Re-intervention on crowns: what comes next?

It is the aim of this paper to consider the treatment instituted when re-intervention is deemed necessary on a tooth which has previously been crowned.

A detailed sample of treatment records of patients has been established at the NHS Business Services Authority (Dental Services Division), consisting of records containing indirectly placed restorations for patients of age 18 years or older from January 1991. For each tooth treated with a crown, the subsequent history of intervention on that tooth was recorded.

There were data on 47,474 crowns available for analysis, with metal-ceramic (bonded) crowns dominating the data (overall, 80% of crowns being these). There were 10,426 crowned teeth with re-interventions in the study period, with 36% of the re-interventions involving recementing, 17% being replacement crowns, 13% direct restorations, 12% root treatment, and 19% of crowned teeth being extracted and/or replaced by a denture. The longer the interval since crown placement, the higher the proportion of extractions or direct restoration and the lower the proportion of recementing.

Recementation is the most frequently recorded re-intervention, with the incidence of this decreasing with increasing age of the crown. In 17% of re-interventions, the next intervention was a replacement crown.