Edward L. Loev, DMD

I agree with Dr. Nealis; it appears that the porcelain cracked off of a porcelain-over-metal crown. Cracking can happen when a bite is off and/ or when individuals clench and grind their teeth. I would suggest seeing your dentist so that they can check your bite and make sure that the contact between your underlying tooth and the crown are still intact. Also, make sure to keep the area clean as jagged edges caused by cracked porcelain can create food traps. Without seeing an x-ray of the tooth and its underlying condition it is hard to know about the health of the tooth. However, barring hidden decay under the margin between the tooth and crown the area can be smoothed, or if you prefer, a new crown can be placed.

The amount of tooth structure fractured would generally determine the restorative procedure most appropriate. If you fractured off just the corner of the tooth and the fracture is not too extensive a composite filling might do the trick. On the other hand if a larger piece of tooth has broken off the tooth would be best restored with a full Ceramic Crown. There is always a possibility that the nerve of the tooth may be involved in which case a crown would be the restoration of choice after monitoring the tooth with a temporary crown for a period of time

The two most likely causes of post op pain could be a dying pulp or a fractured root. If the pulp is dying a root canal procedure should alleviate the pain. If the root is fractured the tooth unfortunately would need to be extracted.

There seems to be a large discrepancy between the size and shape of your upper front teeth. My recommendation would be to have your dentist perform a wax up of your upper front to create ideal shape and form so you can preview what it would take to maximize the esthetic result. I would also suggest bleaching your teeth so as to be able to lighten and or match the adjacent teeth.

The sensitivity was most likely caused by the gel. Some individuals have teeth that are sensitive due to recession or in some cases may have superficial fracture lines which tend to be sensitive. I might suggest that you place some fluoride gel in the trays you were provided before using the bleaching gel in the trays. I would suggest you use the fluoride for 1week before using the bleaching gel again. Then try bleaching with the gel again. If teeth are still sensitive I would discontinue bleaching.