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Brian LeSage, DDS, FAGD, FAACD

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Archives for April 2021

My tooth is fractured beneath a new crown and needs extraction

I fractured two front teeth in 2010, and my family dentist did root canals and crowns on both teeth. As the crowns aged, I noticed them more and did not like the way my smile looked. Also, a left molar tooth was aching on and off, so I decided to see another dentist for a smile makeover.

I love the look of the smile makeover, but my left front tooth became sensitive a few months ago, and my dentist said the tooth needs extra care. She noticed a pimple on my gums and referred me to a periodontist for an exam.

My dentist prescribed antibiotics, and the periodontist confirmed that I need extraction. My dentist disagrees about the extraction and is now referring me to a periodontist. I do not want to lose my front teeth, especially after all the work and money I spent on a smile makeover. – Eiso from NV


Although your smile makeover looks beautiful, we wonder if your dentist took x-rays before completing it. If she took x-rays, saw the fracture, and put a crown over the tooth anyway, maybe she did not understand the potential results.

Root fracture on your left central incisor

Thank you for sending us a picture of your x-rays. Your fractured tooth does not look good.

  • Root fracture – In the middle of the tooth root, we see an old, horizontal fracture line that is likely from your original accident. The dentist who did your root canal at that time either did not see the fracture or tried to navigate through it. The necrotic (dead) soft tissue is gone, so the dentist must have removed it and hoped the tooth would heal.
  • Above the fracture – The inside of your tooth looks choppy and eaten away. Some of the root canal filling material is missing. If your gum pimple originates from that area, it suggests an infection is eating at your tooth roots. And if that is true, you will lose the tooth.

Your right central incisor

Diagram of a two dental implants - before and after crown placement

If a dentist or specialist cannot save your tooth, a dental implant is the best treatment option

Your right central incisor (front center) does not look stable either.

  • Root canal filling material – It stops several millimeters before the tooth ends. You have a new crown on the tooth, it might be best not bother the tooth unless you experience a flare-up. We do not see any signs of infection on the x-ray.

Although your dentist missed the diagnosis of your cracked tooth, you need to get it corrected. You can decide if you want an endodontist (root canal specialist) to examine your tooth and try to save it or proceed with the extraction and dental implant.

You can negotiate with your dentist on the cost of continued treatment for your left incisor because she missed the fact that it is fractured and problematic.

Best wishes for a thorough resolution.


Dr. Brian LeSage, a Fellow of the Academy of General Dentistry, sponsors this post.

I need a root canal on a porcelain veneer tooth

The pain that I thought was a sinus infection turned out to be a tooth infection. My dentist referred me to an endodontist for a tooth with a porcelain veneer on it for eight years. I am concerned that after the root canal, I will need to replace the veneer. Is the endodontist the right one to do the work without damaging my veneer or turning my tooth dark beneath it? Ji from NV


An endodontist is a root canal specialist. And without root canal treatment, the infection will spread into your bone. We are concerned about how a porcelain veneer tooth got infected.

Porcelain Veneer and Root Canal Treatment

You might need root canal treatment on a root can tooth if the tooth becomes weak and stressed. Sometimes aggressive tooth reparation will make a tooth weak.

Conservative Porcelain Veneer Preparation

Depth-limiting diamond bur applied to teeth for porcelain veneer preparation

Minimal porcelain veneer preparation can prevent the need for root canal treatment

A dentist should only remove a half millimeter or less of tooth enamel when preparing for porcelain veneers. One technique, as shown to the right, uses a diamond bur that limits the depth of preparation. Half-millimeter grooves in the tooth are enough to ensure veneers fit well without making teeth look bulky. A cosmetic dentist uses a conventional diamond bur to remove the ridges.

Aggressive Porcelain Veneer Preparation

When a dentist removes too much tooth enamel, the dentin (layer beneath the enamel) is exposed. And the tooth is at greater risk of stress and needing a root canal treatment.

Tooth Color After Root Canal Treatment

A tooth turns dark after root canal treatment. And since porcelain veneers have translucence, the darkness will show through. An advanced cosmetic dentist can improve your tooth color with these steps:

  • Clean out the root canal filler material from your tooth
  • Place a flexible white fiberglass post into the tooth root
  • Fill the remaining space with a light-colored composite

Treatment like the above will prevent darkening for five to ten years.

If your dentist placed and bonded your porcelain veneer correctly, you should not lose it.


Dr. Brian LeSage, an accredited Fellow of cosmetic dentistry in Beverly Hills, sponsors this post.

I need a root canal on a porcelain veneer tooth

“Because of your smile, you make life more beautiful.”
– Thích Nhất Hạnh

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