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

Eiso,

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

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.