A 34 year old female school teacher presents to your office complaining that she broke off a cusp on her lower left first molar. Visual inspection reveals that tooth #19 is missing the disolingual cusp down to the gingival crest, and a large MOD amalgam is present. The patient is a heavy bruxer and she admits that she wakes up sometimes grinding her teeth. The dentist recommends a crown to restore the tooth.
In this patient, the sings I will see when doing an extra an intra oral examinations are enlarged masseter muscle, temporomandibular joint pain, clicking or locking; wear of cusps, and in some extreme cases shortened teeth, indentations of posterior teeth inside of cheeks and borders of the tongue, tooth sensitivity without any apparent reason, broken and cracked teeth, and gingival recession. …show more content…
A PFM will have a very radiopaque core that will corresponded with the metal base, and an outer portion less radiopaque for the ceramic. An all metal crown, will appear a very bright radiopaque all around the crown. An all ceramic crown, which is not recommended for this patient because is only use in anterior teeth where the esthetic is more important, and the occlusal forces are not as strong.
From a strictly functional perspective, this patient may benefit from having a crown with a metal occlusal surface because patients who grind their teeth are at greater risk of chipping or braking the porcelain. In most of the cases, this is not a problem since in posterior teeth the esthetic is secondary when there is a need for maximal strength. Also, this would prevent the patient from wearing off opposing teeth, something that is common in patient with porcelain, and is more exaggerated in patients who grind their
In this patient, the sings I will see when doing an extra an intra oral examinations are enlarged masseter muscle, temporomandibular joint pain, clicking or locking; wear of cusps, and in some extreme cases shortened teeth, indentations of posterior teeth inside of cheeks and borders of the tongue, tooth sensitivity without any apparent reason, broken and cracked teeth, and gingival recession. …show more content…
A PFM will have a very radiopaque core that will corresponded with the metal base, and an outer portion less radiopaque for the ceramic. An all metal crown, will appear a very bright radiopaque all around the crown. An all ceramic crown, which is not recommended for this patient because is only use in anterior teeth where the esthetic is more important, and the occlusal forces are not as strong.
From a strictly functional perspective, this patient may benefit from having a crown with a metal occlusal surface because patients who grind their teeth are at greater risk of chipping or braking the porcelain. In most of the cases, this is not a problem since in posterior teeth the esthetic is secondary when there is a need for maximal strength. Also, this would prevent the patient from wearing off opposing teeth, something that is common in patient with porcelain, and is more exaggerated in patients who grind their