Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

October 26, 2015

The cheapest, easiest, fastest way to fix a front tooth that broke off at the gumline

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Dr. Hall,
I recently broke my front tooth off, right below the gumline. I am looking for the cheapest, easiest, fastest way to fix this. I am 100% against implants.
– Harley from Nebraska

Are you really asking me this? I don’t think you really mean the question the way it came out.

For the cheapest, easiest, fastest way to fix your broken front tooth, go to Walmart, buy a tube of Superglue, and glue your tooth back in. Cheap, easy, fast.

Problem is, the repair will only last for a couple of days. But long-lasting wasn’t on your list of requirements.

Another solution, not as cheap but also easy and fast and, as a bonus, long-lasting, would be to have a dentist bond a glob of composite onto the broken part of the tooth, making a little mound. That would last a long time. It wouldn’t look very good, though, but looking good wasn’t on your list.

Let’s re-order your priorities and make it first, something that will look good, and second, something that will hold up long-term. To accomplish that, there are two options. And neither one is cheap, easy, or quick.

It could be possible to repair the tooth by placing a crown on the remaining root. But that would only work if there isn’t a lot of stress on this tooth. If you have a deep overbite or even just a strong bite, it would be hard to get the crown to stay on. But if you have a gentle bite, it could work. You would need to have a root canal treatment on the remnant of your tooth, then have a good, strong post that’s not completely rigid. Either a carbon fiber post or a fiberglass post would work. The stress on a front tooth is mostly lateral. If you have a rigid metal post going down into the root and then put stress on the crown of the tooth, that stress will transfer to the root through the post and tend to cause a root fracture. If the post has a little flexibility to it, however, it will not transfer stress to the root and thus not tend to fracture the root.

And better yet, I would place two posts side by side, to help resist rotational forces that would tend to weaken the bond to the tooth over time. All posts are perfectly round, so any twisting force on them will tend to dislodge them.

However, if there is any significant stress on this tooth, the only solution that will hold up over a long time would be replacing the tooth with a dental implant. This could cost twice as much as a root canal, posts, and crown, and would take substantially longer because of the healing time required. But it would look good and last much longer. Doing the crown first could have you ending up with the dental implant eventually because the crown would fail.

Bottom line—sometimes the cheapest dental solution is the most expensive, the quickest solution takes the longest, and the easiest solution is the most complicated. It’s generally best to just fix it right in the first place and then be done.

– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

June 9, 2012

Why can’t my dentist get this color right on my implant crown?

Dear Dr Hall,
I was not happy with the color of the crown attached to my implant, so I returned to my dentist who said he thought it was fine and sent me away to “think about it.” I returned and he very reluctantly agreed to re-do the color. I recently had the revised crown attached again, but the color is worse – it is now quite noticeably darker. Both times I visited the lab for color assessment. And both times the dentist did not bother to check the color before attaching the crown. I am very disappointed, but do not want to return to this dentist as he obviously is not able to improve. He also had considerable difficulty with attaching the crown which resulted in considerable discomfort and left me wondering whether the attachment to the implant has been damaged. Post-procedure, I cannot eat on that side of the mouth at all. This implant has cost me a considerable sum. I would like to know what my options would be for correcting the color of this crown, and if the attachment has been damaged, would I need to get a whole new crown and implant, and who should pay for this? Is it possible to place a veneer over the crown? Thank you for your help.
– Mary from Australia

Your case is a great illustration of the great difference between dentists when it comes to aesthetics. Only about 2% of dentists, from my experience, are very good at aesthetic dentistry, and I have people all of the time having a hard time believing that and wanting to know why. (And that 2% is in the US – probably less in Australia). But dentists become dentists because they like to fix things – they’re just not into works of beauty.

Your dentist clearly has a low degree of interest in the aesthetics of his work, and that is the reason this isn’t working. And you have given clear indication here in your e-mail of his indifference. Any dentist who is seriously trying to do beautiful cosmetic dentistry will be very attentive to your opinion and if you thought the color didn’t match well would not try to tell you that it was fine. Such a dentist would actually make sure the color was right in your eyes before cementing the porcelain crown and would not hesitate to send it back to the lab. But your dentist did not have enough confidence in his own color-matching skills to match the color himself but instead sent you to the laboratory. And then, after being burned once and having to re-do the crown, rather than trying it on and making sure you liked the color this time before permanently cementing it, he just puts it on.

You have figured out that you cannot rely on this dentist to get this right. If you want this done right, you have to find a dentist who actually wants to be good at aesthetic dentistry. I wish you had told me where in Australia you are and I could give you some guidance on that, because good cosmetic dentists are few and far between in Australia.

When a dentist sends you to the laboratory technician for the “color check”, that is a pretty good sign that the dentist knows he or she isn’t very good at tooth color, and those cases often end up looking very poor. All the technician can do is look at the tooth that needs to be matched and take notes about the color. Then he or she dismisses you, goes into the laboratory, and tries to follow the notes that were made. The dentist is supposed to have a higher level of skill than the technician, and should know how to make those notes and instruct the technician. And nowadays, with digital photography, it is very easy for a dentist to hold up a shade guide tooth to your tooth and snap a color-correct photograph and e-mail it to the technician, with notes. The technician can then use that photograph and the notes during the fabrication of your crown, and this is often the best way to get an accurate match.

Do not – absolutely do not try to get a veneer placed over the crown. The crown is difficult enough by itself. Get the crown re-done. If that is done correctly, it will not damage the implant at all. Trying to do a veneer over it and get the color right makes it all the more complicated. Besides which very few dentists know how to properly bond a veneer onto a porcelain crown. That could turn this from a simple bad dream into a true nightmare.

If you need any more help with this, please write back.
– Dr. Hall

P.S. – I see you found our website by searching on “dental catastrophe.” I had not thought of that search term before, but it is appropriate!

Click here to read my blog posting about how to ask for a refund from your dentist.

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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