While placing two new crowns last December, my dentist nicked one of the crowns in a Maryland bridge that I got in 2002. The bridge is old, but I had no intention of replacing it because it is in good condition. And the nicked crown is my left front tooth. Two weeks later, I noticed silver showing through the crown that my dentist nicked. He insisted that the problem was from grinding my teeth, but he knew better. My dentist quickly notices any changes in my teeth, so he would have told me if my teeth grinding was causing a problem. Besides that, I wear a nighttime mouth guard.
Anyway, when I complained about the silver dot, my dentist asked me to schedule an appointment, and he placed composite over the dot. Now the dot is showing through the composite. I know the crowns have metal beneath them, but I am concerned that I need a new bridge. Now I don’t trust my dentist. I was supposed to get silver fillings replaced next, but I am hesitant to have him do any more work on my teeth. Do I have a choice or an alternative to replacing the Maryland bridge? – Wendy from Queens, NY
Thank you for your question. Although many dentists have adjusted a patient’s bite and damaged the crown, it usually does not happen to front teeth. Your dentist probably does not want to admit his mistake because it would obligate him to replace your Maryland bridge.
We suggest that you find a dentist for a second opinion. Ask the dentist if the crowns on your bridge show signs of teeth grinding. Some dentists use this method to detect the cause of damage:
- Glide a metal explorer over the porcelain, which will not leave a mark if the damage is not from a dental bur. The metal explorer would leave a mark if a dental bur damaged your crown.
Ask the second-opinion dentist to document their findings. Return to your dentist with an explanation of the results.
Repairing a Nicked Crown in a Maryland Bridge
It is challenging to repair a nick in a porcelain-fused-to-metal crown without replacing the Maryland bridge. Your dentist’s attempt to improve the crown with composite did not work. Panavia is a brand of dental bonding cement that will bond to metal. An experienced cosmetic dentist may successfully hide the metal with these steps:
- Grind away more of the metal to make room for the Panavia dental bonding cement
- Use a micro-etcher to roughen the metal
- Prime the metal before applying a thin layer of the bonding cement
- Cure the cement and apply composite that matches the crown color
- Shape and polish the cement
Whenever it is time to replace the bridge, newer ceramic options will give you durability and natural-looking results. You can also ask about replacing your silver fillings. This technique is not a guarantee. Seek a highly experienced cosmetic dentist for a second opinion to evaluate your Maryland bridge and discuss your options for saving it.
Dr. Duane Delaune, a Metairie, Louisiana, cosmetic dentist, sponsors this post.