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Julian Chen
Julian Chen, Dentist
Category: Dental
Satisfied Customers: 559
Experience:  Practicing General Dentist since 2002
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Have a front tooth that has had a root canal, the a crown.

Resolved Question:

Have a front tooth that has had a root canal, the a crown. It came off twice, the third time it came off it was put back on with pins in the real tooth and the crown. Now it is loose again and will not come off. It moves back and forth. Is there any other way it can be fixed besides a Maryland Bridge? Could some type of device be attached to the back of the teeth on each side and to the crown to secure it. I just do not want to have a front tooth pulled. I am 62 years old. I know when our daughter had braces, after they were removed, several years later some teeth began to move and the dentist put a permanent brace on back of the teeth that were moving. Could something like this be done? Thank you for your advice. Sandra Bumgardner,XXX@XXXXXX.XXX
Submitted: 5 years ago.
Category: Dental
Expert:  Julian Chen replied 5 years ago.
Hello Sandra,

I'm sorry to hear of your dental troubles. Unfortunately, with what you've described, it sounds as though that front tooth will need to be extracted. There are only a certain number of times that the tooth/root is good for in terms of restoring and replacements and it appears its number is XXXXX

You have a number of options:

1) Extract the tooth and be fitted with a removable partial denture (RPD). Oftentimes, these are referred to as "flippers" because of patient's tendency to play with them and pop them in and out with their tongue.

2) Extract the tooth and assuming the adjacent teeth are healthy, restore the gap with a fixed partial denture (FPD). These are oftentimes referred to as a "bridge." They are fixed so you would not have to take them in and out. The downside of bridges is that they do require more maintenance/home care. You have to be diligent to floss along the margins and underneath the "fake tooth" to prevent recurrent decay from forming at the margins. If a new cavity forms on the supporting teeth, the entire bridge often needs to be completely replaced. (A Maryland bridge would fall under the FPD category.)

3) Extract the tooth and restore the area with a dental implant and crown. This is the most ideal way, however, it is also the most expensive treatment. The benefits of going with an implant is that you never involve the adjacent teeth, so you're able to floss and care for the implant as if it's one of your natural tooth. Should anything ever happen to the implant itself, it doesn't jeopardize the teeth next to it. And the same is true in that should a cavity form on the adjacent tooth, it doesn't jeopardize the implant.

From a long-term perspective, option #3 is the most ideal because single-unit implants have a great track record and do last a long time. Bridges typically need to be replaced every 5-15 years (sometimes longer). Most patients do not like dentures (RPD) because they're bulkier and people get tired of needing to take them in and out, or sometimes misplace them. However, RPD would be the least expensive treatment that would be offered.

I would advise against trying to splint the existing, broken crown to the adjacent teeth because by this time, there is a gap that we cannot reliably seal underneath the crown. This will eventually lead to recurrent decay as well as cause the existing root canal treatment to fail. And infection and abscess will form at the root tip, resulting in bone loss.

I hope I was able to address your concerns. If you have additional questions, just let me know and I'll try my best to answer them for you.

Regards,

Dr. Chen
Julian Chen, Dentist
Category: Dental
Satisfied Customers: 559
Experience: Practicing General Dentist since 2002
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