Full gold crown perforation repair

[mike3kgt]

To anybody,

I could not find any evidenced-based information regarding repair of full gold crowns that have had to have RCT through the occlusal surface (4-complete walls). The crown has nice margins and no other discernable pathology.

I have spoken with professors who cannot agree on placing amalgam, composite, or replacing the crown. I can see that optimally, the crown should be replaced, but patient wishes for repair rather than replacement.

Anybody have experience with this or know of literature that investigated it?

-Mike

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[12YearOldKid]

Amalgam if the patient absolutely will not replace the crown. I think composite would be a poor choice because it won't bond to the gold and the shrinkage would leave an unacceptable gap that is bound to result in recurrent decay.

 

[1FutureDDS]

Wouldn't the lab be obligated to remake the crown for free anyways due to the fact that it didnt keep decay from coming back? Or the dentist for not removing all of the decay before crowning?

 

[12YearOldKid]

Wouldn't the lab be obligated to remake the crown for free anyways due to the fact that it didnt keep decay from coming back? Or the dentist for not removing all of the decay before crowning?

????????

 

[aphistis]

Wouldn't the lab be obligated to remake the crown for free anyways due to the fact that it didnt keep decay from coming back? Or the dentist for not removing all of the decay before crowning?

No way. Restorative dentistry doesn't cure caries, it just repairs the damage. Don't forget the reason the tooth needed the crown to begin with. Restorations fail due to marginal decay all the time. Sometimes it's the dentist's or lab's fault, but most of the time it's the patient getting more of the same decay that brought them to you in the first place.

To the OP, I've done a couple crown margin repairs with amalgam that seemed to work well. If you feel like cramping your hands, you could always go for a direct gold repair. Either way, I agree with 12YOK that composite would be a really bad idea.

 

[BDS-DMD]

HOw about you do a gold inlay as if you are treating a occlusal? Probably the best marginal integrity. Fill it upto 3-4 mm from the occl surface,make an impression and send it to the lab.

 

[Periogod]

HOw about you do a gold inlay as if you are treating a occlusal? Probably the best marginal integrity. Fill it upto 3-4 mm from the occl surface,make an impression and send it to the lab.

And get a lab bill almost equal to a full crown replacement. An amalgam will work fine but if you want to get fancy, find a really old faculty member and ask them to show you how to do a "gold foil."

 

[ItsGavinC]

I also vote for amalgam as a "patch".

 

[gryffindor]

I also vote for amalgam as a "patch".

Gold foil, anyone?

Edit: NM, just saw Periogod already suggested it. One of my classmates did have the chance to do some dinosaur dentistry and was supervised on a gold foil to repair an occlusal marginal void on a gold onlay. It was a big day at the school, announcements were made on the intercom, and an invitation was made to all through the clinic newsletter to come watch the historic procedure.

 

[ItsGavinC]

Gold foil, anyone?

Edit: NM, just saw Periogod already suggested it. One of my classmates did have the chance to do some dinosaur dentistry and was supervised on a gold foil to repair an occlusal marginal void on a gold onlay. It was a big day at the school, announcements were made on the intercom, and an invitation was made to all through the clinic newsletter to come watch the historic procedure.

ROFL (but it's probably the truth).

 

[v&andy_yankee]

<threadjack> ^^^Gavin, your kids are growing up too damn fast. I still remember the wee little pictures of them. I feel old now </threadjack>

 

[ElDienteLoco]

To the OP,

Any time I have seen an endodontist do a crown repair (which isn't frequent - they usually just use IRM), they have done it with composite. Most of them are fanatics about coronal seal and would never compromise "their root canal" but putting something leaky on top of it as a restoration. If I'm not mistaken, you were talking about an occlusal repair - nothing near the margin. Also, last time I checked, amalgam doesn't bond to gold either.

For what its worth, I would probably use composite bacause that is what I have seen the oh-so protective endodontists use.

 

[12YearOldKid]

Also, last time I checked, amalgam doesn't bond to gold either.

No, it doesn't bond to gold; but unlike composite, amalgam doesn't have to bond to produce a sound margin. A composite next to gold will leak like a sieve; there is no way around that problem that I can think of (though I am open to new ideas.) Amalgam expands and corrodes producing an acceptable marginal seal without bonding. That's why I would choose it over composite.

But in the end they are both crappy options and the crown just needs to be replaced.

If I'm not mistaken, you were talking about an occlusal repair - nothing near the margin.

ummm... all restorations have margins. Even occlusals.

 

[mike3kgt]

Thanks for all of the replies. I need to present to the patient, does anybody have an evidence based information (journals or textbook info) and not just ancedotal stuff? I certainly see how composite & gold aren't the best seal, but is it good enough?

-Mike

No, it doesn't bond to gold; but unlike composite, amalgam doesn't have to bond to produce a sound margin. A composite next to gold will leak like a sieve; there is no way around that problem that I can think of (though I am open to new ideas.) Amalgam expands and corrodes producing an acceptable marginal seal without bonding. That's why I would choose it over composite.

But in the end they are both crappy options and the crown just needs to be replaced.



ummm... all restorations have margins. Even occlusals.

 

[ElDienteLoco]

Adhesive Dentistry and Endodontics: Materials, Clinical Strategies and Procedures for Restoration of Access Cavities: A Review.
Journal of Endodontics. 31(3):151-165, March 2005.
Schwartz, Richard S. DDS; Fransman, Ron DDS

I don't subscribe personally, but I'm sure you can find access to this in print or electronic form. Good luck.

 

[groundhog]

Gold foil, anyone?

Edit: NM, just saw Periogod already suggested it. One of my classmates did have the chance to do some dinosaur dentistry and was supervised on a gold foil to repair an occlusal marginal void on a gold onlay. It was a big day at the school, announcements were made on the intercom, and an invitation was made to all through the clinic newsletter to come watch the historic procedure.

I had gold foil pounded in on top of amalgam as the patch on an existing gold crown following a root canal redo on the associated upper molar. It looks and feels great. That same rct redo also required a root amputation. Lucky for me, it was the smaller of the two outer roots. The results have been great regarding that procedure too.

 

[Dr. Dai Phan]

If the tooth has an existing crown and is satisfactory, then the treatment of choice would be a simple occlusal alloy on that tooth. The tooth with a crown/occlusal hole is like the tooth with with the occlusal preparation. To redo the crown in my opinion is a waste of patient's time and resourses. Now if the crown has recurrent decay, then that is a different matter. Composite is a poor choice because it is NOT designed for occlusal load as leakage is a primary concern. Gold inlay can be done but more labor intensive and unwarranted.

Dai Phan DDS,MSD
Maxillofacial Prosthodontist