How to tackle cracked veneers, crowns and composite

This month, Manrina Rhode discusses how to go about treating cracked veneers, crowns and composite, and why finding the cause is key.

Today I want to talk to you about cracked crowns, veneers, porcelain, and maybe even bonding – and what you do about it.

It’s surprising how many dentists don’t know that you can repair a cracked veneer or crown with composite bonding. You don’t necessarily need to replace the whole ceramic.

Reparation methods

If something’s chipped, sometimes it’s preferable not to replace the ceramic. If the ceramic was placed recently, if it’s quite a heavy prep and you feel nervous about removing ceramic and potentially removing more tooth tissue, then you may choose with the patient that it’d be better to repair with composite.

And actually, you can do a repair in such a way that it’s completely invisible, that you can’t see that that’s been done. Obviously, you need to use slightly different bonding techniques, and I’m not here today to teach you exact clinical dentistry, but you’re bonding to porcelain rather than bonding to tooth. This means you will treat the porcelain and the tooth slightly differently.

Also, you can use porcelain edge on the porcelain and phosphoric acid on the tooth, and then you use saline on the porcelain. Then you will use prime and bond on the tooth, and finish finish with bond on the porcelain and then composite so that you can you can go on and repair whatever is going on there.

So, let’s understand that you can repair chipped porcelain, crowns or veneers with composite. And, of course, you can repair composite with composite.

What was the cause?

But I think what’s really important is to look at why the restoration chipped in the first place. If you don’t, as a dentist, you need to behave like a detective. If you don’t behave like a detective, and you don’t look into why this happened, then it will continually happen.

And if it continually happens, and you do that repair, then that patient will become the bane of your life because they will come back every other month with that chip and you will have to repair it for free because you charge on that first time to repair it.

So, is it because they have a fingernail biting habit? Or a pen biting habit? Do they open packets with their teeth or break sellotape with their teeth? Is it to do with the way that they’re grinding or clenching, and that the initial restoration wasn’t placed with their occlusion in mind? Do they need to wear a night guard? How are you going to tackle whatever it is that caused it?

Save yourself a headache

If it’s a one off thing and they know what it was that broke it, then that’s fine. If they say that it happened because they were eating a piece of bread, then that should ring alarm bells in your head – it wasn’t a piece of bread, there’s something else going on. Make sure you work out what it was that caused the problem before you go ahead and repair.

You should also work out whether you can give your usual guarantee with this work or whether you’re really not sure and you want to make that clear with the patient. You can repair it but you can’t guarantee your work because you don’t know why it broke in the first place.

That will cover you from the headache that you will have moving forward if you take on a job that you don’t fully understand.

ip for the day: use composite on porcelain – it repairs it really well.

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Visit Manrina’s website here: www.drmrlondon.co.uk.