I need two crowns, and this is what it's been like to get them. I just had two root canals. It was surprisingly
not that bad. Now there is a requirement to make sure I don't need two more, and two more after that. After a root canal filling, you pretty much need a crown.
"As soon as possible" after getting the root canals filled, you set up an appointment with your regular dentist to get started on your crowns. The temporary filling is good for a few weeks, maybe a couple of months if you are gentle on it. Eventually that filling will degrade and your tooth will be break and you might get infected again, but this time your insurance will already be maxed-out, and you will only want to pay for an extraction. Then you're down a tooth until you want to fork out WAY more money for an implant or a bridge. Yes, implants cost more than crowns, by a heckuva lot.
So I called my dentist's office and set up an appointment. I showed up early and was seen very late. The start of the appointment was the start of a(nother) conversation between my dentist and my endodontist. They worked together behind the scenes, developing a plan of treatment . . . while I was cooling my jets in the waiting room. Eventually I was led to a first for me: a dental operating room with an actual full set of walls and a door! Security win!
I had been worried that the root canal fillings could fail, and that I would have a $5,000 pair of teeth I could show you in my desk drawer. They said the main concern is structural: you have a hollow shell of what used to be a strong tooth. To chew on it is to risk breaking the tooth, and that means more $$$ out of pocket. The part I was worried about is re-infecting the tooth. They said the x-rays looked great and the teeth were sealed, pretty much infection-proof. If an infection were to flare up, it would just be in the soft tissue which is less of a problem in my mind. This set me greatly at ease about the money I was about to spend on my shiny new crowns.
I had a talk with the doctor about what was preferred, what is practical, and what would be done that day. We agreed on a game plan and she called up the billing lady to show me just how deep I would be going "out of pocket" for this round. The dental assistant gave me some topical anaesthetic between my tooth (#3) and my cheek, and put a gauze pad in on top of the (minty!) gel to keep me from rinsing the stuff away while I got numb. The doctor came in and gave me one shot with a much smaller, less-painful (but still slightly ouchy) needle than the endodontist used. After a few minutes, she gave me another one because I am hard to make numb in my mouth. I got some sunglasses to keep flying bits of nasty out of my eyes.
They went to put in a rubber dental dam and the clamp wouldn't hold. The doctor went to start working and I stopped her because I could feel it slip. She put a different clamp ("more of a 3 than a 7") and it worked better. Out came The Drill. I could feel the drill when it was hitting tooth, distinct from the feeling of the drill working on the temporary filling.She ground out all the temporary filling material and realized that there isn't much tooth left. She called out for a "red" sized post and the drill to go with it. She started drilling and it was weird. The tooth was numb, but it still transmitted vibration to the jaw, which was not. As she was removing the filling and drilling for the post's anchor, it was shaky. The drill for the post was out of round or something and seemed to be vibrating a lot (shaking my head) more than usual. The doctor thought so also, and she threw the bit in the trash and got a different drill bit. She said later she had to drill down a centimeter, into the roots, to place the post properly. She jammed the post in my tooth.
The assistant whipped up some sort of adhesive, and they spooged it into my tooth around the post. I was left with the barrier dam in my mouth waiting for the stuff to cure for a few minutes. They packed some more filling buildup stuff into the tooth.
My x-ray showed the tooth next door was decayed from being in contact with a decaying tooth. There will never be a better time to work on a tooth than when the next door neighbor teeth are gone, so we did a little side job. They explained to me that, if left to get worse, I would need another root canal filling on #2 eventually, but there is a problem: #2 has a curved root. Cut the | off a capital letter D and that is the shape of the root right by this decayed part. It would be impossible to clean out all the way, so that's an extraction with an implant, or a missing tooth where I would like to be chewing. Not good. Filling time: just a few minutes. The shots I had were actually for this. #3 is dead as a doornail and wouldn't feel the drilling anyhow, but #2 would be killing me as she drilled it out. So she pre-numbed it, drilled it out, filled it, and moved on with the crown procedure.
They pulled out the dam, and then I bit into a blob of silly putty. At least, that is what it felt like. They make a mold of your tooth, so they can make a mold in which to cast your crown. The mold they make of your tooth starts out as a thick gel, about like soft silly putty, on a little plastic tray/sheet with a handle that sticks out of your mouth. You bite down and wait a few minutes while it sets up, then they pry your mouth open off the mold, and take it out.
