33072 Sea Bright Drive, Dana Point, CA 92629, us
Case Presentation #3
Patient needs crown recementation with short tooth and $50
This patient comes to the office with a gold crown in her hand, stating it has fallen off her tooth and she would like it recemented. She has brought $50 to pay for the service. Upon inspection it is noticed that the crown is almost completely filled with amalgam. Upon looking in the mouth, it is clear that what is left of the tooth that the crown is supposed to be retained on, is quite short – no more than 1 mm tall anywhere around the periphery of the tooth preparation. Simply recementing in the normal way would not suffice.
First – WHY is the crown filled with amalgam? The previous dentist had attempted to build up a short tooth to a height capable of supporting a crown by using amalgam. The way the amalgam is attached to the remains of the tooth, of course, determines how well it can retain the crown without itself falling off. Clearly, it was not connected to the tooth well enough, and fell off the tooth, taking the crown with it.
The original amalgam buildup SHOULD have been connected to the remaining tooth structure with retentive pins (the screws referred to in the last case). The dentist seemed to think that he could adhesively bond the amalgam to the tooth – and at one point that was common, if just hopeful, thinking. Clearly, it was not adequately bonded in this case.
First Plan: do a root canal on what is left of the tooth, place a post in the canal space, and build up the tooth with some material that will support a NEW crown, that is made to fit the new buildup. Cost: molar root canal $1500, post and core buildup $500, new crown $1500 – total cost $3500. Somewhat in excess of her $50. This is what 90% of all practicing dentists would do in this case, and the rest would extract the tooth and do an implant and crown, for $4000. But, where is this money to come from?
Second plan: recement the crown with the full adhesive technology that is available to us – cutting no corners at all. The amalgam is removed, the gold cleaned up and electroplated with TIN. The tin oxide layer that is formed inside the gold crown is treated with a special chemical that links inorganic materials to organic materials. The tooth is etched and primed with a substance that ensures a bond to the tooth, and then the crown is cemented using a composite (plastic) cement that fills the crown and connects to both the treated gold and the remaining tooth structure. There are no expenses that the dentist has to cover, so he can do this for $50 if he wants.
Considering this is a real example from 20 years ago, maybe $100 would be appropriate now. It was guaranteed to last a year, and the patient was encouraged to save her money if the bond failed at some point. Over a year later the tooth developed symptoms and a root canal was necessary, but done THROUGH the crown, which stayed in place admirably throughout the procedure. After the root canal a mechanical connection between the tooth and crown was effected, in addition to the adhesive bond.
The patient saved money in the long run, and the expense was averaged out over a period of years.