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Harold · Guest

My dentist seems rushed and rough. What can go wrong with a crown,the usual
things?

Steven Bornfeld · Guest

Harold wrote:
[quote]My dentist seems rushed and rough. What can go wrong with a crown,the usual
things?
[/quote]

The more rushed and rough, the greater the chance something will go
wrong. There are no "usual things" that go wrong with crowns.

Steve

dacconverter · Guest

On Nov 18, 3:03 pm, Harold <Harold_8...@hotmail.com> wrote:
[quote]My dentist seems rushed and rough. What can go wrong with a crown,the usual
things?
[/quote]
A crown is a crown. A rushed crown preparation *may* not look the
ideal crown prep as shown in a fixed pros textbook. ( with experience,
a rushed crown prep wouldn>t appear different from crown prep done at
leisurely pace ) Then again, once the final crown is cemented and the
patient feels comfortable, the rushed drilling becomes a moot point.

I don>t know what you mean by 'rushed and rough.' But from my earnest
standpoint, a dentist who can>t cut a crown in 15 minutes really needs
to work on his/her speed.

Bill · Guest

On Nov 18, 9:31 pm, dacconverter <seagate1...@hotmail.com> wrote:
[quote]On Nov 18, 3:03 pm, Harold <Harold_8...@hotmail.com> wrote:

My dentist seems rushed and rough. What can go wrong with a crown,the usual
things?

A crown is a crown. A rushed crown preparation *may* not look the
ideal crown prep as shown in a fixed pros textbook. ( with experience,
a rushed crown prep wouldn>t appear different from crown prep done at
leisurely pace ) Then again, once the final crown is cemented and the
patient feels comfortable, the rushed drilling becomes a moot point.

I don>t know what you mean by 'rushed and rough.' But from my earnest
standpoint, a dentist who can>t cut a crown in 15 minutes really needs
to work on his/her speed.
[/quote]

I respectfully disagree.

There are too many factors which influence the preparation of a tooth
for a crown. Accessibility and angulation factors may increase the
difficulty and the time for a crown prep. Also, I have to consider the
possibility today that many of the teeth being prepared for crowns may
not even need a crown -- it>s easier and faster to make an ideal prep
on an ideal tooth -- but if the tooth is ideal, why is a crown being
made?

In many cases also, existing restorations may require complete removal
and careful buildup of a tooth for crown prep. That takes additional
time and effort.

I have received many phone calls over the years from patients whom I
have never seen before, asking if they can come in to "put a crown
back on" because their "crown fell off."

This always puzzles me. Crowns are designed not to "fall off." In
those cases where the crown loss was not related to trauma or caries,
I invariably see a tooth which has been aggressively prepped with
inadequate parallelism or insufficient prep height, or both. I always
wonder how much of a factor the "speed" was in the dentist>s
priorities for that patient. A little extra effort expended on
buildups and parallelism is not too much to expect.

- dentaldoc

Harold · Guest

Sorry if I was not clear in my words. Since I cannot see the dentist
working on me, I cannot say exactly what I mean by "rushed" other than
he was very quick and seemed aggressive in the drilling. When I was a
kid, my dad used to take me to a brake shop. They did nothing but brakes
and they were FAST, but very good. They looked as if they could do this
in their sleep. So I guess fast or rushed does not necessarily mean
incompetence. That is why I asked what could go wrong with a crown, or
what USUALLY goes wrong with them.

Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com> wrote in
news:yXZUk.2424$mi4.1282@nwrddc02.gnilink.net:

[quote]dacconverter wrote:
On Nov 18, 3:03 pm, Harold <Harold_8...@hotmail.com> wrote:
My dentist seems rushed and rough. What can go wrong with a
crown,the usual things?

A crown is a crown. A rushed crown preparation *may* not look the
ideal crown prep as shown in a fixed pros textbook. ( with
experience, a rushed crown prep wouldn>t appear different from crown
prep done at leisurely pace ) Then again, once the final crown is
cemented and the patient feels comfortable, the rushed drilling
becomes a moot point.

