Fixing a broken front tooth on a 7-year-old

Dr. Hall,
When I was about 7, I slipped on a monkey bar and it cracked and chipped my right upper front tooth. I didn’t get it fixed right away, but a couple of years later the dentist did a root canal and I also had it filled to kind of match my other front tooth. But now it looks horrible because it’s smaller than my other tooth and it’s discoloring. Would there be a way for my smaller discolored tooth to match my bigger front tooth? And to get rid of the discoloration?
– Vance in Arizona

Vance,
This could be a real problem, if you ask your family dentist to do this. But if you go to an expert cosmetic dentist, such as the ones I recommend on this website, it’s a fairly straightforward case that should require a single all-porcelain crown.

Many cosmetic dentists, me included, won’t recommend doing a porcelain crown on a patient in their teens or younger because often the tooth hasn’t fully erupted. If the tooth continues to erupt after the crown has been placed, the margin ends up very visible, which is not good. So they will repair the tooth with composite, if that is an option, and then do the crown in the patient’s late teens or maybe a little later. And since a composite filling isn’t as strong as a crown, making it a little smaller can keep the composite from breaking.

One problem, though, with composite on the front tooth is that it can be susceptible to staining. An expert cosmetic dentist will have a selection of highly stain-resistant composites to use, but most dentists will just stock all-purpose composites. And then, the tooth itself is subject to discoloration once it has had a root canal treatment.

Here is a photo. This isn’t Vance, but is a photo of another patient who has had a root canal treatment on a front tooth and a composite repair, similar to what Vance would have had. The composite covers about 1/3 of the tooth, consisting of the lower left corner as we are looking at it. You can see that the composite, while it is lighter than the rest of the tooth, is darker than the adjacent tooth. So the composite has discolored some, and the tooth has discolored more.

When a front tooth has a root canal treatment, it also tends to become more brittle over time and more prone to breaking. Doing a crown on such a tooth will actually weaken it more against lateral stresses, which are the types of stresses to which front teeth are most susceptible. So it is wise to put a post in the tooth to strengthen it. A metal post can show through slightly. An expert cosmetic dentist would use a white or translucent fiberglass post. A general family dentist also would probably jump right in and do the crown, but an expert cosmetic dentist would probably want to bleach the tooth first because the darker tooth structure would have to be blocked out making it more opaque than the adjacent tooth, when you want these two front teeth to look exactly the same.

Done correctly, the dentist should get a perfect match with the adjacent natural tooth. It will likely take several try-in appointments to get the color match perfect, and it will require teamwork between the dentist and the ceramist to do this. The tendency of family dentists is to get the color “close enough” and be satisfied with that. But here is a photograph of a case done by one of our mynewsmile network dentists. One of these front four teeth is a porcelain crown, but it is impossible to tell, from the front, which one.

My recommendation—go to one of our recommended cosmetic dentists and get this done right.

– Dr. Hall

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