Fishing for answers

[Brett Hansen CDT]

One of my docs is a member of a peer review board. He showed these pics to me of a fractured e.Max crown and wanted my thoughts about why it broke. The silver part of the perio-probe in the pics is 3mm for reference. The crown looks plenty thick enough. My possible explanations were bruxism, doctor reduced the occlusal of the crown improperly, the lab repressed an ingot? Anyone have any other answers? THanks!

 

[2thm8kr]

Could be a carbide was used on the occlusal by the lab or clinician to refine the anatomy.
I can't believe a broken crown is going to peer review.

 

[CatamountRob]

I suspect the clinician dropped it, then stepped on it and is looking to finger someone else for the f-up.....
Just kidding, but since there is probably no way to discern what actually caused it to fracture, I'd blame it on Bush/Cheney.

 

[PearlZ]

too much space between crown and prep, causing occlusal forces to flex the crown, and shear from the thinnest part (margin) through one side to the other.

crown was held up and not seated properly, masticatory force leveraged the open side causing a split.

doesnt appear to have grinding marks, but i *_SELDOM_* see an emax prep with 3mm of space. amateur design might have missed excursive movement checks?

man could be so many things.

 

[JKraver]

too much space between crown and prep, causing occlusal forces to flex the crown, and shear from the thinnest part (margin) through one side to the other.

crown was held up and not seated properly, masticatory force leveraged the open side causing a split.

doesnt appear to have grinding marks, but i *_SELDOM_* see an emax prep with 3mm of space. amateur design might have missed excursive movement checks?

man could be so many things.

I like that too much space thing just a bad prep with a little dentin spike on is that was lost/removed from model and prevented good seat would be enough you think? Maybe they bite with the force of the jaws of life. Maybe pt was eating rocks. It was plenty thick, could just be a fluke. Stuff happens in dental lab.

 

[JKraver]

what about the porcelain just being in a V shape and not a U shape in the grooves. That could perpetuate a crack. I have never seen one front to back like that I have seen facials/lingual come off.

 

[CatamountRob]

Do you even know if it was pressed or milled? Was it conventionally cemented or bonded?
A bunch of pictures of a broken crown without a die to check fit, or models to look at occlusion or any photos/or x-rays just isn't much to go on.

 

[Car 54]

I agree. Those were the photos I was hoping to see, too.

 

[JKraver]

Do you even know if it was pressed or milled? Was it conventionally cemented or bonded?
A bunch of pictures of a broken crown without a die to check fit, or models to look at occlusion or any photos/or x-rays just isn't much to go on.

There is also only really two photos. One of you don't care about the probe.

 

[JKraver]

If it were milled the mills speed could have been to fast and caused micro fractures. Could of overheated the emax while grinding.

 

[CatamountRob]

The possibilities are endless.....

 

[Car 54]

Yes, all in all, to many variables mentioned here to make a real "guess" as to what happened. It's just emax, it's not bulletproof.

 

[rkm rdt]

