Question:
I'm hoping someone is able to give me some good advice :)
14 years ago (I'm 28 now), my front tooth was broken in an accident, and a
root canal was necessary. Approximately 1/2 to 2/3 of the tooth remained.
The rest was 'added on', using some kind of filling. About 3-4 years
ago, I had the 'add-on' replaced, as it had turned yellow and unsightly.
The dentist at the time assured me that the new material was less likely
to stain. I did not have any 'lamina' or 'bonding' done, as I could not
afford it.
The tooth is once again yellow and ugly-looking, and I'd like to have a
coating of some kind put on it, that would be relatively permanent,
without having to have the whole tooth redone. The dentist I saw says that
the root canal tooth, being so old, is brittle and in danger of breakage
(in which case the whole tooth would be lost). He insists on redoing the
tooth and giving it 'more support' before bonding, etc. My previous
dentist had never mentioned any such thing.
Any advice?
Answer:
Dr. Eichen is correct (IMO), but I would be somewhat reluctant to
"patch-up" someone else's shoddy work. There would have to be a clear
understanding that this was a "compromise" approach, and that if the
whole thing fell apart, that "I" would not be held responsible ("It was
fine until you worked on it").
I am not a dentist, but I have sat across from one for many years as his
assistant. I am fortunate enough to have learned a lot about dentistry in that
my dentist trusts me to educate patients about dental situations just as he
would. I do not diagnos, but help him educate once a diagnosis has veen made.
If the tooth in the front is not having any symptoms, and the color is the
only problem, and I can understand the appearance being a big concern to you, I
would concentrate my efforts on the back tooth that is wide open.
When a tooth has had root canal therapy, the nerve and blood supply to the
tooth is removed, also removing the vitality from the tooth. It is, in
essence, dead material. It does have a tendancy to become brittle and more
easily broken than a healthy, vital tooth. The fact that a tooth has had root
canal therapy also does not mean that the tooth structure remaining will not
decay.
Since the back tooth is open, there is no way that you can properly clean
it to prevent that from happening, and the tooth can decay right through the
root causing you to loose the tooth and the investment that you have already
put into it.
I understand that economics are a big consideration to you , also, but
replacing a tooth that has been removed can be a lot more expensive than
restoring it. Not to mention the fact that having the tooth open for a long
period of time can lead to possible re-infection through leakage inside the
root, and cause an abcess to form which could flare up on you at any time
(usually on week-ends, vacations, or after office hours)
In other words, and I can tend to ramble on...if it were my situation, i
would concentrate my efforts on the back tooth.
But, if the front is what you want to take care of first, the complete
front bonding would probably be the least expensive way to go for now, with the
understanding that the biting-into-the-apple days are over until the tooth is
re-inforced with a post and crown. The average life of the tooth colored
bonding material is about 5-10 years, depending on where it is located in your
mouth, and what kind of punishment it takes from daily life. It will also
stain faster from coffee drinking, or smoking. You got some good mileage out
of the first one!
The next least expensive would probably be to have a laboratory-made
porcelain vaneer made and bonded over the entire front surface of the tooth.
Some of the new porcelains they are using these days are fairly strong, but
some care would still need to be taken as far as biting into things, as it
would not give you complete support.
