My dentist sent me to a specialist who performs root canals. This dentist told me that my tooth has calcified and he cannot perform a root canal. All of my other teeth are healthy and straight. Should I consider a veneer or crown for this front, top tooth? Will it be possible to match it to my other teeth?
What Is The Best Option For A Dead Front Tooth?
Doctor Answers 19
A good root canal specialist (endodontist) isn't going to do a root canal unless you need one. This may depend on whether or not you have symptoms and what the x-rays show. If a tooth is too calcified to treat with a normal root canal, then a surgical procedure called an apicoectomy would usually be the next step.
While it can be more difficult to match a single front tooth to it's neighbors color wise, it's certainly possible to do and do well. Once endodontic treatment is complete, you should have a veneer or crown placed to protect the tooth long term.
If for some reason the tooth can't be saved, then the next best option would be an implant.
What Is The Best Option For A Dead Front Tooth?
Dead (Dark) Tooth Options
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How to treat a dead front tooth
Two things you didn't make clear, has the tooth changed color (gotten darker) than the adjacent teeth and does any infection at the root tip show up on the dental x-ray?
If the tooth has discolored, but no infection is apparent, then you might just consider first trying to bleach the tooth. Although bleaching will lighten almost any tooth, the dentist cannot guarantee that bleaching will effectively match the adjacent teeth perfectly.
If that is the case, then a porcelain veneer commonly the best solution, today oftentimes replacing the need for full crowns on front teeth. Your dentist may have you go to the dental ceramist at the dental lab to have the color matched more accurately.
In cases where the patient has very high expectations, many cosmetic dentists will recommend veneering both front teeth. This insures that both teeth will look more optimum, same length, shape, color, etc. (i.e. both will be mirror images of each other). This is especially true when the other tooth also doesn't look as good (i.e. chips, discoloration, rotations or misalignment, etc.).
Dead front tooth
To treat a tooth that is dead but has no canal for root canal treatment means that only the front surface can be treated.
if you are happy with the colour of the other teeth, then a simple opaque veneer bonded to the enamel will be fine.
If the shape is fine then do not get it trimmed too much.
Dark Front Tooth
The single dark front tooth is the most difficult cosmetic procedure that a dentist can perform. It is tough enough to match a single porcelain crown to a natural tooth, having a dark base makes this even more difficult.
Masking a dark tooth with a single porcelain veneers is challenging because porcelain veneers are thin and do allow some light to pass through. This will result in a tooth that looks gray or "off" compared to the others. Some dentists try to block out the darkness with filling material or an opaque cement, sometimes this works and sometimes it doesn't.
A crown can mask the darkness better that a veneer. The disadvantage is that more tooth need to be removed.
A would recommend going to a dentist that has a ceramist/lab in the office or going to the lab yourself (if the dentist uses a local lab) to ensure that best possible match.
Dead front tooth
If there is no infection in your tooth and it is simply calcified, you will probably be fine without a root canal. If the tooth is cosmetically unacceptable, then a single veneer should be a possibility. Make sure you find a good cosmetic dentist who has the ability to correctly match a single tooth because this can be a difficult case.
Porcelain Crown or Veneer for a Dead Tooth
I am assuming that this tooth has discolored and that is your reason for your restorative options. I would say that after your evaluation by an endodontist it is probably not necessary for a root canal. An all porcelain crown would be a great option for this situation for two reasons. Aesthetically, your crown can be matched exactly to the other teeth around it. Also, the crown will help protect your tooth against fracturing since the canal is calcified and there is no longer any blood supply to the tooth. Good luck.
A Good Foundation for a Healthy Smile
Before you consider the restorative solution for this tooth, you need to resolve the need for root canal. If the tooth hurts to chew on, you have spontaneous pain or there are radiographic signs of pathology, you will need to treat that first. If the tooth is calcified as you say, be sure the endodontist evaluates it under a microscope. Using ultrasonics and magnification, most calcified canals can be located and treated successfully. If that technique is not successful then a discussion needs to take place regarding a surgical approach to solving this problem versus extraction and an implant. Once you have resolved the root canal issue then you and your dentist can decide what is the best restoration for this tooth. If there are no fillings or discoloration in tooth, then a simple bonded filling to close the root canal access will suffice. If the tooth is more compromised, then consider internal bleaching, a veneer or a ceramic crown. Your dentist should be able to explain the advantages of each with you. As far as matching a single tooth (in the aesthetic zone) is concerned, this is not usually a problem as long as the dentist provides key information to the lab including photo's of the adjacent teeth with and without shade tabs, the actual shade(s) and any characterization that may exist. For more difficult cases you may need to meet with the lab tech so he can customize the shade for you.
Options for A dead (dark) front tooth
First see and talk to the root canal specialist about the need for a root canal. If the danger of current or future infections or pain are present then get the root canal as it will save lots of grief. If the root canal is done, this may open up the possibility of an internal bleach which may solve any darkness issues with out further restoration other then a filling. The concern about an all porcelain veneer over a dark tooth with an untreated nerve problem is that the tooth may get darker with time which will show through the veneer or it may proceed to a full abscess causing pain and swelling. A veneer is always possible over a discolored tooth if the nerve is not a potential problem. If the tooth is too weak from the root canal if needed due to other fillings in the tooth, that may be a case where a white post and an all porcelain crown could be done. Rely on your trusted dentist and the root canal specialist to give you good advice and don't be afraid to ask questions. Good luck!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.