Monday, October 22, 2012

Episode 398/500: Crown Removal - Richwill Crown Removal Tabs

There are a number of ways to remove crowns - not that you typically want to remove definitely luted crowns - but - there are the times when it "just has to be done".

Just like this morning.....

Chief Complaint: 55 YO female presents with a chief complaint, "my crown is loose - can you cement it back on?"

There are many things that run through my mind when a patient presents with this scenario, including:


  1. If it fell off, what's the success going to be if I just cement it back on?
  2. How many times has it fallen off?
  3. Did it fall off - or - did the tooth/core fracture?
History of Present Illness:  The patient's crown on tooth #13 (FDI #25) was dislodged over the weekend and caused some discomfort.  The tooth has been previously endodontically treated and the full coverage restoration was placed approximately 5 years ago.  

Clinical Exam: Tooth #13 crown was still intact intraorally and on the preparation.  By using an explorer and engaging the palatal crown margin and lifting coronally, I was able to start moving the crown.

Radiographic Exam:  Tooth #13 has been previously endodontically treated and does not appear to have a post placed in either canal.  Periradicular tissue is normal (radiographically)

So - the story continues - as I am about to remove the crown, I"m thinking that perhaps I had better capture a triple tray impression of the quadrant to ensure that if the crown/tooth fractures, I will at least have a "go-by" stent to fabricate a provisional restoration.  The other option is of course, to take/make alginate impressions - however - this is a sick parade/emergency patient and there really isn't time.  I suppose that as I reflect - I could have taken alginate impressions and rebooked her for another appointment.  Either way - here we are.

Anyways, long story short - the crown wouldn't come off and I suspected that she had fractured her core.  After provision of some local anesthetic (you'll see why if you look at the photo), I just couldn't get the crown off w/ hemostats (my crown removal forceps were at our other clinic). So, we scrounged around and found these friends - the Richwill Crown removers.  These are great little friends that only work in specific situations - and this was one of them.  Dental versions of jujubes, these guys, once heated and placed on the crown you intend on removing - make life just a little easier.  However, just like the instructions say - ensure that the opposing dentition is intact, or you may be removing a restoration from the opposing arch as well.

The little tag of tissue was most likely the culprit causing the patient some discomfort when the crown was rocked to the buccal.  This discomfort was also a great hint that most likely the tooth/core was fractured.

Now what to do?!

Here are the instructions for these green friends.

http://www.almore.com/Instructions/Richwil%20English.pdf
richwill crown remover, crown, removal, fractured crown, dental crown,
The crown removed from it's resting place of 5 years.  The white core material appears to be a composite core buildup.  
There was no post placed, and it's hard to determine how
much ferrule was used.

richwill crown remover, crown, removal, fractured crown, dental crown,

richwill crown remover, crown, removal, fractured crown, dental crown,
I'll be $4 that the little tissue tag was causing the discomfort when
I tried to remove the crown w/out local anesthesia.

richwill crown remover, crown, removal, fractured crown, dental crown,
Ok, the crown is off.

Now what?

9 comments:

  1. Can we see a radiograph? How much tooth structure was left? Will you be able to salvage by placing your own post and core?

    ReplyDelete
  2. I really enjoy reading your blog and I will definitely bookmark it!

    ReplyDelete
  3. Mold Removal Toronto ★ 100% FREE Estimates
    ☎ Call Now (647) 694-3617 Low Cost Mold Removal Contractor ✔ Visit Website NOW.
    s of Mould Removal Jobs Completed in Ontario. Restoration Company in Toronto.
    mold removal toronto

    Also more details click here

    ReplyDelete
  4. Its great to know how dental crown is removed. Actually I want your suggestion regarding a dentist, Its here http://www.drkezian.com/los-angeles-dentist.php . I have a plan to take complete smile makerover treatment from this dentist. Should I take their service or choose other one. Thanks

    ReplyDelete
  5. So painfull i see ,glad you had removed that crown by the surgery !
    For us , it is now easy to get
    Dental implants in Boca Raton & Palm Beach for one or more missing teeth with Dr. Katz, a board-certified oral surgeon in Boca Raton. Their team is specialized in dental implants and Mole Removal at Boynton Beach!

    ReplyDelete
  6. Inspect crown prep, realign to then..
    Drill out core and relute or
    Make a more aesthetic and functional crown using your technique now

    Regards
    Rey

    ReplyDelete
  7. Crowns are fundamentally the same to finishes aside from that they cover the entire tooth and are utilized as a part of situations where a ton of tooth has as of now been lost. Crowns can be produced using a number f diverse materials relying upon the need and capacity of the crown. And additionally enhancing appearance, crowns can be made to fortify frail teeth.

    ReplyDelete
  8. I'll be $4 that the little tissue tag was causing the discomfort when
    I tried to remove the crown w/out local anesthesia.cheap garbage cans for sale

    ReplyDelete