I don>t know what you mean by 'rushed and rough.' But from my earnest
standpoint, a dentist who can>t cut a crown in 15 minutes really
needs to work on his/her speed.

Maybe semantic difference. Rushed to me means insufficient time
spent, not "fast" or quick".
Fast can be careful and well-done. Rushed to me implies sloppy.

Steve
[/quote]

dacconverter · Guest

On Nov 19, 2:49 pm, Bill <dental...@hotmail.com> wrote:
[quote]
I respectfully disagree.

There are too many factors which influence the preparation of a tooth
for a crown. Accessibility and angulation factors may increase the
difficulty and the time for a crown prep.
[/quote]
That>s true, too. But they become less of an issue as you become more
experienced. Really, how many times must you keep drilling to get a 1
mm shoulder/bevel?

And believe me, no one enjoys going to the dentist, let alone having
to open their mouth for long time.

Also, I have to consider the
[quote]possibility today that many of the teeth being prepared for crowns may
not even need a crown -- it>s easier and faster to make an ideal prep
on an ideal tooth -- but if the tooth is ideal, why is a crown being
made?

[/quote]
Most dentists prep for crowns when there>s an MOD decay, a coronal
fracture, and/or a large old filling that is marginally failing. Of
course, you can still do the tradtional composite restoration on them
but haven>t we all learned of how large fillings will break or fail? I
don>t want to put up with tightwad patients who talk of how it was ME
who put in the filling that broke. You also can>t reproduce the
original tooth anatomy anyway.

[quote]In many cases also, existing restorations may require complete removal
and careful buildup of a tooth for crown prep. That takes additional
time and effort.

[/quote]
When I come across those, and if they have a pre-existing deep
filling, I also suggest to the patient a prophylactic root canal.

Will it cost a bit more to the patient? Yes but I>d rather charge the
patient more and get the job nailed completely rather than risk a
nasty phone call in the future explaining to me how the crown is
starting to hurt like hell and that I am responsible for it.

It>s not like the past. People are no longer as naive and you have to
protect yourself. Saving tooth enamel doesn>t bear much meaning to the
average patient. They only know what looks good, how good it feels,
and if it>ll last.

[quote]I have received many phone calls over the years from patients whom I
have never seen before, asking if they can come in to "put a crown
back on" because their "crown fell off."

This always puzzles me. Crowns are designed not to "fall off." In
those cases where the crown loss was not related to trauma or caries,
I invariably see a tooth which has been aggressively prepped with
inadequate parallelism or insufficient prep height, or both. I always
wonder how much of a factor the "speed" was in the dentist>s
priorities for that patient.
[/quote]
Actually, I sometimes end up over-prepping and result in a teepee
crown prep because I was spending too much time on one tooth. And,
even with the best of intentions, it>s not uncommon to accidentally
overreduce for occlusal clearance when trying to drill just a tiny bit
for that perfect 1.5 -2.0 mm space.

For anything you do, I won>t argue that rushing through a procedure is
likely to create mistakes. But I wouldn>t establish causation between
time spent and a poorly done crown. There>s not enough evidence.

Mark & Steven Bornfeld · Guest

dacconverter wrote:
[quote]On Nov 18, 3:03 pm, Harold <Harold_8...@hotmail.com> wrote:
My dentist seems rushed and rough. What can go wrong with a crown,the usual
things?

A crown is a crown. A rushed crown preparation *may* not look the
ideal crown prep as shown in a fixed pros textbook. ( with experience,
a rushed crown prep wouldn>t appear different from crown prep done at
leisurely pace ) Then again, once the final crown is cemented and the
patient feels comfortable, the rushed drilling becomes a moot point.

