A patient attended our surgery in 2011 with a complaint of extreme sensitivity underneath an old crown. I was asked for a second opinion as a previous dentist had offered either to root fill the tooth and then place a post and new crown at a cost of £1200.00, or the Five Star Option of extract the tooth and place an implant at £2200.00.
At the exam I took a radiograph (X-Ray), which showed the tooth had healthy bone levels and no sign of an abscess.
From the symptoms the patient described, I hoped it was a case of the crown de-bonding in which we would only need to clean up the tooth and re-cement the crown at a cost of £80.00
Unfortunately when I removed the crown, this wasn’t going to be the case, the tooth was grossly decayed.
Although it initially looked bad I removed the decay until I had gotten the tooth to the a position where all the decay was removed and the margins were clear.
I had recently attended a day lecture with Prof Pascal Magne, based on adhesive dentistry.
During the lecture Prof. Magne presented the evidence that with modern day adhesives, we could get more than enough bond strength to hold a crown in place bonding it to a flat surface.
He also stressed the need for impeccable bonding procedures, following the instructions to the letter. The bonding procedures we use are the same used to bond airplane wings and high class sports cars, so good enough for them, good enough for me.
Having removed all the decayed tooth, but leaving any stained tooth that was 80-90% hard I gently chamfered the edges to increase the available bonding surface with minimal loss of tooth substance. We then used our Cerec CadCam system to produce a crown that was bonded into place on the same day.
At the time I carried out this treatment I was unsure if it would succeed, it was very much a leap of faith and belief in the integrity of the research presented by Prof. Magne.
I had explained to the pt that this was very much unknown territory for me , however if the treatment failed I would still have the option of root filling the tooth to place posts to hold a crown or extraction and an implant.
This treatment above was carried out March 2011, this picture and radiograph was taken March 2018. The tooth has been trouble free and the nerves remains healthy.
7 years is still a short period for a successful crown. I consider the bare minimum for a crown to be 10 years, at that stage the crown has cost the patient about £1.00 per week which I think is a good deal. However I only get happy when it enters the 15-20 year lifespan and allow myself a congratulatory moment when a crown lasts over 20 years.
As ever the lifespan of any dental work is a team effort dependant on the patient’s good diet and brushing, regular scaling and professional cleaning.
I have no idea how long this will last. The nerve of the tooth may die and require root filling, the crown may de-bond, but I will be able to deal with both of these events and would be confident that with treatment I can extend the useful lifespan of this tooth for a considerable period, hopefully 20+ years. By which time this patient will be in their 7th decade and replacing a tooth may not be so necessary and I am sure the technology of implants will have improved beyond all recognition by then.
As a dentist I know all the work I place will eventually fail. Any treatment I carry out should have a consideration of how I will treat the patient when or if the work fails, and the patient aware of this plan and cost.
As this tooth stand I still have plenty of options of replacing the crown, root filling the tooth or placing an implant in the future, we could be lucky and never have to explore any of these options.
Since placing this crown I have placed about 9 crowns in the same fashion and to date all are functioning well, what started out as a leap of faith has become a standard treatment, such is the value of ongoing education and embracing new technology.
This crown design fulfils my credo for all treatment, it is the simplest treatment option, with a reasonable prognosis, that produces a functional restoration, needing the least tooth preparation.
Double A treatment? Adhesion and Addition, no healthy tooth was removed, far better than the 5⭐ option.