There was so little tooth left to work with, they had to make some room around it. In the old days, this involved a knife. They broke out a LASER and gave me some pink LASER safety goggles instead of the sunglasses, and went to town. The doctor ended up removing what seemed like a lot of gingiva, but she was okay with it so I was okay with it. In actual use the LASER sounded like a TASER going off in my mouth. Tick tick tick tick tick tick tick tick, and the doctor was moving the wand (the size of a fat pen, with a cord attached) all around the tooth. The ticking, I think, was my flesh turning to vapor (a normal part of LASER ablation surgery). It didn't smell, and it was cauterizing as it went, so it didn't bleed. That's pretty nice, considering what was going on at the time. When there was enough exposed dental margin, she cleaned it up to receive the temporary crown.
They took one more mold, to send off to the lab which will make the permanent, porcelain crown. It was, once again, like biting into soft silly putty, but this time I had to hold tight and not move my mouth. Getting this wrong is an expensive step, because they'd have to make a whole new crown if you mess up this mold. They pried the stuff out of my moustaches, pried my lips apart, and then the doctor helped me open my mouth. She trimmed the excess plastic off the sides of the mold and sent the mold off to the crown makers' lab.
Then it seemed like she was doing a magic show, they were moving so fast. All of a sudden, POP out of a mold comes a blob of yellow/white plastic. That was the temporary crown. The doctor trimmed it with hand tools, explained what was going to happen, and slapped the crown in place with some temporary cement. I said it felt big. She said wait while it cures. We went through a few rounds of bite-down-and-grind-on-the-marking-paper, trim the crown, and repeat. In a few minutes I had what felt like a workable occlusion and we called it a job.
The doctor said the gums would feel like they had a coffee scald, and she was right. Ibuprofen took the edge right off that, and a couple days later it is once again the case that I have to remind myself to take ibuprofen to help it heal faster, because it doesn't hurt. She said to give it a day, then stop chewing on the other side (#20) to avoid breaking the tooth (the temporary filling, she said, would likely be okay for a few more weeks). Set up an appointment to come back and have the permanent crown fitted. Pay the lady many many dollars. Go home.
Annoying: I spent a long time waiting for stuff to start, cure, set, or be done. This was a two hour office visit with about half the time spent in the chair. They did at least keep sucking the pooled spit out of the back of my mouth from behind the dam.
Cost:
$1400+ Update! $1500 split into two lowlow payments. Insurance is maxed-out, so this is pretty much straight off the top of my checking account. If I had only one root canal to cover with a crown, this would not be a problem, but I
had to have two to change my mind about something.
Scary parts: None, really, after having two root canals. The laser was new to me but it didn't hurt OR stink, so no big deal. The needle was smaller this time. Yes, they still used the zeeeeeeeee drill but honestly I'm getting used to it after hearing it so much lately.
Pain: Yes, this time. They burned off a good bit of gums, and it stung when the shots wore off. Chewing is uncomfortable when ibuprofen wears off, even several days later. It STILL feels better than before I went in to be seen the first time, by quite a lot.
I am a little worried about occlusion with the permanent filling, but I'll be sure to be a pest until they get it right.
Update September 12: The peramanent crown is temporarily fitted. This visit was VERY brief. There were a few minutes in the waiting room, a few minutes of talking, and a few minutes of work. I spent more time in the driver's seat of the Hot Rod getting there and back, than in the dentist's chair.
The dental assistant was new and worried she was going to induce some discomfort. She says she has to squeeze the temporary crown a bit to break the seal, and twist to get it off. Then there will be some scraping to get the temporary adhesive all off the tooth. I told her it was root canal-filled already and not to sweat it but just go ahead. She did. Removing the acrylic temporary crown took about 3 seconds. I didn't feel anything, but the tooth is insensate due to the root canal work. She scraped off a little adhesive. She showed me the permanent crown (looks like the top of a regular tooth) and at my request compared the temporary and the permanent side by side as we waited for the doctor.
The doctor came in and there was some more chit-chat about my teeth and my (lack of) insurance. She had a look in my mouth and made several "mm-hmm." noises to herself. A little more scraping on a tooth with no feeling, then she popped the crown in. This was the part I had been more worried about. I mean, it's PORCELAIN - if they get it wrong, how are you going to fix the shape for proper occlusion? Well, this ain't your grandma's statuary porcelain. It's got quartz and some aluminum alloy whatnot in there and you can shape it and polish it with no trouble at all.
