Crown Still High – Diagnosis and Management

The patient is in the chair with a new crown. They say: "It feels too high, it's bothering me." You check with articulating paper – the contact seems too strong. What happened?

Before reaching for the drill – check the cause. Grinding without a diagnosis can damage the restoration or may not resolve the issue at all.

Five Causes and How to Differentiate Them

1. Incorrect impression – the model did not accurately reflect the preparation geometry The scan was inaccurate or had artifacts. The lab designs based on this model – the crown sits higher than it should.

Diagnosis: remove the crown (if temporarily cemented) and check if the model on the bench matches the preparation in the mouth.

Solution: new impression, new model, remake of the crown.

2. Incorrect bite registration – models in the wrong position The bite registration was inaccurate or the lab incorrectly mounted the models in the articulator. The crown is designed based on an erroneous mounting.

Diagnosis: check the bite registration – was it uniform, were all occlusal surfaces covered by material?

Solution: new bite registration, check in the articulator, adjustment or remake.

3. Temporary tooth not considered in the design If there was a temporary (composite, temporary crown) in the vicinity and it was not visible on the scan or this information was not provided – the lab did not account for its height.

Diagnosis: was there a temporary in that area when the impression was taken?

Solution: inform the lab + potential remake.

4. Cement layer thicker than expected Especially with conventional cementation. The cement spreads – lifting the restoration by 0.2–0.5 mm. The patient perceives this as "too high."

Diagnosis: remove the crown and check the amount of cement remaining on the prepared tooth.

Solution: clean, re-cement with less material. If the problem persists – check the preparation's retention.

5. Lab error in occlusal design The lab incorrectly modeled the occlusion – too high in the articulator, or the designer did not check with articulating paper. This happens rarely.

Diagnosis: check the crown in the articulator – does it sit too high on the model?

Solution: remake with design correction.

In-Office Procedure Step-by-Step

1. Articulating paper – precisely determine where the occlusal contact error is (a single point or the entire occlusion).
2. Foil shimstock – is the crown too high everywhere or only in one area?
3. Remove the crown, if possible (if temporarily cemented).
4. Check: preparation, temporary tooth, cement remnants.
5. Make a diagnosis – which of the above causes.
6. Action: grinding (minor adjustment), re-cementation, or remake.

When to Grind, When to Remake

Grinding a ceramic crown is indicated for minimal occlusal discrepancies (up to 0.3 mm), when the preparation and registration are correct. When grinding: use water cooling, finish with ceramic polish or diamond paste – do not leave a rough, unpolished ceramic surface.

Remake is necessary when the impression was incorrect, the registration was incorrect, or the crown sits too high in the articulator (lab error). Grinding will not correct faults in model mounting.