This is a situation most dentists face every week. A patient comes in with a broken tooth (either with or without prior root canal treatment)and would like their tooth fixed. This poses a dilemma for dentists. Most are aware that teeth do not have enough exposed tooth available to safely hold a crown are more likely to fail than teeth that have do have sufficient 'ferrule'(sound tooth structure around the base of the tooth that can be used to anchor crowns). In my experience, it is extremely desirable for teeth to have at least 1.5 mm of ferrule in order for me to fabricate a predictably long term restoration.
What should a dentist do if a patient wants his tooth fixed and it doesn't have sufficient ferrule? First he or she must make the patient aware of this issue and its ramifications. The fact is that if a crowned tooth has insufficient ferrule, it is more likely to fail. The remaining tooth structure is much more likely to fracture and can even lead to the loss of the tooth. With this fact in mind what should a dentist do?
Ideally a patient who wants this sort of tooth restored has two good options. The first is the road least travelled. It involves having the tooth orthodontically extruded and after it stabilizes having a crown lengthening procedure. This will allow for an aesthetic result and a more predictable restoration since the resulting restored tooth will have the desired amount of ferrule.
Another option is to forgo orthodontic extrusion and just perform a crown lengthening procedure ( removing bone and gum from around the tooth in order to expose more tooth structure). This can work well but can result in removing supporting bone from adjacent teeth and can cause aesthetic problems, since the resulting tooth can look too long and appear to have experienced gingival recession and 'black holes' interproximally(missing papillas).
Often patients offered either of these two options are hesitant to give approval to either and are insistent that the tooth be fixed as is. Although dentists sometimes go along with this request, it can lead to the eventual loss of the the tooth. How long such a restoration will last varies, but it is not a gamble that patients should take, if they want to keep a tooth long term.
Still another option, not yet mentioned, is that some broken teeth should be extracted and have bone grafting and an implant placed, while there still is sufficient bone available at the site. Implant restorations can be extremely predictable when placed in good candidates with the proper amount of bone support.
Questions... I have a decayed last molar/ root canal/cap. Seen specialist. He said too much decay and if fixed would not last 2-3 years and have to be pulled, so pull it. Got second opinion and she said she would take out the decay as much as she could, see what was left, show me x rays and actual photos and her recommendation. What was left was a shell 3X an egg shell with 1 side gone. One root also has decay that she could not get. She said not worth saving. She had mentioned removal of that root and then lengthening the remaining tooth as an option on her suggestion, if what she saw when done, was worth saving, and I told her I would go through all that and have the finances to do so. Will get implant if have be pulled. Is there any hope? How long does a tooth usually last that has had root canal anyway? And if any hope, where can I find the specialists? I live in VA.
ReplyDeleteI had a root canaled crowned lower tooth. It lasted 30 yrs. Had the other teeth pulled; one at a time and 2 yrs. ago, that tooth broke off at the base. I have little insurance, retired and can't afford any kind of bone grafting. I really don't want what's left pulled; as myaw will look strange; outside of moth. Any cheap suggestions?
Deletepull it! My husband nearly died because of three failed root canals. He was 66 at the time.
DeleteAn implant is your best aesthetic choice and healthy choice, if you have to have that tooth.
How long it lasts depends on what you chew/eat with that tooth. I only eat almonds on my left side - my own teeth.
Loved all your information, by the way!. your article was spot on!
DeleteIt sounds like saving the tooth may be less predictable than an extraction, bone grafting, and implant placement. Patients may make a decision to 'heroically' try and save a tooth with a number of procedures and then be upset when the end result doesn't last five years. It doesn't sound like your second dentist has offered any guarantees. She has just indicated she is willing to try.
ReplyDeleteYou should ask her for a recommendation to periodontist and ask what they think. What will the prognosis be after a crown lengthening procedure?
You can also get the nerve kill and still have your tooth and if need be still do the crown.
DeleteWith the way cosmetic dentistry had evolved, I believe that nowadays, it is possible. Me and my dds austin thinks that this is possible. Thank you for sharing!
ReplyDeleteThanks for sharing this article, it has really been a great read. I've never dealt much with ancaster dental. I've got a nephew I'm taking into an appointment for his mom who is working and I hope it all goes well, I'm really nervous about it.
ReplyDeleteI have had root canal and crowning for 2 teeth they broke and fell off from near tha gum line i have consulted 4 - 5 dentists majority told me that i have to get implant to fix them one denstist told me that there is no need of implant they can fix it by just placing new crowns and he said that they would last if taken care of can please someone suggest me should i get this or not plz help i really need help
ReplyDeleteI have upper left moler near front broken at gumline, dentist recommends extraction, bone graph and implant. This is just too expensive for me.