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5lFy2vMZiKFxcTOSCdT7h5VlGxLI5HGxt7uhpW6VJt6NHg4RyHvp7LCOYrF4TGBxoTfzowITT2NL6fHwrwFzUMeIebT7EY6aXoLC4C51q3ygC3ACmEsUa5QLd0d4jr+Efn6UY20Y0FpmUX+7pe3lVbFii+kdrfj+Hd6nxqdcKqjuqCSeJ1JPiTTiWI7SQywPnimkaFz3G3jXUnXI2vHjY87VRvtGY8ZZf/ADH/AFr0LtQqmAx8SzJwH2bXPxsfjWO/ZgrHOavhrjfCs9vm/wB7J/jb9aVWJ2YOtKo1VeBQjpZKltSfQHwuapKIpQ7CvStmfRkJsMuIG0sMIyqs7bq6xkqGKu+/sCM2t7UGPoydlwrri42XFzNCpEJIAEc8gkBEveBEH+fjprPaGyWW/uFQNHW8wf0dOz4xXxkUa4JlV5DA5DKYVlL23vdADW58L1DJ9G+J9uTB72IiSJpxiArZRGrBX+qzXLgsmmaxzg30Ip3KUtMhgsA8rZUF+p5KOpNaQqiBSP3gFmPI343q+HYGaMwLh8XG8GIlkiaUwOrI6LIdU3nfUmJlvcW00N70BiOwmJaPHv7Qn9haRbCFhvjHAkxsd53LiQDnVY54wrjayvaByQrDQqdDerfYG1DLHa/eXQj86j7VdkGwWHhlkdJmnieXIEdDGEjVySxchgC4HAcav8V9Fk+Elw27xSP7RKIL7hgE+rkkzkbw5tIyLXHHjT7z2OvjQdZDzro86uT2OxIxy4P2iDM2HfE7z2eS1klSPJk33Hv3vflwqi26nsskse+hxO7i3haEZQGvIpicZ3swyDnz4VU5Mai41OK7erPb/ZTEYPDjESTwyKGhV0WB0Yb51jBzmVhozDlraotgbClxm/ZJ4YEgyhjJEz/aTOWLCVQoA+VHea2Ot9AgagwJspH4WcemY2+BFXeC7KSSRvKMfhN2su5EggdkYsyIpVhiLau4XzqDZ/ZHFtisXh2lgjMCQzZ91JIJRKrAFRvFKfujcHNrzpfJifSgia6Go7YXZybEQYaaTEQ4Y4vSCLcPOWO7aTvOJFC3SNmtbQW1vpUMnZ3F7nFSZoc+FlMO5EbsZWyxlSkudcuYSra6m3jR8mI6ULemlquIeyE7Yx8IMVh88cKTO3s0lhvHZQlt/wAbLe/iKrodgYl8NhcQJISuJnSAjcv9TvJWiEjHe98ZgBbT7Y10pfJB0oByTUZiA7zcuAo/aWyJMOXzzQvkxQwuVYnRmJw6z5wTI1gA2oseHGjdn9j5cTh4Jji4IhiGKxxth5GJbvkJnEwubRk3sOFHeDrWWOgLczwqm2j2e4sNDxrcYPsnNIcVv5Y8LFgmKzSZGmzMEEl41BUhcjI1zr3rW0vRsnYnFNjGwRmhH1BnWfdORIudUybreDdsCde8wsR5A74nJXjmzvtsPP3g1euZYVRyAyOoYEcr8mHKrvZ30Zy5cLK2IVHxWJkwzIYSd0yCfMb5xm1gItp9rwqw7XbAOB3MLYqCdhdDGiFJIwEzq0gMraEEchxFRMoqssO1CqLFCSelEQYeXEFWZkEV7lATc+DH8qv4Po0aePASb6FfbrFbQPeK+GkxGpEoz/u8vAcb+FWWxPo4kWLEXx0MSQzvGzyQEDuqneLGYBR3hp8acz/Y1+lfG6rpf0FGKbr3Km2D2NeWAT+2YZVaaSBGMEjh2WdoIyrCYDvsBb+IDWi9ldk8VJNiommw8BwhjDMY3kVxIhcSA7xMgy20N7G+pq5yxHWqTH4EGF1AubZ788y6n4XHrWU3VbmCX6yWPeRTbpwgliH1coMaNdRmbhnKnvHVfSsZilyuyjgGYe42oz1dWCfoNu6VOpVCtm7um5KmU0iKA33ZsW7N7S/in/5UVbHsXiY02bsgSRhzIyJGdPq39nnfeD+VHX+evHYds4hMNLhUltBMSZEyRm+ZVVrORmGijnToO1mMjjw8aTAJhWzwDdRHKRG8YuSt27srjXreo61Ur17Cyqj7eZ0EiKwZoybB1GAjLITyuNL+NGojftqJi31bbOm3cdgMhGIw+bvfevdfLLXjsfabGMMRef8A7YPr/qoe99UItO73e4ANPOu4ntVjTNFiDiG3uHVljKxxjuNbOrIFs4OUaHpcWOtHWjtHpk2L3WBwL/8AElX0fGTI3wY1otoRKjSQaXx7TkddMIqn/livJsbtyXHBBipipjIeKNYlhVJBqJQpuWcX4kkC501oraO18RJLDM+KdpcOXMLCOBQhkXK91CWa66a8Nar4si7wZ9NI76IGAEOBmuOu+IUD/wBD4V6TtXHBXmzW/s2HTEp4MRiUJ9y29a8E7S7TkxUjmeVpGZFjZgiLZELlVsigDWRjr1oXbPbnaDu+8m7s0Xs8h3USkxEtoLLoe+2vHWi43UEvl7kDfbkR/wCGS/8Auoa8v2wiSY9o4sO+GWWaCMxvnvIzYtllxC5h9lg3L8NAx9r8d7QMQcR9asRgVtzDbds6uVy5bXzKNfCiMVtjEzzJiJZi00eTdvu4gFyMWHcC2bVudEwsFseqdtsHI+F2ncoy7hJIlBu4aBWkOZbaXZFt1rPfR9Mgw203kXeRhQzJe2dBhrst+Vxp61k49r4oSYiX2hs+KVEnJhgIZY1ZEAGSw0Y+dR4PFTQxyxQzMkcyBJFyRvmAj3d8zqSDlo6XWi7TbedkcTCuy3cYcCE41AsBe+TPjIVQ5+eVmD/y2q02bE42rtLO+YNhsGU7oGRf7QMnjqCb+NeYw47EJCYI5ysJkWXJu4ms6yLIDmZSSMyA29Kl/wD6PGrOZRiTnnVIZG3MGqxiRowBksNXbXx8KVwpzKNSIJpNn7BXDSiGUmPJKUEgUjAT5roeNwCPWr/sizQx432yRZ3XGoJJQgRWYw4UI2QaLluv+G9efbG23i8JCsEE4ESCyCSJJWj433bm1uJ0bMBew00oFsbiBDND7TJu8QzPNdYi7OwUM28K3UnIOHDlajpR2j0bs/hGj