Dear Dr. Crapo: I’m eighty years old and I just broke a tooth, at least that’s what I thought, so I went to the dentist. It was very painful when I bit down but it was two days before he could get me in. By that time it seemed that every time I swallowed it hurt. When he saw it he said I’d split the tooth and it’d have to be pulled. I asked if he couldn’t save it and put a crown on it but he said he couldn’t and would send me to a specialist because it had to be taken out surgically. I told him I couldn’t part with the tooth, so I left his office and went to see another dentist. He told me something similar but gave me more options. He said that I’d split the tooth down the root and the break was below the bone. He suggested I get it pulled and have an implant. I hadn’t even thought of that, so I asked him how the tooth could be saved if implants didn’t exist. He said I’d have to see a specialist to have the gum and bone cut back so that a crown could be made to fit at or just below the break. He said I’d probably have to have a root canal because the break was close to the nerve and by the time the tooth was trimmed up for the crown the nerve wouldn’t be happy, so I’d need to think root canal before the crown. He said that theoretically I could be going to three specialists to get the tooth fixed or two to get an implant crown. What’s best?
In 1965, 1975 or 1985, saving the tooth would have been the best option. It would have been handled by three specialists – a periodontist – one who has been trained in gum and bone surgery around the teeth; an endodontist – one who has been trained to treat the inside of teeth; and a prosthodontist – who trims the tooth and prepares it to receive a crown.
This is still a valid way of treating teeth. Some dentists are trained to do all three procedures.
Are you trying to save the tooth because of cost, your age, or the thought of an implant puts you off?
If I was a family member I would suggest the implant for several reasons. First it’s stronger. It will not decay and it maintains the bone better. It is a less complex procedure and there is less pain because an immediate implant placement is relatively atraumatic - the gums and bone are not cut away.
The time from start to finish is about the same as if three specialists are involved and the cost may be similar.
Done well, either option will serve you well.
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