Solution for a front tooth completely broken off

A front tooth, which has already had a root canal years ago and then a crown, has cracked and broken off up inside the gum. My dentist is suggesting to put a porcelain crown on the adjacent front tooth and use that as the support for the new crown to replace the broken one. Friends suggest an implant. What is your opinion if price was not an issue?
- Joe from north Florida

Joe,
It would be best if we could see the x-ray or had a little more information, but I’ll try to be helpful and give you some things to take into consideration as you make this decision.

You have to realize that we’re operating from limited knowledge here. But from what I know and what I’m visualizing, it sounds like the broken front tooth is unrestorable, that it is broken down too far and has too little root to support a crown on its own. If that is the case, we would lean toward the dental implant replacing this one problem tooth.

Here are some things to take into account.

1. If this tooth has broken off, that suggests to me that you have some reasonably strong forces at work in your mouth, enough to break off a tooth. Now your dentist is suggesting using your remaining healthy central incisor to support BOTH front teeth. Placing a crown on a front tooth involves shaving all around the tooth. This reduces the circumference and thus reduces the tooth’s resistance to shearing forces. This isn’t a factor for crowns on back teeth, but it is an important issue with crowns on front teeth. So you could be setting yourself up for, maybe ten years down the road, having BOTH front teeth broken off.

2. From the dentist’s point of view, the advantage to supporting this replacement front tooth by doing a crown on the other front tooth is that he or she may be unsure they can color match the natural tooth with an implant crown. These central incisors need to match perfectly or your smile will look funny. Doing the two crowns is easy – since they’re both made in the lab they will match each other. This is why I suspect your dentist may want to do it this way, and is a reason for you to be wary.

Here’s what we’d recommend. As I said, I’m at a disadvantage in not knowing exactly what the situation is with this tooth, though I know enough to be worried about what your dentist is planning. We’d suggest a second opinion. You are really in need of an expert cosmetic dentist, if you end up going with the implant and single crown. Perfectly matching your natural tooth with an implant crown requires skills on the higher end, beyond the reach of maybe 98-99% of dentists.

If you’d want to come to our office, we’d be happy to see you. But it looks like you’re quite a distance from us. I would suggest checking with the American Academy of Cosmetic Dentistry and looking for an accredited member or an accredited fellow near you. With either of those credentials, a dentist has to pass stringent examinations of both knowledge and clinical skill, which would insure you that they know what they are doing.

This blog sponsored by Wellington FL dentist Dr. Sam Sadati.