29tEtrvIMPKrcypslj5NGwFEdhJo/2fgopQDvWk3YPOSGZ5lt4jdlv5a8+HafG73fe1HeZN3m3GH1TNmAPc6395oDD7QxKLAi4lwuFdpIfq4bqzBwxJyd4ESuLHrS6UdosO1aj9p40niJlAJ5A4aAkDpfnbjYdK3PZSdF2fssPGJC82VDcjdvkxBEgHMgKwt/evyrzOaZ3kkllcvJIwd2sq3IRUHdUADuoKL2b2nx0EawwYkrElwgMMLWBJNsxS5486q43RSzbbbRw5jwW3Q0hkJklfMwUGzYKAhSFAHdFhw4AVosQ9trKemAmNv/ERfpXlGyNs4uKWaZMQS01jNvUSRJWAsGMYyhSF07uXQC97U1dt4s4g4r2lt9JG0RbdxFdzmDKiIVIUA69e8bk0vjp9o9N288bHZTxfYlxolHjvcJiXJ9S1/WvPvpZeP29suGeNwQJMQc+TE3gjKKhtlJUAjQ37hrD4rtrjoDDh1mGTBODh80cZK5Y2Rbm3e7kjDXw6VfbW7QYrGQwNiZt4ATIqiONAGysl7qoJ0Y6UpjTtes9k8TGuC2Mrx52kjjWJtPqmGBkcuPNFZdPx1C7IMHtMyQNiU9qmzQLfNILRd0W18fSvK4O0uMjXDouIsuE/cDdQnLaJoRc5e93HYa+dG7K7W49N4y4rKryNI/1EBLOwANrrpwFExtG43PYueOPZUBeAlTj8qxMWBiaTaRWInML3RmU2P4astkIVxe2N7eYHcHKFykocKbRADnbS/OvMBt7GlAm8lMe+9pFosODvRPvw+q8N5rb0o3BdpcWsssi4qRJJsm8zwQC+7XKthksNOlPpS7RTQ7SAkkWOB8Om8ukD5s0KmNLRnNr1b+egdox2kY8m7w/m1+d60OJiMskks0hkklKs7lUW+WNY1sFAAGVBVRtuG2S2v2h8j+da2Xr5R9qorSrlKoMwNTr1DmrqtQekzUI9E3oZ6BB2GGg8qP2fhgTmPI6L+I+PgPjTNnYXugsPIVZJcaWFq1mPndRa5jMK7qc7EjofyvwPlVLJhpF1SS46ObD0c/nV4mKINgbjofyNR4jKQW5feH9c6q6pbALtPc92WMppfMAGQg/euKz/AGlxKyFTGQRzIPurRRQFLgG6XuBxyX+8Oq8iPGsX2giyYhwAF4HKOAuov8b1nn4i8dbaTDHMLcxV3BH3EbqovWWixgsrDQ2Hy1rY7L72HjP90/6jVQq4i05yBTla4041H7KzU0oHfpQmLmIAb8Lo3oGF/gTVp+zT1obaeG+pfrlb4C9TYad341BmuabK5J89akEdIEDTr09Yqhne1AItTF7xsOVQqS2goxrRLfn8SacBTtwjXi3HwXn+lO+8bcgB+f6VzDR5QXb7R1PgOlcwvC55m/vpkxnayC2IJ/Eqt+R+VaLAr/ZID4H50B23isI3/iX8x+dF7FkvgovBpF/zkj4MKi+Nr+o6y0bhkAS5GlybdTewoVqstnLdQTyvYevGlj7KjYENteNPkiB405DSZq2iXEit+lVW3rWQeZ+Qq4qp26n2T5j36/lSy/E57URFKpMlKsVq7MOorRdmOyz4rvFt3Fr37Zibccq6XAvqb++hMVs+P7hv5ir/AGF2heFd1IgKZci5RYqNeA5/aNXlx2K48sbf7Dk7BRAX3zsOXdVb+PPSp8L2Pww1sz2/Exv8NDVrtbbCLhhIpDLa4A8uFVuwNotLGj3H1gzDX8R/oVjc/LtnBjZ4HDARoLhRY9Re3nes92h3URSxy7wlBroG4gX5A8NefnWl2o4RTc20JNeT7bebEh5AuZQSQOYXlceVXjb7jDkxxk1Vxqpuailm+PH0oPs3tXfJupP3qDieLqOf8Q50XiIBWsu45LNJIJ9M3Q/Dn6Vju0WLWZzInC+Txso0PrrVtt3FBIsoPebQDw5n+utZI1nyZfS8J9r98IUOQ9AR7q3fZ0Ww0Q8G/wBbVQTx54opbXui38Dax+VXexcSNynhmHuZq0xibdicThTfNGbHpyNNTFMNHW3lwqffDrTWnWnUpOI40LPgywPe4gj3i1OWccqmXzpGCwsV1BCkEgEk+XAeFEpABxrkUoVbdCw9AxA+FRSzE8KQcxM4HChosOXNzREWF5mjRZRRoB3VYxc8qEw6GRs7CwH2F/8Aka6ymVrn7A+JFFk2pkGxr3sg+9x8hxqWMUPh+8zN6DyFEqaIFb2nwu8wz9UIcehs3+Umsts3axiXd27t83qQAfkK3kihgVPBgVPkwt+dee7L2TJPIUGgT949tEANiT1NxoOdTm0wm/D0Dspsj2sbxiUj1AItma2ht0F/lWjbssq91ZTa33gL/CitkQphsKANBGnPS58fEn51m9odq2JyQa20LnnbmPifWs5u3w6unHjj/ZaYrYbouYAOPDQ+41WLOl8pIVvwt3W9FPH0qumLMuZ8Qxb8IJoVcPn0clh/e1+dbzHNyZ5YX1GhoDbCXjPgQfy/Om43s7i4YhNFvFjPAjvp6qbgVSRbXmctDMid5WCyLddQpIBGovp4U8t+kzz6K1KqveHqa7WGlaaVIwCLCtztnZsX7MjlyKJL/aGh40qVdl/6wYTYkQkZo37yHipJtqdavuzWFSPGtGgsixK6rc2VmYhiBy4DThSpVwcv5PX/AI3+MH9KGJdYe6xF3ym3Tpes52exbmBnLEvG2VG5gW4E8/W9KlWmDl5vYPtRGI8dC0YyljGSRpctlzaeNz76tMaLE0qVXPyrC+mH2nITI1zexsPKghxrtKsMvbSN7sdz7LH/AA/maHwUzWOv3j+VKlW09RAxJm61PE5pUqoh8IoqMUqVIncMgzSfxf8A1pU4jHSu0qU9Aio1oLG8DSpU8g5EoyjyqHEnQ+VKlQbkGiDypsbmlSoAfETtfj8BU2w5isDgWALysdBq294nTU6ClSrPP034vyO7YbQkMSLmOU6kAAX9wrO4E12lWnF6Tz3ysolvVjhIx0rlKujFy1tuz+0JPZpI810ANlIB48eIvXm23O65y6UqVGU/qMPaiVqVKlXM2f/Z