The thing didn't fit. HORRIBLE occlusion. Marking paper, bite/grind. Then (and this surprised me) she popped the crown out again and drilled it while she held my (new, fake) tooth in her hand! Press it back on the tooth and tap/tap/bite more marking paper. Still no good, remove tooth, adjust with a hand drill, replace tooth. I was ready to accept this occlusion but she didn't like the expression on my face. She pulled it again, talking about this one tiny little spot she had in mind ("one little bull's eye right in the center") and gave it a touch with the drill. Crown back in. Bite-bite. It felt like there was nothing unusual there. Like teeth. Like it fits as it should. The assistant whipped up some temporary glue and the tooth was glued together. Done. Time for more talking.
We had a discussion about the shape of the tooth vs. the shape of the gums by this tooth. There is a little gap where the gums were shot away with her LASER, and she mentioned for the first time that she had to remove some BONE with the light! Holy wow and I didn't feel a thing, with only two shots of pain killer! Well, the gums will grow back v.e.r.y. s.l.o.w.l.y. and they won't take the natural shape they used to have. Food might want to get stuck beside the tooth. She decided to let me test-drive the new tooth and see if I can tolerate the way it interacts with food. If necessary they can ADD to the crown to make it stop collecting stuff in the space between the crown and the tooth next door.
Pay the lady many many money up at the front desk. Same after-care instructions as before. Set up an appointment to get started on the next crown (#20) in a week from now and possibly a permanent seating of the permanent porcelain for #3, or a re-seating of the temporary (plastic) crown while #3 is sent off for adjustment.
Pain: none. Seriously, it didn't hurt and it doesn't hurt. They were wiggling heck out of my tooth, so the gum is a little less pain-free than before they went in there today, but it doesn't hurt by any stretch of the imagination. 1000% better than before, when I had an infected tooth. There is a little gap around the margin of the new crown. I'm not sure what to think about that but I'll talk to the dentist about it next time.
Cost: the second of two payments of $750. Straight out of pocket. Ouch.
Scary bits: none, unless you're dentist-phobic.
Bonus: another operating suite with four walls and a door. I really really don't like the idea of being laid out with people working on my head and no walls around us. Sure it's a low-risk environment, but so what?
The plan: Try the tooth for a week. Maybe have it seated permanently, then on to drill/post/fill/temporary crown for tooth #3.
Update September 20th: The second crown was prepared-for today (build-up & post, acrylic cap on #20). I went in for a 2-hour appointment and spent almost exactly 2 hours in the chair.
The first order of business was more minty gel to numb the gums by #20. There was some discussion about what would happen and we looked at my x-rays on the computer which remains an amazing thing to be able to do. Once again I remembered too late that I forgot to take ibuprofen before going to the dentist but they dispensed some as I was checking out so that worked out. The doctor came in and had a look, ordered an x-ray, and answered a question. The temporarily-attached permanent crown has a dark line visible inside the mouth and there's a little seam around the edge of the crown. The line is the metal margin and the seam is acceptable, normal transition between crown and tooth. She called it good after feeling with a fingertip and scratching with a probe. Then she started giving shots. The stuff they injected in my jaw squirted out a little around the needle and it tastes BAD . . . but after the shots were administered, they rinsed out my whole mouth and sucked it all out so it only tasted funky for a minute.
This tooth (lower left bicuspid, #20) is almost touching its mate on the top jaw. The crown can be pretty thin. A porcelain crown made this thin will break sooner rather than later, but a gold crown will cost more. A porcelain crown also needs about 3mm of margin to be exposed but gold only needs maybe half of that and the root canal doc cut the tooth down pretty short. Gold is the material of choice for this tooth. I asked about getting zapped from one tooth to another (galvanic potential) and she said with the other nearby fillings as they are I probably will not have a problem with the 'chewing on tin foil' effect. The bigger problem is that gold is not tooth-colored. She decided to use a "noble" white gold alloy because it is (in her professional opinion, in her words) "less bling-y".
An impression was made to help make the temporary crown. This was, once again, rather like biting into soft silly putty. Again, I had to laugh as I was sitting there with a mouth full of silly putty. It tastes like Tums.
They went to place a dental dam and the doctor had the good idea of asking if the clamp on my tooth was bothersome. It was, a little, then it was a little more and I figured it would only get worse, so I spoke up. She gave me a couple more shots in the gum which gave a little pinch each, so it is a good thing I got them. If it hadn't hurt to get the shots I would have felt a little silly, but it was obvious that (as usual) I was going to take more drugs to get numbed-up. So, more shots and then they positioned the dam the way the doc wanted it to be.
The preferred practice is to remove about half the root canal filling, to make room for the post that will be holding the crown in place. This removal was done with a regular dental drill with water spray and suction. At one point my lip was sucked into the suction tube because the assistant was distracted watching what was going on. I made a face and she apologized for it . . . but I had made the face because of the noise it made! I thought she had grabbed the dam or something, but as I was currently under the knife I couldn't clear up the confusion. Oh well, no harm done. They cleared out the temporary filling and went to do something on the instrument tray. The drill bit hit the floor.
