Uncontrolled Bite Forces
Q: A number of months ago I broke a tooth off at the gum line. It was the tooth beside a front tooth and just before the eyetooth. It’s a tooth that’s had fillings over the years and I guess it got weak and snapped off as I was chewing some soft bread. It doesn’t hurt and I’m making out OK without it but it bothers my wife of fifty years and attracts attention when I smile.
I saw my dentist and he said it would be hard to put a crown on it because there is not a lot of tooth left. He said I should probably get the rest of the tooth out and put an implant in its place. When he told me it would take four to six months to have an implant and tooth put in, I had to think about it. I asked him if the implant would be as strong as my tooth and he said he thought stronger.
That’s good but I thought why did it break in the first place and not the front tooth or eye tooth - there was no decay to weaken it the dentist said. I want to get it fixed, the space that is, whatever is the best, but I’d like a few more answers before I proceed so that I feel good about my decision. Any suggestions?
A: Your dilemma is not uncommon. We see this two-three times every year. In your case, there are several reasons for the breakage of that tooth despite no decay to weaken it. The most important two factors are your bite - the way your teeth hit when you chew your food and the other is the weakening of the tooth through repeated fillings. A third factor is the life or vitality of the tooth. Insult in the form of disease (decay), grinding and harsh chewing, cause stress and weakness that can cause death; a dying tooth becomes brittle and more susceptible to breakage. If you can see a small edge of tooth above the gum and if your bite is a significant factor (this shows up as significant wear on your surrounding teeth) my suggestion is that you crown the broken tooth and the eyetooth next to it.
Have your dentist ensure that the crowns are fused so that although from the front they look like separate crowns, they are immutably fixed (“welded”) together. This will provide a dispersion of the bite forces in such a way that the bite load is spread over both teeth. If your tooth broke because of too much force, it is unwise to expect an implant by itself to be the best solution. Too much force on an implant will cause bone loss around it. Sometimes an implant will be used but joined with the eye tooth - again, if your bite dictates it.
Based on actual patient cases
Calvin Ross Crapo