 

[CatamountRob]

What I would tell the Dr. is this:
There is no obvious contraindication for an E.max crown that would explain the fracture. A picture of a broken crown dosen't give you any "context" to explain why it failed. Therefore the best you can do is list all the reasons why an E.max crown might fail, which does nothing to explain why this crown failed.

 

[JKraver]

"Looks like it could have been a hammer doc"

 

[PearlZ]

as to how it can be fixed: here bite down on the stack of thousand dollar bills...

 

[user name]

I adjusted the contrast and played with it a bit to better show the 'cracked' surface.

Thats not a clean break. Looks to me like it was sprued at two different spots and youve got a weak area where the material joined in the press.

 

[Patrick Coon]

Many good theories, but hard to say for sure without actually examining it.

One more theory: lab blasted the internal surface before sending it out of the lab, reducing the fracture toughness (~50%) of the crown.

 

[2thm8kr]

I adjusted the contrast and played with it a bit to better show the 'cracked' surface.

Thats not a clean break. Looks to me like it was sprued at two different spots and youve got a weak area where the material joined in the press.

View attachment 19790

Nice work Dr. Holmes.

 

[user name]

Nice work Dr. Holmes.

Now if I were using the new Hybrid 16 second scanner, I wouldnt have had time to do that.

Someone tell Charles007.