-aenial Flow) have made this much simpler. The teeth are waxed up on a model, and a plastic template made into which the composite is injected. Much, much better than doing by freehand.
If you build up your front teeth in this way, then your back teeth won't touch initially, but will come together after a few months (the Dahl Principle or Dahl Concept).
 

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