Does the entire crown need to be replaced if the porcelain part is broken?

[clubwestpua]

Does the entire crown need to be replaced if the porcelain part is broken?

I have a crown on #32 mandibular arch (lower jaw) and its porcelain portion is broken.

I moved to another state recently, and the dentist there told me that the entire crown needs to be replaced. However, my insurance company only covers crown once every 7 years, and I had my crown done in 2008.

Doe the crown really need to be replaced entirely?

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[Roto Picante]

If you want it fixed yes. Don't know the situation of the rest of your mouth, but why you crowning a wisdom tooth?

 

[clubwestpua]

If you want it fixed yes. Don't know the situation of the rest of your mouth, but why you crowning a wisdom tooth?

oh I meant 31. so I guess replacing the entire crown is the only option... and this would cost me $600 🙁

 

[7 Iron]

Yep, an entire new crown needs to be fabricated if the porcelain has chipped or separated somehow from the metal.

 

[Daurang]

If you're in SoCal, you can get that crown replaced for $200.

 

[HupHolland]

I have repaired chipped porcelain with success. HF etch, silane, bond, composite. I let the patient know it's not permanent and that the crown will need to be replaced when the repair chips off.

The more important question is: why did it fracture to begin with??

hup

 

[Halcion]

I would say it depends where the porcelain fracture/chip is. If it has fractured so that there is an open margin or open contact, then I would definitely replace. If it is on the occlusal to where it appears it is more porcelain wear rather than a fracture, then I wouldn't necessarily replace it. Just my two cents.

 

[txaggie03]

what opposes the crown? Your natural tooth or another crown/restoration?

 

[DrJeff]

I'd tell a patient in that situation that if the substructure that actually contacts the tooth structure is fully intact AND the patient is fine with the appearance and can keep it clean, then if they want to, keep it as is (okay I'd probably smooth down any rough edges on/around the porcelain fracture point) if they want.

If the patient isn't happy with the appearance, or wants it repaired, then it's time for a new crown since longterm, repairs of porcelain fractures don't have very good success rates. If the patient wants to have the crown replace, as already mentioned in this thread, the most important thing as a clinician that i'm going to do prior to working on that tooth is take a critical look and figure out why the porcelain fractured in the 1st place, so as to do my best to prevent a future porcelain fracture.

My 1st hunch when I see a porcelain fracture is always going to be that the tooth structure directly under where the fracture occurred wasn't reduced sufficiently to alow for proper thickness of materials in the crown to maximize it's strength (this will be the answer the majority of the time in my experience)

Occasionally, the fracture can be due to laboratory fabrication issues, but this in my experience tends to be much less common

 

[doc toothache]

In the words of a famous guru, deciding whether such a crown should be repaired or replaced is determined by whose crown it is. "If it is one of ours it gets repaired, otherwise it gets replaced."

 

[HupHolland]

I'd tell a patient in that situation that if the substructure that actually contacts the tooth structure is fully intact AND the patient is fine with the appearance and can keep it clean, then if they want to, keep it as is (okay I'd probably smooth down any rough edges on/around the porcelain fracture point) if they want.

If the patient isn't happy with the appearance, or wants it repaired, then it's time for a new crown since longterm, repairs of porcelain fractures don't have very good success rates. If the patient wants to have the crown replace, as already mentioned in this thread, the most important thing as a clinician that i'm going to do prior to working on that tooth is take a critical look and figure out why the porcelain fractured in the 1st place, so as to do my best to prevent a future porcelain fracture.

My 1st hunch when I see a porcelain fracture is always going to be that the tooth structure directly under where the fracture occurred wasn't reduced sufficiently to alow for proper thickness of materials in the crown to maximize it's strength (this will be the answer the majority of the time in my experience)

Occasionally, the fracture can be due to laboratory fabrication issues, but this in my experience tends to be much less common

Add occlusion to the list of potential causes. Often times patients contact initially on their 2nd molars before sliding into MICP.

Next time, before prepping a 2nd molar, use a leaf gauge to deprogram the patient and find out where their first tooth contact is. You'll be surprised how often it is a 2nd molar. Same reason why you'll reduce the occlusal surface 1.5mm while prepping and when you check your clearance you mysteriously only have 0.5mm!

Hup

 

[jay47]

You can repair porcelain, but it would be highly likely to fail if it is on a second molar. You can put more force on second molars than any other tooth, plus there is a high chance for interferences and failure of a fracture. Why do you need to have it replaced anyways? Is is just esthetic? Is it cracked to the tooth structure itself? If you can simply smooth it down and leave it alone, why not just do that? The purpose of a crown is to keep a tooth structurally sound and intact while providing function, if it still does that, leave it alone.

 

[djeffreyt]

tut tut tut...you all know the forum rules.

Ya'll just gave dental advice over this site to a person we've never seen.
OP: next time pose you're question as a hypothetical question so we aren't giving you advice

That being said, I agree with Dr.Jeff, and Jay. We "J" named docs tend to stick together.