Prosthodontics & Occlusion · patient case question
What is the MOST appropriate treatment?
Patient case: Failing anterior crown in a bruxer
Patient: 49-year-old woman.
Chief complaint: My crown feels loose and it does not match my other teeth.
History: Crown placed approximately twelve years ago. Partner reports night-time grinding.
Findings: Porcelain-fused-to-metal crown on a maxillary anterior tooth with a visible metal collar at the margin and gingival recession. The crown is markedly brighter and whiter than the adjacent teeth, which are distinctly yellow. Generalized wear facets on the posterior teeth. The crown moves on digital pressure.
Show answer and explanation
Correct answer: B. Remove the crown, assess the abutment, and fabricate a new crown
- A. Veneering composite over a metal collar is a cosmetic patch that leaves the loose fit and the caries risk untouched.
- B. CORRECT. The restoration has failed on three counts — it is loose, the margin is exposed, and the shade is wrong. A loose crown almost always has caries beneath it. Remove it, evaluate the abutment, and remake.
- C. Ceramic and metal do not respond to bleaching agents; only natural tooth structure does.
- D. Recementing preserves every problem the patient came in with and seals bacteria against a possibly carious abutment.
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