how do you fix occlus on crown?

[Stephie3]

hey i already put cement inside the crown. then when i checked the occlusion with articulating paper, there were dark marks on the crown and the teacher said i need to adjust occlusion so the dark marks were no longer on the crown. how do i fix this? am i supposed to drill down part of the aluminum crown? it doesnt make sense to me because if you drill on the crown its going to screw up the crown. so am i supposed to adjust occlusion by taking tooth structure away from other teeth or removing cement inside the crown or what. i dont even know. yay dental school.

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[Johnsen]

Grind antagonist, and next time check occlusion/fit prior cementation.

 

[tinman831]

Is the occlusal all metal? You can adjust so long as you don't perforate the crown.

 

[OceanDMD]

hey i already put cement inside the crown. then when i checked the occlusion with articulating paper, there were dark marks on the crown and the teacher said i need to adjust occlusion so the dark marks were no longer on the crown. how do i fix this? am i supposed to drill down part of the aluminum crown? it doesnt make sense to me because if you drill on the crown its going to screw up the crown. so am i supposed to adjust occlusion by taking tooth structure away from other teeth or removing cement inside the crown or what. i dont even know. yay dental school.

Have you learned wherre to adjust? Do you understand the rule of bull, nonworking interferences during lateral excursions, etc..etc..? Do you know what a high spot or interference looks like when checking with articulating paper? I would make sure you are very familiar with all of this before you start adjusting teeth. As simple as it may be, it will save hours of clinical adjustments.

As far as your original question, adjust porcelain with a fine diamond, and polish with porcelain polishing cups/disks. You really dont want to adjust the opposing unless there are major clinical prep height issues, or if you think you are going to perforate. The alternative is cutting that new crown off and remaking it.

 

[Rezdawg]

Adjust the porcelain first before you drill away on the opposing tooth.

Make sure you always check contacts before cementing.

 

[bigstix808]

is this a temp ION crown? i've never heard of a final crown made of aluminum??

with that said, if its the temp crown you're worried about being high, then either make another one or grind the O surface.

 

[jay47]

hey i already put cement inside the crown. then when i checked the occlusion with articulating paper, there were dark marks on the crown and the teacher said i need to adjust occlusion so the dark marks were no longer on the crown. how do i fix this? am i supposed to drill down part of the aluminum crown? it doesnt make sense to me because if you drill on the crown its going to screw up the crown. so am i supposed to adjust occlusion by taking tooth structure away from other teeth or removing cement inside the crown or what. i dont even know. yay dental school.

Why the hell would you ever take away healthy opposing tooth structure for proper occlusion on a crown? Isn't the rule never to take away healthy tooth, especially if it is porcelain because it's going to wear anyways?
Check excursives, gind crown, grind shearing cusps over functional cusps on the crown if you can... etc...

If you didn't prep the crown properly with enough depth, then you'll run out of space quickly, but that is your fault for not prepping properly and checking for clearance.

 

[Flipper405]

don't you have instructors around to ask about this in the clinic?
did the patient go home without the occlusion fixed?

 

[OceanDMD]

Why the hell would you ever take away healthy opposing tooth structure for proper occlusion on a crown? Isn't the rule never to take away healthy tooth, especially if it is porcelain because it's going to wear anyways?
Check excursives, gind crown, grind shearing cusps over functional cusps on the crown if you can... etc...

If you didn't prep the crown properly with enough depth, then you'll run out of space quickly, but that is your fault for not prepping properly and checking for clearance.

lets say you have clearance issues (maybe you are prepping 18). Ask yourself this: would you prefer to have the opposing adjusted 1-1.5mm to make room for the occlusion or risk possible pulpal complications by prepping to the required depth? I know what my answer is. In practice you sometimes compromise. Not everything is ideal.

 

[Rezdawg]

lets say you have clearance issues (maybe you are prepping 18). Ask yourself this: would you prefer to have the opposing adjusted 1-1.5mm to make room for the occlusion or risk possible pulpal complications by prepping to the required depth? I know what my answer is. In practice you sometimes compromise. Not everything is ideal.

Well, if this is the case, then the material of choice should probably be switched from a PFM to gold. That way, you don't face pulpal complications and you save 1 mm from the opposing healthy tooth, which is quite a bit.

There will always be exceptions in the real world, you are correct, but saving healthy tooth structure should always take precedence over any other option.

 

[Vapor1122]

don't you have instructors around to ask about this in the clinic?
did the patient go home without the occlusion fixed?

I'm wondering the same thing.

 

[DrJeff]

Well, if this is the case, then the material of choice should probably be switched from a PFM to gold. That way, you don't face pulpal complications and you save 1 mm from the opposing healthy tooth, which is quite a bit.

There will always be exceptions in the real world, you are correct, but saving healthy tooth structure should always take precedence over any other option.

