Background: Accurate documentation of tooth-supported crown restoration failures is crucial for assessing dental care quality. At the University of Michigan School of Dentistry, failure rates from Electronic Health Record (EHR) reports were notably low, however, experts in the quality improvement committee suspected underreporting. The current study aimed to evaluate failure rate through manual chart review (as opposed to electronic report writing) to confirm the accuracy of the electronic reporting and to try to understand true failure rate. Methods: A retrospective review analyzed 250 consecutive tooth-supported crown restorations placed in predoctoral clinics from May to December 2019. Data from EHRs, including patient details and procedural codes, were compared against manual chart reviews conducted by two calibrated dentist reviewers. Failure was defined as the need for retreatment within two years post-placement. This study assessed failure rates based on tooth type and contributing factors such as biological, esthetic and mechanical issues. The prevalence of miscoding was also evaluated to align EHR-reported failure rates with actual clinical outcomes. Results: Manual chart reviews identified a 9.6% failure rate – much higher than the <1% reported from EHR data. Maxillary molars showed the highest failure rate at 52.9%, followed by mandibular molars at 43.6%. Miscoding was prevalent, with non-specific codes accounting for discrepancies. Biologic factors, such as recurrent caries, esthetic issues and mechanical failures were notable contributors. The study also found that, in an academic setting, porcelain/ceramic and CEREC crowns had higher failure rates compared to Porcelain-Fused-to-Metal (PFM) crowns. Conclusion: The study highlights the need for standardized and accurate coding practices in dental education settings to ensure reliable data on crown restoration failures. The wide gap between EHR-reported and manually reviewed failure rates highlights the impact of miscoding. Enhancing training around coding protocols, faculty calibration and EHR system functionalities is essential for improving clinical documentation, supporting student learning and ensuring high-quality patient care.