Anything below the height of the work surface in an American operating room is "dirty" so a new drill bit was produced and work continued. They drilled the hole for the core with their second-smallest (yellow?) drill bit, and put a titanium pin ("post") in the tooth. The glue wanted to push the post out of its hole, so the doctor grabbed my jaw on one side and the post in my tooth on the other side and squeezed my jaw. I could feel the bounce/give as the post pushed on the rubbery root canal filling material. It was wierd but didn't hurt and the jaw-grab only lasted a moment while the glue set up. Then she went to take out a little bit of temporary filling stuff she didn't like seeing in there, using a pick. When she realized how deep the tooth was carved away, she broke out the drill again. The post she placed was apparently a little long, so the doctor said not to worry if I saw any SPARKS coming out of my mouth; it's just that titanium does that when you grind on it . . .
The tooth was filled in stages (like #3 was), with brief use of an ultraviolet curing light between layers of filling stuff. The LASER came out again. It was a different light this time - no safety goggles were used by the professionals but I had some UV shielding goggles on already. Good thing I did because I got a mini-shower from the cooling water when they were zapping my gums into me-smoke with the LASER. It didn't stink or hurt. A few bits of cotton packing were placed around my mouth and they took a final impression to send to the lab to fabricate the permanent crown. There is a concern that the gingiva was seeping too much for a good impression to be taken, but that's not a big deal because another one can be made when I go back (AGAIN) in a week and a half.
They brought out the temporary crown and the doctor shaped it a little with the drill while she held it in her hand. She got it pretty close by guesswork; it required one adjustment once it was placed but then it was good. She started using a probe to clean out the excess adhesive, and I started wincing. The anaesthesia were wearing off and I could feel her poking me a little. It felt about as zingy as getting shots with a very fine needle, not too terrible. She noticed my discomfort and started working noticeably faster, which was nice.
A bit of Vitamin E gel was spread on my gums. There was a bit of after-care instruction lecture, a bit of pulling impression-making rubber off my lips, a bit of $1400 on the credit card, and I was off back to work. I was officially excused from brushing or flossing behind #20 for a day because of all the gums they zapped off, and I had to get another $8 bottle of medicated antiseptic mouth rinse to use for a week.
Pain: not so much, but I've got some ibuprofen because I am pretty sure my gums would be hurting if I let it wear off
Scary parts: it's all pretty mundane by this point. It was a little freaky feeling the pokes from her cleaning probe right at the end there.
Cost: another $1400 gone, but with a hundred bucks off because I paid all at once. They also gave me a break on the price difference between gold and porcelain because they know I'm strapped for cash and the doctor is interested in getting the best result vs. highest profits.
Last visit, they wanted me to take home a special little brush to clean out the holes around my new "teeth." I forgot it at their office. Once again this visit, I forgot to take my little bitty hole-in-your-gums toothbrush home with me.
The plan: Go in another week and a half and see what's up. Possibly seat the permanent gold crown on #20 or possibly take another impression. Possibly permanently seat the permanent crown on #3 or maybe have it sent back to the lab for adjustment. We're waiting to see what the gums do to close up the gaps. It does collect food but it cleans out easily.
Yet another visit: I went in and I wasn't sure what was up. Nothing much, but they broke my tooth.
The gums were seeping too much, and the final impression for the crown for #20 was not acceptable. The idea was to pop off the temporary acrylic crown, take an impression, and pop the temporary back on. In actual practice, this meant the dental assistant was cranking REALLY hard with a forceps on my temporary crown. She was pulling so much she was hurting my gums; it felt like she was pulling the tooth out. She called the Dentist. The Dentist called for drugs.
I was relieved when she said they had never yet pulled a tooth while trying to pull a crown. Your gums would have to be in VERY bad shape for that to happen, apparently. Okay, but it still felt like she was pulling my tooth . . . but . . . As it turns out, they had used a little bit of permanent crown adhesive around the edge, just in case. That lead directly to this thing being VERY stuck in my mouth.
Minty numb gel. A couple of shots. Can you feel this? she says. Nope, go for it. Cool points for use of the billiards term "english" to describe the removal of a dental crown. Somewhere in there, the removal forces were too great and the plastic crown was chipped. When she finally got the thing off, the Dentist called the tooth "highly retentive." No kidding. They rinsed, dried, and took the impression. Strictly temporary glue this time, the temporary crown went back on. It had a little hole on one side, but no big deal. After the shots wore off, my mouth didn't hurt much, and the next day it was pretty much normal-feeling.
