What if a loose crown or implant crown came off?

How to deal with an implant or tooth crown that fell off

Posted on: March 4th, 2012 by Lissauer Dental: Jeffrey B. Lissauer, DMD 8 Comments
Loose crown came out

Illustration of a loose dental crown that came out being placed back on the tooth

This week, I received a nice present in a jewelry box.  It was a crown that came out of a patient’s mouth while she was chewing.  Crowns, or “caps”, can sometimes come out or get loose.  Patients randomly come in with a crown that ends up in their hand, as it has loosened from the tooth on which it was comfortably resting for years. Luckily, they very rarely are ones that I have made, and usually they are quite old.

I am always fascinated by the way in which patients bring these loose crowns to my office; the usual carrier is a baggie, but I have seen margarine containers and even fancy ring boxes. Either way, we clean and disinfect the loose crown and try it back in the patient’s mouth. We take a digital x-ray and examine the fit with a fine dental instrument. We then check the tooth. If there is no decay and the crown fits well, it is re-cemented. If there is decay that affects the margin and fit of the crown, the decay must be removed and a new crown made. If the decay reaches the nerve, a root canal and a post/core would be needed as well to remove the nerve and disinfect the tooth.

Many times, a crown is placed on a tooth after an endodontic procedure (root canal), and the crown is loose because the post that was placed after the root canal has loosened.  The tooth is carefully examined, and if the post has been loose for a while, the root canal may have become re-infected; in this situation, a new root canal, post and possibly a new crown is needed.  Usually the post and crown can just be recemented as a simple solution, but careful evaluation is a must to ensure a proper fit and no decay.

Simply, it is imperative to go to a dentist as soon as possible after you notice a crown that may be loose in your mouth.  The longer they are loose, the higher the chance that decay may develop and that the crown cannot be reused.

As for implant crowns, they also can loosen.  We try to make all implant crowns retrievable, so they can be simply retightened.  Another type of implant crown is one that is cemented onto an abutment. If an implant crown is loose that was initially cemented, it is more problematic. The crown may be snug, but the abutment may be loose.  In this case, the crown must be taken off the abutment, and then the abutment must be tightened; sometimes, this result in the necessity of making a new crown.

As for our “present” in the jewelry box, we carefully cleaned the crown. We made sure the tooth was healthy and clean without any decay, and our x-ray reveled that the crown still fit well. We used the best and strongest cement and instructed our patient not to chew on her “jewel” for an hour and a half. Our patient was happy with the simple solution.

 

As always, please let me know if there are other dental topics that you would like me to discuss in this blog!

8 Responses

  1. Judy says:

    My implant crown has come off now for the second time. It was originally done about 4 years ago and first fell off after 13 months. Now it is off again. Could my implant “screw” be the problem?

    • Implant crowns can loosen over time and come off due to strong biting forces gradually causing the screw to loosen. Sometimes, there is a problem with the actual screw, but rarely. Whenever an implant crown comes off or feels loose, you should see your dentist as soon as possible to address the situation.

  2. Bert Levinson says:

    My implant was made about 18 months ago and has just fallen out for the 4th time. Each time my dentist cleans it and cements it back without charge. Last time he said it would be extra strong and long lasting cement but it still fell out. I’m sure he is a good dentist but I do worry that next time I will swallow it when it falls out and I am now less than confident when eating since I expect after four times it is only a matter of time before it falls out again. Any advice?

    • Jordan says:

      Implant crowns can loosen over time and come off due to strong biting forces gradually causing the screw to loosen. Sometimes, there is a problem with the actual screw, but rarely. Whenever an implant crown comes off or feels loose, you should see your dentist as soon as possible to address the situation. The biting force on the implant crown may need to be reduced in this situation, taking a little bit of the porcelain off of the biting surface of the crown.

  3. kathy says:

    I broke off a crown by chewing something that I shouldn’t have been eating. (a carrot). I have also had root canal on this tooth after crown and a couple of years later the (something came loose & a post was put in). Now that I broke it off, dentist says I need an implant. Is that absolutely necessary? Just because I broke it off it didn’t break itself off .

  4. David says:

    I have an implant where the crown is cemented to the abutment. This was completed late last summer on the bottom, left, back tooth. The crown fell off and I swallowed it during dinner. I didn’t even realize it until I was done. Should I be responsible for replacing the extraordinarily expensive crown? Should I expect to pay $1,000 to replace a crown every time it is lost? I’ve invested $2,500 for the entire procedure. If this were a car I would have left it unlocked with the keys in the ignition. What are the consequences if I do not replace the crown? Thank you in advance for the advice.

  5. Xenobia says:

    I just had a check up with a new dentist and he said that the only 2 crowns I have need to be replaced because he can input the tip of his tool under the crown. I’ve had these crowns for 2-3 years without problems and they never came loose, however I am worried about doctor’s statement of vulnerability of infection even although I had root canals done on both. Should I go ahead and spend money on replacing the crowns despite not having any issues with any one of them? I really appreciate your advise

  6. Jaye says:

    I have 2 implants, 1 with a screw on crown and 1 with a cemented on crown. They are both approx. 11-14 years old. The cemented crown fell off a few days ago and I now realize that the bacteria inside the crown has been the cause of the awful in my mouth for the past couple of years, and I do not want the crown put back on. The screw on crown is easy to clean and much more sanitary IMO.

    Is it possible to have the abutment changed to accommodate a screw in crown?
    Can the abutment be removed and the implant capped for now until I can afford a new crown?
    Who would change the abutment– the oral surgeon or the cosmetic dentist who made the crown?

    Thanks!

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