Prosthodontics & Occlusion · patient case question
What is the most appropriate next step before recementing the crown?
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. Occlusal analysis using mounted diagnostic casts
- A. Correct. The failure is a force problem, so it must be diagnosed before it can be corrected. Mounted casts, an evaluation of centric and excursive contacts, and an assessment of anterior guidance identify what is overloading the restoration. Recementing without this simply resets the clock on the same failure.
- B. Incorrect. Stronger cement addresses a symptom rather than the cause. Three failures already indicate the problem lies elsewhere.
- C. Incorrect. There is no pulpal diagnosis and no symptoms suggesting pulpal involvement. Endodontic treatment is not indicated.
- D. Incorrect. Crown lengthening is indicated for inadequate ferrule or biologic width violation. Neither applies here.
Practice Prosthodontics & Occlusion questions Prosthodontics & Occlusion study notes