I’m 35 years old, and my tooth number 7 (right lateral incisor) is turning dark and has been for at least 5 years. My endodontist said the tooth is still viable (I was able to feel ice and an electric current, although my response was delayed). There was a possible, very faint horizontal fracture observed on the x-ray, and a root canal was deemed optional at this time.
I’m debating between getting the root canal done or pursuing a cosmetic procedure.
I’m under the impression that a root canal can weaken the tooth, but I was also advised by the endo that bonding would have to be applied to several teeth in order to achieve a cohesive look.
What are the cosmetic options for this kind of issue? Should I go ahead and get the root canal done now since I’ll likely need it in the future, or is it better to hold off and keep the tooth strong for as long as possible.
Which option is the least invasive and best for my oral health?
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To me, “optional root canal” is the same as saying “not necessary to do a root canal.” So why would you want to do a root canal if it isn’t necessary? Either your tooth is infected or it isn’t. If it is infected, a root canal treatment is necessary. Since it’s not, I would leave it alone.
And I am skeptical that you have an actual horizontal fracture in the root of the tooth. A crack would be possible. A fracture seems highly unlikely. If you had a fracture, the tooth would be dead. Furthermore, if there were really a fracture, a root canal treatment would be problematic because it would traverse the fracture and thus be susceptible to leaking and failure.
Your tooth gradually turning dark could be because of some trauma you had some time ago, at least the five years during which it has been turning dark. Trauma can cause a tooth to build up defenses in the form of what is called secondary dentin. This will cause the tooth to darken somewhat and will also cause the living pulp tissue to shrink which would make your tooth less sensitive to cold or other stimuli.
The bottom line is that, from what you’re telling me, the only problem that has been diagnosed for your tooth is that it is turning dark. The solution to that would be a porcelain veneer or direct composite bonding, either one at the hands of a true dental artist. In the unlikely event that you later need a root canal treatment on this tooth, it would be a simple matter to do that after the veneer or bonding, since root canal access is gained from the back of a front tooth. You need to be very careful who you ask to do this cosmetic work because the color manipulation would be quite tricky and you do need to have this tooth match the surrounding teeth. I believe that only 1-2% of dentists have the passion for appearance-related dentistry plus the training to make this tooth look perfectly natural. I would not bond several teeth because it isn’t necessary, provided you have a properly skilled cosmetic dentist. The reason your endodontist is suggesting bonding several teeth is because your basic family dentist would not be able to get this tooth to match any other way. Furthermore, the problem with getting a dentist to bond several teeth is that if he or she doesn’t know how to color match teeth in this situation, they probably aren’t very good at bonding either and would want to crown several front teeth instead. But if you gave me your city, I could find you a dentist who could get the tooth to match – perfectly – with a very conservative restoration.
Good luck with moving forward.
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About David A. Hall
Dr. David A. 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 advanced internet marketing for dentists.