I had root canal treatments on my 3 front teeth when I was 14. Since then the dead teeth have started to discolor. I asked my dentist what I can do to get these teeth whiter and he told me my only option was to have crowns put on them. My dentist put the crowns on but they were a darker grey than my teeth were to start with and so he had to reorder them and re-do the crowns. After several procedures of tugging and pulling and re-doing his work I finally got the right color crowns.
Two weeks after the final crowning my front tooth busted off completely, my dentist then put a post in that tooth without giving me any other options such as an implant or bridge. My dentist swears that it was not his fault the tooth busted off and that it was weakened from the root canal, but I feel that it was from the constant tugging and pulling and re-doing the crowns twice that weakened the tooth. I looked online and saw that I could have just had those teeth internally bleached instead of crowned to get them whiter. They have never given me any trouble or pain in the past. Is it standard procedure for a dentist to not offer internal or zoom bleaching as a non invasive option to whiten those teeth instead of the expensive crowns that weakened my teeth throughout the procedure? I would have just had that done if it had been an option!
—Amber from Oregon
Yes, your dentist could have contributed to that tooth breaking off. However, the stress from doing and re-doing the crowns is only minor. It is the fact that crowns were done instead of the more conservative porcelain veneers, and that he didn’t put posts in the teeth when he prepared them for crowns.
Teeth that have root canal treatments tend to get brittle and so generally it’s a good idea to put crowns on them to keep them from breaking. However, on a front tooth the stresses on a tooth aren’t vertical but horizontal, so a crown will actually weaken a root canal tooth at the neck of the tooth and make it more susceptible to breaking off completely.
Internal bleaching is a helpful treatment but will probably not be adequate for making a root canal tooth be the same color as neighboring teeth. What I would have probably done in your situation is to do the internal bleaching, then place fiberglass posts in the teeth to strengthen them against breaking off, then do porcelain veneers instead of crowns.
The question that needs to be asked now is when will the other two teeth break off? They are in the same situation. They should have also had posts, and I would go in now and put those posts in before they break off, too. For front teeth, it isn’t recommended to put metal posts because they are rigid. Their rigidity causes them to transfer stresses to the root and risk root fracture. Flexible fiberglass posts will reinforce the tooth without risking root fracture.
—Dr. David Hall
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