Update October 17: Permanent crown on, Temporary crown back on.
I went in first thing in the morning and signed in 15 minutes early. I had barely sat down when the lady called me back (THEY were early for the appointment!). I sat in the chair and had a chat with the dental assistant about what was in store. #20 to get the permanent (gold) crown permanently seated. #3 permanent crown to be checked, possibly sent out for adjustment while I wear the temporary again.
The dental assistant pried, poked, pulled, poked, and pried, and in a minute my "highly retentive" temporary crown on #20 was off. The gold replacement looks an awful lot like silver, but they tell me it's a white gold alloy. Okay fine, in it goes for a test-fit. Too big. Neighbor teeth too close together. It only went on half-way. She put a roll of cotton in to hold my mouth open without smashing the crown, and the doctor came in. The Dentist looked at the tooth, popped the crown out, shaved and polished the oversized gold, and test-fit it again. Better. Once more, and it fits good enough for her liking. Pop the crown out for a final polish.
Then it was time for #3. I said there was minimal food pack between the teeth, no big deal. The Doctor doesn't think there should be ANY food packing in between the teeth, so she wanted her lab to add material to the porcelain crown. The assistant went in and took about 5 seconds of prying and the crown popped right off.
Gluing the gold filling in place was quick. Pack some cotton by the gums to keep my cheek away, and blow the stub of my tooth totally dry with compressed air. "Stay open." Put a dab of glue, jam the crown on the tooth stub, insert a thick wad of cotton, and "Bite down hard and I'll be right back." My jaws got tired but I pretended to be a wolverine and held on. There was some concern that the bite wasn't quite right, so there was a double-checking on the crown on #20 but she didn't want to adjust it (remove material from the top) too much. It's easier to remove gold than to add it, especially in the mouth. Welding joke: what do you use to weld new material onto a gold filling? Goldenrod! (rimshot) More marking compound tap-tap/grind, and a minor polish of metal off the top of the replacement tooth. Rinse and suction out the gold dust (!).
The temporary crown was re-installed on #3 while the permanent is off to the shop for an adjustment. Apparently they can add material to ceramic crowns. Magic stuff, that. A dab of glue, push the crown in place, bite on more cotton for a minute, and we're done. The only part of this process that was painful was the finish-up. The assistant used picks and scrapers to nick off the excess adhesive from around the edges of the crowns. These crown margins are very near the gumline, so there was a moderate amount of stabbing my gums involved. Only slightly painful. They also used dental floss to get the chips of glue out from between the teeth, and this meant REALLY getting in there under the gumline. The adhesive they use to permanently install a crown is pretty irritating to the gums, so this is an important step. Note: when somebody
else flosses your teeth, that is not a great experience 100% of the time.
A digital x-ray image was taken of #20 to verify the crown was on right. Followup care instructions were given and I was off. Just over an hour to seat both crowns. The cost was already paid before this visit so no bills were involved.
The gut feeling: When I was in the chair, I was a little apprehensive about the funky feeling I was getting from the gold filling. Something was hitting something, but it was hard to tell with my gums having been poked-at so recently. Now that the glue is setting up for real, it is moving less. I think the gold was flexing on the tooth or something, but that should stop or else I'll be back to ask what's up.
The plan: Nothing very hot or cold and no hard chewing for a day. There is one more visit to get the permanent porcelain crown on #3, and that SHOULD be it.
Pain: Not so much, but then again these teeth are root canal-filled so this is to be expected. If they were not filled, this part of the process would probably SUCK. When they removed the crowns, there was a sensation from the gums like someone was trying to pull my teeth out. If the tooth could feel it also . . . :(
Cost: No additional charges, I already paid the full fee for the crowning service.
Update October 18: I was right. The crown stopped moving when the glue fully cured. I went easy on it yesterday to give it a chance to set up without moving around too much. When the dentist was adjusting the bite, I think she thought I was saying I felt contact between the teeth, but it was the squashing-around of the margins of the crown, pushing against the nearby teeth. I had her shave it down until there was minimal contact but it still held the marking paper between the crown and the opposite tooth when she gave the paper a little tug. My uneducated guess says that if it doesn't get enough stress from a normal bite to flex the crown with wet glue, it will have minimal chewing stresses for the life of the appliance. That's good because I don't want to do this again any time soon!
When I open my mouth, you can see this shiny thing inside. When I smile, you can't see it. #20 is far enough back unless you are super self-conscious about your smile you can get gold on it.