ReplyDeleteThe tooth isn't causing me any pain/issues, other than the exposed portion being discolored. Can I wait to have the recommended treatment in a few years if it causes me pain or are there ramifications to waiting?
Sometimes when a patient isn't prepared for the expense of the treatment needed to have an implant, a broken tooth can be left in place until the patient is ready. The risk is that it may become infected. If that happens, it may be time to have it extracted, rather than risk the infection spreading.
DeleteIs there a mouth rinse or product that could be used in the interim to avoid infection?
DeleteYou could use peridex if you dentist advises its use
DeleteEnamel sheared off right upper first molar the other week, leaving a 45 year old stump of amalgam. I have other missing teeth, and the left upper first molar has been broken and leaving the amalgam stump for almost two years. I can't get restorations done, and, am not well enough, nor have the money for - substitute teeth, shall I call them. If I go to a dentist, he or she will only be able to tell me that the teeth should be extracted, right? So, the better choice is to see the oral surgeon - that is, IF I decide I should not wait - -and I want to wait and keep using these teeth. (It is quite the shame that Medicare does not cover dental, isn't it. But, even if it did, in my case, I've about had it with "loss" of any kind, for the time being).
DeleteHey nice post man! Thanks for incredible info.Arlington dentist
ReplyDeleteGood evening there how are you doing I am still trouble with my wisdom teeth it is broken in my gums it is still holding the infection in my gums and broken teeth is holding the infection in my gums I itch really bad no dentists where I lived at they are not going to pull it or mess with it at.all I have been lot.of Anobolics it haven't clear up the infection with it
DeleteI have had a root canal and tooth rebuild twice on the same tooth second moler from the back on the right side, it has now broken off below the gum line, it is not causing any pain should i be getting the rest of the tooth extracted or is it fine as it is
ReplyDeleteYou should see your dentist to determine whether the tooth should be saved.
ReplyDeleteI've got 2 teeth on the upper back that have huge holes in them and a terrible cracked. Medicaid dentist says he has to extract them that there's no chance of doing a root canal or saving my teeth. He travels from office to office and he's not in his own practice. Is extraction my only option? Hes got me scheduled for five.
ReplyDeleteYou probably could benefit from a second opinion. Even if he is correct, hearing the same thing from another dentist would probably make you feel better. If on the other hand you find out you have alternative options, that would be good to know as well.
ReplyDeletehave had a root canal and tooth rebuild twice on the same tooth second moler from the back on the right side, it has now broken off below the gum line, it is not causing any pain should i be getting the rest of the tooth extracted or is it fine as it is
DeleteIspindeldds great feedback but you never answered anonymous her question in a nutshell because the tooth is broken from the gumline is it safe to leave it like that or must that access tooth be extracted due to possible infections?
I have an old molar 2nd from the back - due to a really old root canal and crown from 20+ years and then replaced (crown) approximately 4-5 years ago.
ReplyDeleteNow the molar tooth and crown fell out when chewing gum and on the interior side; it's sharp and now I am beginning to think that it's part of the tooth. I am not trying to save the tooth - do I need to go in to the dentist to have the remaining tooth (it's broken to the gum line) extracted?
I believe it's due to medications that I take that my tooth failed. I floss 2x a day and brush with a Sonic Care toothbrush.
No pain, I am rinsing with a hydrogen peroxide/water mix for 5 minutes after brushing. Will that help to avoid infection until I can get into the dentist?
I have a similar situation, my #5 tooth broke off at the gum line. An oral surgeon suggested I see my endodontist to have the nerve removed. The reason he is not comfortable with cutting out the root is because I am a cancer patient receiving a monthly injection of xgevia, but I haven't had one since August. However my ctx level is 134 hince the reason he is uncomfortable with proceeding. He said if I have it done I risk severe complications or do nothing and see what happens. Your thoughts?
ReplyDeletei havea tooth near the upper front which has snapped at the gum line, leaving some ferulle? to work with. 2 dentists so far have said they wouldnt do anything heroic with the tooth, and have recommended extraction. one dentist has performed a root canal in the meantime to avoid infection whilst i make a decision. i preferably want the tooth built up, understanding the risks. this is because i am terrified of having a tooth extracted in case it permanently spikes my already severe tinnitus. (i have known people to have permanent spikes from dental work). the other issue is i have had all of my amalgams out, and my dentist said that she would use a stainless steel post if i were to proceed with restoration. are the fibre reinforced composite resin post systems an option? what do you suggest? i hate my teeth aesthetically by the way, have a few missing teeth, shortened teeth from grinding etc.....what about the use of snap on smiles as a temporary fix as i cannot afford an implant (nor am i prepared to take the risk of more metal in my mouth or trauma that might impact on my tinnitus).
