What do You Think?

[dmonwaxa]

Recieved a call late yesterday evening from a client. After a adiscussion I asked him to forward me some pics. This case was done by another lab and I have some ideas of what it is; what do you think?
What caused cracks in porcelain.

 

[TheLabGuy]

Two things......
1. Notice the wear facets, pretty heavy, which gives me the thought their is some parafunction with a major load being distributed on those anterior teeth. Suggest a TENS and NTI to diagnose what's going on.
2. Used a high expansion cement/bond on all ceramic/low MPa crowns/veneers.

 

[amadent]

first let me start off by saying what a shame, case looks really nice
i agree with LabGuy has to be some sort of para function
we had a case like this years ago- remade the units a few times with the same result after about the 3rd set , Dr. filled us in that the patient was a electrician and he used his anterior teeth to splice wire -
point is sometimes we look for fault in what me do and sometimes it is not us who are at fault
Greg Amendola MDT

 

[dmonwaxa]

Rob, if parafunction as suggested wouldn't you expect to see some shearing off at the incisal edges?

 

[TheLabGuy]

Rob, if parafunction as suggested wouldn't you expect to see some shearing off at the incisal edges?

It appears like the bonding technique was good and this is just the beginning......in time you would see the shearing off, the vertical cracks is just the start.

Amadent, I concur, I dealt with something similar yesterday (amish lady stepped on her FRS) and the appliance was just made a few months ago.....so who pays? Eat it? It's not my fault or the Dentists' fault, and the last time I checked that's who I cover in my warranty. Before I get dragged over the hot coals, I only charged 50%, maybe the patient will take the other 50% and buy some glasses or softer shoes...

 

[dmonwaxa]

LOL

 

[dmonwaxa]

Warranty If I buy a car and run into a light pole is tha covered under warranty? FRS, it may not break but would certainly distort with the right amount of force. Fracture lines on crowns are too vertical to suggest parafunction;could be wrong, but thats my two cents.

 

[JohnWilson]

Rob I wish you luck on this one. I worry this will come back and bite you. I know you were being a good guy and trying to service your client and perhaps your client is different than most.

As I see it, the Dr is not eating this, he may offer some sort of discount or he will offer the remake at lab fees, or partial lab fees.

If he is doing it for nothing I will strip/dance naked in front of the Good Morning America window in Rockefeller center.

Next time this happens ask your client if he buys a new car and crashes it the next day is the dealership is going to fix it for free.

 

[CatamountRob]

Do you know what they are made of?

 

[JohnWilson]

Warranty If I buy a car and run into a light pole is tha covered under warranty? FRS, it may not break but would certainly distort with the right amount of force. Fracture lines on crowns are too vertical to suggest parafunction;could be wrong, but thats my two cents.

You reading my mind damn it???

 

[TheLabGuy]

Oh yeah, I agree wholeheartedly but I already made my loot on this project. 50% covers labor/cost of materials. I think he is charging the patient 50% as well. I'm just being a nice guy......

 

[CatamountRob]

Rob, John, I've got one for you. Last fall I made a 3 unit implant supported bridge (7, 8 & 9). I was there when it was inserted and it looked great, I saw the x-rays and it looked great. Guy was headed south for the winter and they cemented it with temp. cement, I don't know why. Just before he was to come home it came loose, goes to a doc down there and he cemented it permanently. Unfortunately it wasn't seated all the way and last week it was cut off and I have it to do over again. No one asked me to discount it, but I'm going to, the guys a retired Reverend and I'm not above hedging my bets for the hereafter! Rob

 

[dmonwaxa]

You reading my mind damn it???

Gotcha,,,,LOL....Or were you reading mind's...

 

[dmonwaxa]

Rob, John, I've got one for you. Last fall I made a 3 unit implant supported bridge (7, 8 & 9). I was there when it was inserted and it looked great, I saw the x-rays and it looked great. Guy was headed south for the winter and they cemented it with temp. cement, I don't know why. Just before he was to come home it came loose, goes to a doc down there and he cemented it permanently. Unfortunately it wasn't seated all the way and last week it was cut off and I have it to do over again. No one asked me to discount it, but I'm going to, the guys a retired Reverend and I'm not above hedging my bets for the hereafter! Rob

Had a few sacreligeous thoughts but that quickly dissipated as I busted out laughing..... seriously we all need to do some good deeds whenever we can cause the hereafter is forever

 

[Al.]

They look like press and stain empress or empress eshtetic?

 

[dmonwaxa]

That's what I'm thinking too Al. What do you make of the fracture lines though? I know you may lack knowledge in this arena.....cause you don't make or see any failures...haha

 

[rkm rdt]

Perhaps a nightguard is in order.

Heavy contacts could also be the culprit here.

 

[dmonwaxa]

Perhaps a nightguard is in order.

Heavy contacts could also be the culprit here.

Aha! Thats what I was thinking also. Need to get models and see if they contact the incisals at the point of fracture. Feldspathic porcelains tend to fracture in a curve under tenson. These fractures are more liner, vertical and involve the incisal and cervical. What could it be from ? ? Notice the discoloration on either side of the fractures?

 

[ChrisR]

Looking at the picture it looks like there is edentulous space in the posterior. Possibly #18 & 19 missing ? Lets assume the opping side of the mandibular arch is the same, and they are leucite glass. Could the occlusal load these teeth have to bear now be the reason for the cracks?

 

[AL1]

In my opinion, for all of them to crack like that, it would be highly unusual to be from masticatory forces.
I am wondering if there were micro fractures either from pressing, cutting off the sprue or baking.
Then when seated the hydraulic pressure forced the fractures.
Or the wrong cement was used with an incompatible cte .
That happened to me on a six unit anterior veneer case on the Dr.`s wife.
They were regular porc. and he decided to use a new bonding cement he never used before.
They all cracked and he had to cut them off and we started over.
Needless to say his wife was not happy.