Several years ago, I had an accident that damaged a couple of teeth years ago. My dentist fixed it with root canals and dental crowns. It was fine but after some years, my natural teeth started looking not so good and I decided to have a smile makeover done. It looked fine, but after a while one of the fractured teeth began to bother me. I went back to the cosmetic dentist and they did an x-ray. There was a pimple on my gums and she said I needed to have that tooth extracted and get a dental implant and another restoration. She thinks I need to see a periodontist for that. Is there another option? I am not sure I want to lose a front tooth. I’ve attached photos of my smile and the x-ray. Can you give me your opinion?
Lucy
Dear Lucy,
Your smile makeover is fine. That has no issues. However, I am concerned about a fractured tooth. Either your smile makeover dentist did not do x-rays or her diagnostic skills were off.
In the middle of the tooth #9 is a horizontal radiolucent line that looks like an old fracture. Admittedly, I have to do some guesswork here, but I am thinking this dates back to your original accident. One of the reasons I feel this way is the root canal filling crosses the fracture line. That means either the dentist who originally did your root canal treatment didn’t notice the facture or he tried to navigate past it and remove the necrotic tissue in order to stimulate healing.
Looking at the x-ray, the end of the root looks healthy. However, everything above the line looks like it is being eaten away. The root canal material is gone. If where you had the pimple on your gum traces to that area, that means there is an infection eating away at that area. If that is the case, the tooth is unrestorable. It will have to be extracted and replaced.
All total, your dentist is an excellent cosmetic dentist, however, she overlooked some important things. I am going to suggest you talk to her about this and ask her to work with you on the fee and treatment. You offer to pay for the tooth extraction and dental implant, but ask her to cover the implant crown. This would make the total cost even out to what you would have paid if the diagnosis would have been done right to begin with.
On the plus side, your dentist has the skills to provide you with a beautiful implant crown that blends perfectly with the adjacent teeth. That is something to be grateful for.
This blog is brought to you by Atlanta Periodontist Dr. David Pumphry.