ReplyDeleteI have the same tooth problem. My lower tooth is broken and the only thing left is like a frame of the tooth. Its really broken because i can see the gum at the center and the only thing left is like a frame of the tooth. Its been aching last week. Should I ask the dentist to remove the small part of that teeth?
ReplyDeleteMy crowned tooth pulled out screw posts & all at gum line. It was a little jagged. Was going to see if dentist will extract the balance. It’s an eye tooth. Today the gum has swollen and become tender enclosing the the area the tooth was. Will this go down or will it not until I have it extracted?
ReplyDeleteYour root may have a vertical fracture and that is why your gum might be swollen. It is best to visit your dentist ASAP.
DeleteThanks for post! which is useful for who all are searching for best painless root canal treatment in Chennai is always give you the quality Dental treatment with your comfort level.
DeleteDear Dr. Spindel,
ReplyDeleteI had a root canal therapy on my 1st left lower molar 3 years ago. Yesterday, the tooth broke (both the tooth and post came out while I was chewing a gum). The dentist said that the tooth must be extracted. I asked if there was any possibility of restoring the tooth, but didn’t get a specific answer. The senior dentist called me in the morning and said there wasn’t enough tooth structure remaining to replace the core and crown. I suspect they’re right, but still want a 2nd opinion. However, I live in Switzerland and in my experience, the approach here can be quite conservative. I would love to hear your thoughts, but couldn’t attach the X ray here.
I am aware that a single-tooth implant is the best long-term solution here. It’s just that this happened at the worst possible time ("If there is a worse time for something to go wrong, it will happen then"). So I’m desperately trying to find out if there’s any chance of restoring the tooth, with full understanding that it may be an ultra-short term solution. I know that this sounds (and is) ludicrous, but I’d just like to buy some time…
Anyway, I wanted to thank you for this very informative and educational blog. I am a physician by training and an impossible patient by nature, and I really appreciated reading your knowledgeable views, insight and thoughts.
Nice blog and thanks for sharing this information. I will really refer my friends to read this blog. A beneficial blog to all dental patients. root canal treatment in India is low in cost.
ReplyDeleteDoctor,
ReplyDeleteI had a root canal several years ago and never got a crown due to the costs involved. The tooth has now broken at the gum line. Since I had already had a root canal do I need to have the tooth
Taken out or can I leave it be? Can I still get an infection even the I had a root canal to this tooth already?
Dr. Spindel,
ReplyDeleteI had a root canal several years ago and never got a crown because of the costs involved. Recently the tooth broke to the gumline, it causes me no pain at all. Since I already had the root canal on that tooth do I need to have the tooth taken out or can I just leave it? Will it still get an infection even it I have had the root canal done?
If a root canal is finished but not protected with a proper seal that keeps saliva away from the guttapercha it can get infected since the cement used in sealing the canal can wash out and bacteria can travel toward the apex of the root. This contamination is common but not always clinically apparent on a radiograph of the tooth. In my practice, if the root is not does not exhibit a periapical radiolucency (evidence of an infection) I do not feel it is urgent for my patients to have the root removed. In most cases the optimum treatment plan involves removing the root and following up with an implant within 6 months. Retained roots do help maintain the bone around them so that they can be "place holders" for future implants.
ReplyDeleteMy #31 was badly decayed due to “temporary” metal crown that was on ~20 years (w/o a good seal, so foodctrap and difficult to clean).
DeleteIt abscessed 7 months ago but I got it to calm down. 3 weeks ago, that “temporary” crown fell off while I was flossing. It’s now almost like a wave shape w/ large gap under the tooth, catching everything I eat...
Other than when food gets caught (rice is the WORST) I’m asymptomatic. The plan was to extract but nothing else recommended since hidden in back.
Wondering if I could safely leave the root 1) since no plans for bone graft or implant 2) to preserve bone
Never had root canal done BC I had hesitations, AND had connected root at bottom so Dentist wanted done by endo and wouldn’t touch it
My husband's crown broke and now the tooth broke off. I can see white filling from the root canal he had 20 years ago. Can it get infected? Should he have it pulled?
