InHealth: Why is my new crown still bothering me?

By Ruth Rojas, DMD, PLLC | September 2022

Did you have a new crown or perhaps a veneer made for you and it never felt quite right? Is the tooth or gum sensitive? Is your bite off? Did the crown break or come off? It may be that your tooth, gums, and/or bite were not evaluated correctly, and that the treatment was not the appropriate one.

Crowns and veneers are a great treatment to replace lost tooth structure, and to protect from further wearing and breaking. They are also used to correct alignment, color, and shape of the teeth, as in smile designs or even to correct the bite. 

As a prosthodontic specialist, we look at every possible aspect of teeth, bite, gum health, and bone level that may interfere with the long prognosis of a tooth. Very often I see referred patients because of broken new crowns, recent restored teeth broken at the gum line, or crowns/veneer coming off. The most common cause, other than trauma, is a weak tooth structure under the crown or a bite problem. 

In order to place a crown or veneer, the tooth has to have enough structure remaining. When a tooth is prepared (grinded) there must be enough width and height in order to preserve the strength of the tooth as well as to hold the crown in place. When a tooth is ground down too thin, the probabilities of fracture at the gum line increases. If the height or width of the tooth is compromised, a build-up may suffice. In more debilitated cases, a root canal and post may also be needed to rebuild a missing part of the tooth before placing a crown. 

The mistakes start when we try to save a tooth while ignoring the parameters. Sound, parallel walls and height are the keys to a successful crown retention.

If your gums are bleeding around a new crown, perhaps the required measurements between the crown, the gum, and the bone have been violated. To maintain healthy gums, a crown margin must be at a given distance to the bone and should not be embedded into the gums too much. These two issues create problems with cleaning and maintaining bacteria at bay, hence the constant gum irritation. The long-term problem with these violations of health parameters is that the chronic inflammation will erode the bone underneath and can cause a periodontal problem.

When a crown is coming off or braking, perhaps the space between the top and bottom tooth is not ideal, or the bite was not adjusted correctly. All materials have a minimum thickness requirement to minimize fracture and enough space is paramount. 

The most common cause of a problematic new crown is the bite. If the bite was not adjusted properly, the risks of pain and sensitivity are high. These could be felt on either the crowned tooth or the opposite tooth. An incorrect bite can cause further problems, such as permanent nerve damage or crown fracture. 

My advice is not to wait, and to go see the dentist. Explain what is wrong with the tooth and have it evaluated. The sooner it is addressed, the better the chances are to avoid the tooth having a permanent and irreversible damage. 

Dr. Ruth Rojas Prosthodontics & Cosmetic Dentistry

Ruth Rojas, DMD, PLLC

3400 S Tamiami Trail #301, Sarasota, FL 34239

941.951.7711 • www.drruthrojas.co