Consultation note — Marcus Okafor

The patient presented for consultation regarding possible decay beneath an existing crown, with a history of kidney transplantation, and was referred for endodontic and prosthodontic assessment. The patient reported no current pain, sensitivity, or jaw-related concerns and had last attended the dentist approximately six months prior.

Clinical examination revealed normal TMJ opening without tenderness, unremarkable masticatory muscles, and generally adequate oral hygiene, with minor calculus on the anterior teeth and inflamed lingual gingivae. Occlusion was Class I with approximately 10% tooth wear and significant grinding facets, particularly affecting teeth 14 and 24, with an edge-to-edge anterior relationship. Multiple posterior crowns were present on 27, 36, 37, 46, and 47.

The existing crown on 47 is an older metal-ceramic restoration with a marginal ledge and gap, cement washout, and suspected recurrent decay beneath it. The crown on 46 is a newer ceramic restoration, although a possible marginal defect and suspected decay were also noted. BPE was not recorded.

The patient agreed to proceed with removal of the existing crown on 47 under Valium sedation, with an estimated cost of approximately $1,500–$2,500 depending on the extent of decay, core requirements, and radiographic assessment. A subsequent appointment will be arranged for placement of the definitive monolithic zirconia crown on 47, followed by a further appointment for delivery and adjustment of a night guard.