ReplyDeleteHello.as usual a fracturedtooth broke leaving partial roots because one root came out .it was a rootcanalled tooth but as I amhiv am afraid of surgery as well as infection.I am a vegetarian and avoid sugar.if left and kept clean is itsafe?
ReplyDeleteI fractured my tooth 9upper bicuspid)below the gum but above the bone. The emergency dentist pulled out the broken piece. He said to give it a few weeks to heal and then a surgeon could do gum surgery so a crown could be placed. He put medicine in and protected the tooth with a temporary filling. He called the next day and I told him I didn't have pain so he said I was probably going to be okay. It has been 6 weeks now and I still do not have pain but the regular dentist wants me to have a root canal before attempting to fix the tooth. I'm kind of confused now about what to do. I thought I would be going to an oral surgeon but now am going to see an endodontist instead. The reason I'm worried is that I am a new patient and this is an HMO type of plan where the insurance is also the employer of the dentists. I wish I had stuck with my traditional insurance. I'll be switching back next year.
ReplyDeleteFor your peace of mind, I suggest you go for a second opinion. You are not restricted to in network dentists for this consult, but might consider paying out of pocket for advice.
DeleteMy tooth broke of while dentis was exstracting it now the root still there but my gums close my root im now suffering of swollen gums and abcess
ReplyDeleteMy crown came off, part of my tooth and post is attached to the crown. The rest of my tooth is at gum line. What are my options??? (I had a root canal done couple years ago and dont feel any pain)
ReplyDeleteOften there is not enough tooth remaining to save the tooth. Your best bet is to visit a dentist to make a proper determination. A crown lengthening procedure that removes bone around your tooth may make it possible to save your tooth, but often it can compromise the teeth adjacent. The best option is often and extraction and single tooth implant or three unit bridge.
ReplyDeleteHi, my tooth just broke off at the gum line due to decay. It doesnt hurt at all. I believe the nerves and all have already died bc i previously experienced severe, practically crippling pain from it but havent felt any in about 2 months. Anyways, sorry, i have absolutly no way of going to a dentist, finance wise that is, will my tooth/jaw be ok? As in will it get infected or cause me any more pain? Or can i just leave it alone now and not worry about it?
ReplyDeleteYou should see a dentist because the tooth either may already be infected or if not, it may become infected.
DeleteI think many people on this site has asked the same question to "lspindeldds" but he responds vaguely or not answering the question. The patients are asking given that they had a root canal and their tooth broke off with the crown they have a tooth stump on the gumline: is it safe to just leave it given surgical extractions are expensive? or will it be infectious at some point? I would like to know what makes a crown or implant less infectious than just leaving the chip tooth that is on the gumline?
DeleteI've had a broken ( to gum) top right very back molar for over 5 years. Never had pain and still don't.It actually started to crumble to this point 5 yrs ago. It never got infected either. Not one problem but now the tooth in front of it is going to be pulled due to a cavity and they want to dig out the rest of the tooth I'm speaking about. Is all that necessary?
DeleteMy daughter had a post crown fitted a few years ago.It fell out with half the post still attached and half still in her tooth. Is it unusual for the post to snap?
ReplyDeleteWhen there is insufficient tooth (ferrule) to support a crown, then the crown puts additional stress on a post and it can come loose, or even cause a post to break.
DeleteTo take care of your mouth is very important for you and your small baby you should take some proper prescription for it. Thanks for posting this blog its really nice.
ReplyDeleteDentcoat DS
I just had a first time crown placed on a almost front tooth that has come off twice in the 3 days since I've had it. Im so upset! What could be the reason?
ReplyDeleteMy brand new crown keeps falling off and has to be recemented. What is the problem?
ReplyDeleteNot enough retention?
ReplyDeleteSo, what has to be done? I dont want to have to pull it. Will a new crown have to be made?
DeleteBtw... Thank you for your response.
DeleteWithout examining what remains of the tooth and looking at a radiograph I can't advise. Hopefully there is enough tooth to make another crown after repreparing the tooth.
DeleteI wear dentures at the bottom and now the roots from my teeth are showing and have an odor causing my dentures to smell, what can I do about the smell?
ReplyDeleteI have gap between my front two teeth and during my 2 visit for composite filling between the gap the dentist removed the fillings alongwith 1/2 of my natural teeth creating the gap like space of one tooth.the teeth cut off is till gum line and I don't feel the pain can I go for composite filling then put on braces will my teeth move a little bit forward or suggest me for a better treatment
ReplyDeleteA dental implant is used to support one or more false teeth. It is a titanium screw that can replace the root of a tooth when it fails. Best dental implants
ReplyDeleteI have a bridge/crown over teeth #11-13. Tooth #13 has decayed under bridge. Is there any way to get a build up done to that tooth without having to have bridge completely remade?
