Crouching Metal, Hidden Cavity

One of the big benefits of using a ceramic like emax CAD is that it is radiolucent.   That means we can catch issues on x-rays long before the become a problem!   Porcelain-fused-to-metal crowns many times block out caries, and it can become worse over time.   Crouching metal.. and the Hidden Cavity.

Even on routine bite-wing x-rays, metal (even zirconia) can overlap caries, on our “cavity checking x-rays!”   So, are they really “cavity-checking” when materials can block them out?   Something to think about, I guess.

This was a case where caries happened quickly and spread to the pulp.  Root canal therapy was required, and the depth of the caries apically has us concerned regarding biological width.   Although the Omnicam of CEREC can easily image many millimeters subgingivally, we decided to use a “margin elevation” technique with a glass-ionomer (Fuji II LC.)  This would make for easier margin placement for the final crown, but give the fluoride uptake/releasing characteristics of the glass-ionomer to work in our favor.

We will re-evaluate the gingival health over the next few months to determine if crown lengthening would be beneficial.