I don>t know what you mean by 'rushed and rough.' But from my earnest
standpoint, a dentist who can>t cut a crown in 15 minutes really needs
to work on his/her speed.
[/quote]

Maybe semantic difference. Rushed to me means insufficient time spent,
not "fast" or quick".
Fast can be careful and well-done. Rushed to me implies sloppy.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Amatus Cremona · Guest

Machine milled onlays

--
/

Amatus

/
"dacconverter" <seagate1556@hotmail.com> wrote in message
news:596e558d-a73f-4aba-b101-69d38969b630@v15g2000yqn.googlegroups.com...
On Nov 19, 2:49 pm, Bill <dental...@hotmail.com> wrote:
[quote]
I respectfully disagree.

There are too many factors which influence the preparation of a tooth
for a crown. Accessibility and angulation factors may increase the
difficulty and the time for a crown prep.
[/quote]
That>s true, too. But they become less of an issue as you become more
experienced. Really, how many times must you keep drilling to get a 1
mm shoulder/bevel?

And believe me, no one enjoys going to the dentist, let alone having
to open their mouth for long time.

Also, I have to consider the
[quote]possibility today that many of the teeth being prepared for crowns may
not even need a crown -- it>s easier and faster to make an ideal prep
on an ideal tooth -- but if the tooth is ideal, why is a crown being
made?

[/quote]
Most dentists prep for crowns when there>s an MOD decay, a coronal
fracture, and/or a large old filling that is marginally failing. Of
course, you can still do the tradtional composite restoration on them
but haven>t we all learned of how large fillings will break or fail? I
don>t want to put up with tightwad patients who talk of how it was ME
who put in the filling that broke. You also can>t reproduce the
original tooth anatomy anyway.

[quote]In many cases also, existing restorations may require complete removal
and careful buildup of a tooth for crown prep. That takes additional
time and effort.

[/quote]
When I come across those, and if they have a pre-existing deep
filling, I also suggest to the patient a prophylactic root canal.

Will it cost a bit more to the patient? Yes but I>d rather charge the
patient more and get the job nailed completely rather than risk a
nasty phone call in the future explaining to me how the crown is
starting to hurt like hell and that I am responsible for it.

It>s not like the past. People are no longer as naive and you have to
protect yourself. Saving tooth enamel doesn>t bear much meaning to the
average patient. They only know what looks good, how good it feels,
and if it>ll last.

[quote]I have received many phone calls over the years from patients whom I
have never seen before, asking if they can come in to "put a crown
back on" because their "crown fell off."

This always puzzles me. Crowns are designed not to "fall off." In
those cases where the crown loss was not related to trauma or caries,
I invariably see a tooth which has been aggressively prepped with
inadequate parallelism or insufficient prep height, or both. I always
wonder how much of a factor the "speed" was in the dentist>s
priorities for that patient.
[/quote]
Actually, I sometimes end up over-prepping and result in a teepee
crown prep because I was spending too much time on one tooth. And,
even with the best of intentions, it>s not uncommon to accidentally
overreduce for occlusal clearance when trying to drill just a tiny bit
for that perfect 1.5 -2.0 mm space.

For anything you do, I won>t argue that rushing through a procedure is
likely to create mistakes. But I wouldn>t establish causation between
time spent and a poorly done crown. There>s not enough evidence.

Dartos · Guest

With mechanical devices, it>s okay to slap things around and use
a bigger hammer when needed.

Speed in a dental office (as has been stated) is not necessarily
'bad'. However, 'rough' is.

Fast is fine as long as the quality of work is good and it is
*smooth*. Don>t jerk cheeks, jab instruments, etc.

JMO,
D

Harold wrote:

[quote]Sorry if I was not clear in my words. Since I cannot see the dentist
working on me, I cannot say exactly what I mean by "rushed" other than
he was very quick and seemed aggressive in the drilling. When I was a
kid, my dad used to take me to a brake shop. They did nothing but brakes
and they were FAST, but very good. They looked as if they could do this
in their sleep. So I guess fast or rushed does not necessarily mean
incompetence. That is why I asked what could go wrong with a crown, or
what USUALLY goes wrong with them.[/quote]


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