ReplyDeleteI have to get a root canal and have crowns. unfortunately, my teeth underneath the crowns are shaved down quite a bit and the teeth underneath the crowns are also very thin is there a way to preserve the crowns and my natural teeth with a root canal?
ReplyDeleteI just had root canal don't in middle of spring and dentist left whole and tooth wasn't strong enough and know hang half way off the gum line on my left front tooth and on right tooth chip has hole in middle and hasn't fixed yet.
ReplyDeleteYou should see your dentist ASAP. Most teeth need to have a permanent restoration placed soon after root canal is completed. Most posterior teeth need a crown. If the tooth is left open it can cause the root canal to fail. Also often tooth structure that is left can be weak and need the protection from occlusion that a crown offers.
Delete12 years ago my dentist put crowns on all my upper teeth. A few months ago #9 started to throb-dentist took exrays could not find anything. The entire crown broke off at the gum line and it is still trobbing why?
ReplyDeletePossibly the tooth's pulp is not happy. It may even be non vital. If the tooth is still restorable it may need a root canal.
DeleteMy regular dentist did a root canal on one of my front tooth. The instrument broke and was stuck in my tooth so I had to see an endodontic to finish the root canal and take out the broken intrument. after a year, the front tooth which has been crowned broke below the gumline after I used a sonic tootbrush. I guess from the vibration. My dentist said because of tooth decay and he suggested to have it extracted.While visiting Bangkok, I went to see a dentist for second opinion and he also suggested extraction and do a bridge or implant. Do you have any other suggestion for my treatment. I live in Hawaii.
ReplyDeleteProbably the easiest thing to do is what your dentists already suggested. Some patients are candidates for orthodontic extrusion followed by crown lengthening, but this is not always predictable and it is not faster or less expensive.
DeleteHi Dr., Ispindeldds, my left lower molar has broken off from the gum line and only the root canal is left. That happened in 2007. Is it possible to have it extracted? How is it extracted?
ReplyDeleteThank you!
The remaining tooth can be split into two parts and each half can be extracted with the help of a straight elevator. This tool is pushed between the ligament and the proximal bone and will tend to loosen and elevate the root out of the bone.
DeleteI recently about 3 months ago had 5 crown put in the front of my mouth. I knew i still needed work done like a root canal done on my upper top molar teeth. Just about a week ago my teeth on the left side all began to hurt so bad till i could feel it in my gums and my jaw. Even the teeth at the top left front on the side of the front teeth that also how a crown was hurting and sensitive. So i was perscribed augmentin 875mg which stopped the pain but now that teeth with the crown has falling out all the way to the gum line. It’s no tooth hanging it’s all the way a the gum line. I can see the little teeth inside the crown that feel out. What should i do. Right now i don’t have enough money for a dental procedure due to the pandemic and me being self employed. I’m scared ...are all my teeth just going to rot and fall out.
ReplyDeleteThere was a small dent for several weeks and 3 days ago my #28 tooth broke. The inner 1/3 of the tooth from the inside is no more and the damage went below the gumline. What's still left is standing. I didn't feel pain nor did I have any blood, in fact at first I thought a biece of the peanut had stuck, then I realised it was my tongue touching the broken tooth. Today I went to a dentist. He said the recommended option is to etxract it but if I don't want he can make an effort to save the tooth. He went on a root canal procedure, removed the nerve,now it has a small filling and I'll go again tomorrow to check it. Any suggestion? I can't affort a new tooth-I had my #13 removed some years ago and left the gap. Not 40 yet, I feel awkward to get a second tooth missing.
ReplyDeleteHey I have a broken molar back lower left corner the tooth it self has broken away and there is nothing left but what looks like gum is there anything left in there should I be worried it doesn’t hurt at all I pulled the last fragment out this evening ??
ReplyDeleteThis blog was extremely useful. I really appreciate your kindness in sharing this with me and everyone else! upper teeth.
ReplyDeleteWisdom tooth broken past the gum line and is healing over leaving the tooth covered with the gum
ReplyDeleteCost... Period. Implants and these procedures are expensive and we are not a country that sees fit to grant its citizens with a meaningful life of affordable healthcare. That is the sole reason for patients not wanting these procedures and preferring things be handled as is.
ReplyDelete