Prosthodontics & Occlusion · patient case question
Each of the following is an appropriate part of managing this patient EXCEPT one. Which is the EXCEPTION?
Patient case: The Crown That Keeps Falling Off
Patient: 32-year-old female
Chief Complaint: “The crown on my front tooth has fallen off three times this year.”
Background: Healthy, no medications. Reports jaw soreness on waking and has been told she grinds her teeth. Non-smoker.
Medications: None
Vital Signs: BP 112/70 mmHg · HR 68 bpm · RR 14 · T 98.4°F
Findings: Deep overbite of approximately 80% with minimal overjet. Wear facets on the incisal edges of the mandibular anteriors. Bilateral masseter hypertrophy. Tooth #8 carries a ceramic crown with an adequate 2 mm ferrule and a healthy periodontium: 2–3 mm probing depths, 4 mm of attached gingiva, no recession. A separate new crown for #30 is being tried in at this appointment.
Show answer and explanation
Correct answer: A. Free gingival graft at #8
- A. Correct — this is the exception. A free gingival graft is indicated to augment a deficient band of keratinized tissue or to arrest progressive recession. She has 4 mm of attached gingiva and no recession, so there is nothing to graft and no benefit to be gained.
- B. Incorrect — this is appropriate. An occlusal guard protects the restoration from nocturnal parafunctional forces, which cannot be eliminated by adjustment alone.
- C. Incorrect — this is appropriate. Reassessing the preparation geometry, the resistance and retention form, and the choice of material is a logical part of preventing a fourth failure.
- D. Incorrect — this is appropriate. Selective adjustment redistributes force away from the restored tooth and can substantially reduce the load driving the failure.
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