Patient's Name:

E-mail Address

Tooth / Teeth Involved:

Existing Crown/Bridge is how many years old:

Purpose

There are three primary reasons to remove an individual crown or bridge that has been previously cemented in place:

1. Attempt to preserve and reclaim crowns and/or bridges that have fractured while in the mouth.
2. To render necessary treatment to a tooth that is difficult or impossible to perform without removing the existing crown or bridge.
3. Confirm the presence of dental decay or other pathology that may be difficult to detect or may be obscured while the crown/bridgework is in place.

Understanding the Risks

I understand that the removal of crowns and bridges includes possible inherent risks such as, but not limited to, the following:

1. Fracture or Breakage

Many crowns and bridges are fabricated either entirely in porcelain or with porcelain fused to an underlying metal structure. In the attempt to remove these types of crowns, there is a distinct possibility that they may fracture (break) even though the attempt is done as carefully as possible.

2. Fracture or Breakage of the Tooth

Due to the leverage or torque pressures necessary in removing a crown, there is a possibility of fracturing or chipping the tooth. In some cases, these fractures may be extensive enough to require tooth extraction.

3. Trauma to the Tooth

Because of the pressure and/or torque necessary in some cases to remove a crown, these forces may traumatize the tooth and injure the nerve (pulp), potentially necessitating a root canal to preserve the tooth. Instruments used to remove crowns and bridges may also inadvertently lacerate the gums, other oral tissues, or the tongue.

4. Failure of Conventional Removal Methods

Certain methods and instruments are used in conventional attempts to remove crowns from teeth. In some cases, none of these methods will effectively remove the crown, which may result in the tooth being inadvertently extracted. This may require:

• A new bridge.
• An addition or extension of an existing bridge if the affected tooth is an abutment.
• Construction of a new bridge if this is an individual tooth within an arch.

5. Inadvertent Extraction of the Crowned Tooth

In extremely rare cases, the amount of pressure or torque required to remove the crown may result in the accidental extraction of the tooth. If this occurs, it may necessitate:

• A new bridge.
• An addition or extension of an existing bridge if the affected tooth is an abutment.
• Construction of a new bridge if this is an individual tooth within an arch.

6. Post-Treatment Responsibilities

As with other types of dental treatment, it is the patient’s responsibility to seek attention if any complications occur postoperatively. Patients must diligently follow all preoperative and postoperative instructions given by the dentist.