Insight 69 — Managing an Open Proximal Contact at Crown Delivery: A Practical Chairside Approach

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Clinical Explanation

When marginal fit and occlusion are acceptable but the proximal contact remains open or weak, reshaping the adjacent natural tooth with composite — in selected cases — can replace sending the crown back to the laboratory

This note is about the moment of crown delivery — when marginal fit and occlusion are acceptable, but the proximal contact is still a problem and sending the case back to the laboratory seems like the only way forward. What follows is an alternative chairside approach and two considerations that are decisive in carrying it out.

• Clinical Explanation
  When a crown has ideal marginal fit and occlusion but an open or weak proximal contact with the adjacent tooth, sending the case back to the laboratory is not the only option. In selected cases, reshaping the adjacent natural tooth with composite can serve as a practical alternative approach.


• Reduced Laboratory Risks
  Avoiding the potential hazards of re-firing ceramic (such as minor changes in marginal fit).


• Reliable Bonding
  Taking advantage of reliable enamel bonding on the adjacent tooth.


• Time Management
  Resolving the problem and delivering the final restoration to the patient in the same appointment.


• Clinical Considerations — Emergence Profile
  The composite must be placed without creating an overhang or a step along the tooth, to prevent plaque accumulation and gingival inflammation.


• Clinical Considerations — Composite versus Ceramic Wear
  Ceramic has substantially greater wear resistance than composite. Over time, continuous friction between the two surfaces can lead to composite wear. The direct consequence is a likelihood of the contact weakening again and food impaction returning in the long term. For this reason, assessing contact tightness with dental floss at the patient's periodic examinations is highly important.

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