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Dr. Crapo

Not Again!

Q: Dr. Crapo: Yesterday, my upper left front tooth that has a veneer on it fell out. It was the second time this has happened since it was put in less than two years ago. I saw a dentist other than my own and was informed that the veneer had not fallen off but the whole tooth had broken off with the veneer intact. It was broken right to the gum level. The doctor assessed it and said that I’d have to have a root canal, and then a post put in so that a new crown would have something to attach to. I asked him why this tooth had failed and the tooth beside it, which also has a veneer, didn’t. He said he didn’t know but did say I have a deep bite. He said that people with deep bites tend to wear their front teeth more and put a lot of stress on them. He thought this tooth was getting more stress than the other tooth and had developed cracks that got bigger and bigger, until the tooth snapped off at the gum line. He said the veneer didn’t fail, the tooth failed. I understand that now, but I’m still without a tooth (thank goodness he put it back in) and don’t know what to do. If I do a root canal and new crown will that last? He also said my roots are short, meaning I have less anchorage of the post to hold the crown. What can I do? Is this my only option?

A: You have several options but the cause of the problem needs to be understood before you proceed. Approached from a minimalistic perspective, replacing your veneer with a root canal and crown, is the fastest solution. The great concern is the element, which is causing the breakage in the first place, is still present.

Another solution is to splint the new replacement crown with new crowns for the teeth on either side, thus creating three crowns bonded together. This is a much stronger solution but still the cause has not been dealt with. Is it strong enough? Probably, but that could change (especially with a deep overbite) if the element of stress progresses, thus putting even more pressure on the front teeth.

Another solution is to remove the root of the broken tooth and place an implant. Again, a very strong solution (costing about the same as the splinted crowns) but one that is easier to brush and floss.

These are good solutions for your broken tooth, however the next step is to find the solution that also solves the cause for the breakage in the first place.








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