Amy is an attractive lady, a Realtor by profession. Back in her 20s she had chipped her front tooth badly and ended up needing to get a root canal and crown on it. She was content until one day she was eating and bit down hard on something in her food. Wham…..her tooth broke off near her gum line.
Amy was devastated, actually in tears!
She came into our Orange County dental office in Laguna Niguel as an “emergency” patient and in tears. “What can I do?,” she asked. “I can’t go out in public or to work missing my front tooth. There must be some treatment you can do to give me back a front tooth.”
What happened to Amy is unfortunate, but not all that uncommon. If a tooth has a large cavity or substantial amount of tooth broke off, then root canal and crown treatment are often the two treatments to save the front tooth. The only problem was that Amy’s tooth was already very weak, and then she suffered additional trauma when she bit down on the hard object. That was way more than her weak tooth could handle. Thus, breaking off the crown.
How much tooth is left is a major consideration when treating a broken tooth
When trying to salvage the tooth for Amy our first consideration was how much tooth was left ABOVE THE GUM LINE? If there is 2-4mm or tooth ABOVE the gum line, then with some heroic dentistry a new crown can oftentimes be made. But the patient must understand that there is absolutely no guarantee that the tooth won’t break again.
If the tooth breaks at or below the gum line, then it is unlikely that the tooth can be saved. In that case, the tooth would be extracted and either a dental implant, fixed porcelain bridge or some cases a removable partial denture made to give the patient back their front tooth.
In Amy’s case, as one can see in the photo, there was some tooth left above the gum line. So she was in luck! Since her tooth had already had a root canal we explained to Amy that we could try to save her tooth by placing a post and core into her root canal filling and by doing that we could create enough tooth above her gums to place a new porcelain crown on.
Amy tears began to stop.
“When can you do that for me?” she asked. “I have to go to work today and I can’t see clients looking like this?”
To Amy’s delight we said we could build up her tooth with the post and core and make her a temporary crown right then and there. We would do what we needed to do, make her a new tooth and she would be done in just over an hour’s time and be able to go to work as normal. In two weeks time her porcelain crown would be completed by our ceramist and we would then remove her temporary crown and cement on her final porcelain crown.
We were able to do everything exactly as planned and Amy got her new crown on her broken front tooth two weeks later. However, that being said, it must be stressed that this kind of heroic dental treatment to save a broken tooth cannot always be done and oftentimes it is not the best long term solution. Again, alternative treatments options like a dental implant, fixed porcelain bridge or sometimes (but rarely) a removable partial denture are better ways to treat a patient with a broken off or missing front tooth.