Why do I need to replace this crown-Overhang!

One of the most challenging aspects of clinical practice is convincing patients to go through with elective asymptomatic treatment. One such area is crown and bridge.

 This X-ray will appear repeatedly on this blog. Right now let's focus on #19-there is a clear overhang on the distal aspect!

This is how we explain the need to replace this crown to the patient:






 


" A crown needs to fit the tooth like a skull-cap fits the head-tightly around the seam. This crown is sitting on the tooth like an oversized hat-sticking out! This will eventually lead to food impaction leading to a cavity on the tooth and/or bone loss which will eventually lead to the tooth needing to be extracted."

It helps to have a comparative bitewing to show a well sealed margin like the one on the right.

Inferior Alveolar Block:

The most common complaint I get from patients regarding Local Anesthesia on the lower arch is that their lip felt numb but they still felt the pain when the dentist drilled on the teeth!

This happens because the operator administered the Long Buccal Nerve Block before verifying that the Inferior Alveolar Nerve Block has kicked in. There are 2 essential steps to do so:

1) Always use a long needle.
2) Don't start injecting till 90% of the needle is in the Pterygomandibular Space and you have hit bone.
3) Ensure that the side of the lower lip is numb EXACTLY to the middle. I also verify with an explorer in the canine area.
4) Do not adminster the Long Buccal Nerve Block till #1,2 and 3 have been completed!