You'd be suprised sometimes, especially in the molar region how many times you end up where the appropriate adjustment isn't to the newly inserted crown, but to the opposing tooth. If you have a situation where do to either tipping/rotation of the opposing tooth that creates the classical "plunger cusp" or a situation where there's hyper-erruption of the opposing tooth secondary to either an existing uncontoured restoration that was in the tooth your crowning now or some similar condition that allowed the hyper-erruption to occur, then very often I'd be adjusting the opposing as long as when I'm done I end up with my occlussal plan restored and continuous with the adjacent teeth.

*Most* of the time though, I'll be adjusting the "variable" that I just inserted into the equation, the new crown. But there are plenty of exceptions to that rule, and that's where you need to think about what the problem is, why it happened, and what's the most appropriate way to fix it (notice that I didn't say the right way to fix it, since often there's multiple proper answers that have much to do with your level of training and big picture goal for the restoration of that patient)

 

[OceanDMD]

You'd be suprised sometimes, especially in the molar region how many times you end up where the appropriate adjustment isn't to the newly inserted crown, but to the opposing tooth. If you have a situation where do to either tipping/rotation of the opposing tooth that creates the classical "plunger cusp" or a situation where there's hyper-erruption of the opposing tooth secondary to either an existing uncontoured restoration that was in the tooth your crowning now or some similar condition that allowed the hyper-erruption to occur, then very often I'd be adjusting the opposing as long as when I'm done I end up with my occlussal plan restored and continuous with the adjacent teeth.

*Most* of the time though, I'll be adjusting the "variable" that I just inserted into the equation, the new crown. But there are plenty of exceptions to that rule, and that's where you need to think about what the problem is, why it happened, and what's the most appropriate way to fix it (notice that I didn't say the right way to fix it, since often there's multiple proper answers that have much to do with your level of training and big picture goal for the restoration of that patient)

Just like when you are adjusting the occlusion on that resin composite you just placed, I bet you neeeeeeever remove any "healthy" enamel. You make sure that bur only touches the filling.
There is no way in hell Im going to get my patient numb, reduce the prep, take a new impression, reline the temporary, and get the patient back when I can adjust a plunging cusp 1mm and seat the crown in 5 minutes.

 

[Rezdawg]

There is no way in hell Im going to get my patient numb, reduce the prep, take a new impression, reline the temporary, and get the patient back when I can adjust a plunging cusp 1mm and seat the crown in 5 minutes.

I dont think this was ever suggested as the alternative.

lol, I said there are exceptions in the real world, but that saving healthy tooth structure, where possible, should take precedence. Never said you were wrong, but was making a general statement for readers of the thread.

And I mentioned the gold crown because if, when doing the crown prep, you notice that there is a lack of adequate space, then a PFM is probably not the route you'd want to take.

 

[aphistis]

I dont think this was ever suggested as the alternative.

lol, I said there are exceptions in the real world, but that saving healthy tooth structure, where possible, should take precedence. Never said you were wrong, but was making a general statement for readers of the thread.

And I mentioned the gold crown because if, when doing the crown prep, you notice that there is a lack of adequate space, then a PFM is probably not the route you'd want to take.

But 9 times out of 10, it IS the route the patient will not only *want*, but *demand*, you take. Next time you have an attractive 25-year-old female patient with a beautiful, wide smile and a buccal fracture on #18 or 19 needing a crown, and you want to tell her she has to have a gold crown because of clearance questions, give me a call first. That's a conversation I want to watch you have.

Like Jeff and Ocean said, sometimes you have to reconcile priorities that are not only competing, but mutually exclusive. You can rail and fuss and resist all you like, but you're still going to have to do it just like all the rest of us. Welcome to dentistry.

 

[Rezdawg]

But 9 times out of 10, it IS the route the patient will not only *want*, but *demand*, you take. Next time you have an attractive 25-year-old female patient with a beautiful, wide smile and a buccal fracture on #18 or 19 needing a crown, and you want to tell her she has to have a gold crown because of clearance questions, give me a call first. That's a conversation I want to watch you have.

Like Jeff and Ocean said, sometimes you have to reconcile priorities that are not only competing, but mutually exclusive. You can rail and fuss and resist all you like, but you're still going to have to do it just like all the rest of us. Welcome to dentistry.

I love how so many assumptions are made from my simple posts...as if I havent experienced any real world dental situations, even though Ive see 20+ patients a day for over a year. I may be a noob still, but Ive been there and done that, more than enough times.

When suggesting a gold crown, it was to the OP. Typically, your average dental school patient isnt going to be a hot 25 year old bombshell. There is nothing wrong with suggesting an alternative to the patient. If they dont want the gold crown, then you notify them of situations that may arise. Ive done plenty of gold crowns on 2nd molars...sure, the majority of people may not care for them, but there is still a market for it.

Ive grinded away opposing tooth structure a decent amount of times...and most of the time, my patients are quite uncomfortble with the fact that Im drilling away at a tooth that wasnt a problem. In fact, just a few weeks ago, I had a patient refuse to let me touch the opposing tooth. Then what?

Again, my posts are mostly aimed at the OP...getting through dental school is much different than getting through the real world. Even then, saving tooth structure is and should be a primary goal...if all else fails, then you make compromises.