Typically, when a tooth has been root canal treated and more than 50% of the tooth structure has been removed due to a chip or cavities, it is recommended that the tooth have a crown made for it. A big reason for this is that once a tooth receives root canal treatment, the tooth becomes more brittle, because the blood supply inside the tooth has been removed, and therefore can be more susceptible to future cracks or chipping, especially since not a lot of tooth structure remains.Not having x-rays or being able to visually examine your teeth, it's hard to make a definitive statement concerning your case. But based on what you described, a crown for that tooth would likely be your best option. However, that's definitely not your only option.You don't have to do anything you don't want to do, and leaving the bonded filling there instead of having a crown placed is acceptable treatment. It just might not be ideal treatment, and you should be aware that by doing so, you may be taking a risk for that tooth chipping or cracking even more in the future.
If the chip is small, you are not feeling any pain, and no nerve is exposed, it is possible for a tooth-colored bonded composite filling to be placed to repair the chipped area. However, depending on where the chip is located, how your bite looks, and what shows up on the x-ray of that tooth, the best long-term solution could possibly be a crown. The potential problem with placing a filling in a chipped tooth that would be better served by a crown is that over time, the stresses of your bite and other forces on the tooth may cause the tooth the crack or chip even worse. A crown holds the tooth together a little better, and is more effective at preventing future cracks or chips versus a bonded composite filling. I would definitely consult a dentist and have him or her look at it, and they can give you a better idea of what your options are. A bonded composite filling may do the job, but you may be taking a risk of that tooth chipping or cracking even more down the road.Also, tThere is a reason your tooth chipped in the first place, and it could be due to a misaligned bite, grinding habits you may have, an existing large filling that weakened the remaining tooth structure, or some other reason. I would try to pin down the cause of your tooth chipping and ask your dentist for ways to address the root cause of the chip, to prevent this from happening to the same tooth or other teeth.
Some patients have a harder time getting numb with the anesthesia given. This could be due to your unique anatomy, or how quickly your body metabolizes - or processes - the anesthetic. If you have been told that the tooth requires a root canal, I would move forward with getting the root canal done, because waiting to get it done could worsen the any infection that is present and compromise the ability to keep that tooth in the long-run. I would make sure to tell the dentist who will be doing the root canal that you have had problems in the past with getting that tooth numb. Sometimes the dentist can give you more anesthetic, or a different type of anesthetic that might work better for you. If the dentist is made aware of that, he or she can take steps to ensure you feel as little pain as possible while having the root canal done.
Yes, silver amalgam fillings are still used today. I have found, however, in working at several different offices and settings, that they are being used less and less. A big reason for the change is due to the aesthetics of silver fillings - many patients prefer and even request only having tooth-colored composite fillings placed. Both materials are great to use for fillings, and choosing which filling material to use is largely based on your dentist's preference and professional judgment.
If you want a more predictable, aesthetically-pleasing result for replacing your old crown in terms of matching it with your other teeth, placing a veneer on the tooth next to it would be your best option.The problem with replacing a single crown on one of your front teeth is that it can be difficult to perfectly match that crown to your surrounding teeth, since the crown is porcelain and your teeth are natural tooth structure. It looks like you have already experienced this to a degree with your current crown - it "sticks out" a little more than your other natural teeth. If you are ok with the possibility of your new crown not matching perfectly with your surrounding teeth, and would rather not shave down the adjacent tooth because it has healthy tooth structure, then that is a good plan of action. It will just be a little more challenging to have your new crown match perfectly to your surrounding teeth, but you would be wisely preserving tooth structure on your adjacent natural tooth.The decision is yours to make - would you rather have perfectly-matching front teeth (and go with a veneer on the adjacent tooth), or would you rather preserve as much natural tooth structure as possible (and leave that tooth alone, only replacing the old crown with a new one)? Both are acceptable treatments.
