Crown on Tooth with Jagged Angles - Both at Gum Line and Tooth Itself is Split Down Middle? (photo)

Can a tooth crown be attached vertically on #20 premolar?? That leaves the front of the tooth alone. The gum line is jagged and recessed due to excessive brushing, and can't see how a crown would ever blend at gum. Also a crown there would remove perfectly good tooth that is most visible. A crown placed around entire tooth leaves little structure, only half a tooth to start. Can a crown be attached vertically - the forward half left as is and crown cemented vertically to back?

Doctor Answers 5

A Few Things Going On

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From the xray, as I am sure you already know, it is apparent that tooth 20 needs endodontic therapy. Sometimes after a root canal it may be possible to place an only on the tooth in question.  I would recommend a crown in your particular situation.  When looking at the photos, it is apparent that you are clenching/grindning your teeth. I can see this from the worn edges of the lower front teeth as well as the abfraction lesion on tooth 19 (that is where the dark spot is at the gum line). Review of the x-ray also reveals widened periodonal ligaments, the fibers that connect the tooth to the bone.  These become enlarged when too much force is applied to the teeth. For this reason, I would recommend a crown, possibly a "bruxir" crown.

In addition, it appears that your lower jaw is narrow, and your lower teeth are inclined towards your tongue. This is a classic example of a mouth breather. this narrow arch also makes one more prone to snoring and sleep apnea. Have you been diagosed with tmj?


Hope this helps

West Palm Beach Dentist

Crown on Tooth with Jagged Angles - Both at Gum Line and Tooth Itself is Split Down Middle? (photo)

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Conserving as much natural tooth as possible is always a main strategy in repairing dental problems.

In your case the damage goes far further than what you see from the outside. I suspect that an additional 30% of the tooth is damaged under the surface.

You also have reasonable concerns about wanting any sort of new dental crown to blend well and look natural at the gum line. You'll be surprised to see how well a good cosmetic dentist can make the final result look.

The best way to get a conservative result is to clearly express your priorities to your dentist. Then have a clear exchange until you feel like you are on track with the right technique.

There is a huge cavity, so don't delay because this tooth looks like it will begin to hurt or swell up very soon.

Crown on #20 tooth

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Congrats on your dental photography.  good x-ray as well. It looks like you developed a cavity under an old filling that weakend the tooth to the point of fracture

My opinion on what I see is that by the time the tooth is cleaned up, more than half the tooth structure will be missing. Furthermore, the nerve is practically exposed to the fracture/cavity. I already see changes in the ligament which suggest either an inflammed, dead or dying nerve. This tooth will end up with a root canal therapy if you want to save it.

Your question about leaving the forward half intact: This is essentially an Onlay.  There is not enought sound tooth structure to do this. The only treatment that will last and avoid problems with pain, or further fractures, is a root canal, plus a core build-up (maybe a post), and a full crown over top.

The fracture/cavity is also deep under the gum. It is possible you may need some gum trimming with a laser to be able to get a clean margin there.

Sorry for the bad news, but you have a badly broken down tooth. Another good option may be to take it out an replace it with an implant. This may actually be stronger in the long run. 

Good luck

Dr. T

Mauricio C. Tijerino, DMD
Miami Beach Dentist

Most cases crowns are needed after root canals

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Looking at your X-ray, you need not only a crown but also a root canal. Unfortunately, your tooth/filling is broken as such that has caused a nerve damage. Therefore first a root canal needs to be done to remove the damaged nerve and seal the canal to prevent you from getting an infection. After, you need to support the tooth so upon chewing you wouldn't break the tooth any further. Since doing a root canal will hollow out the tooth further you really need a full crown to hold the tooth together and prevent further fracture. If you hadn't needed the root canal one could have restored the tooth by doing a partial crown (Onlay) in order not to touch or shave the part of the tooth that is intact. You can ask for a cosmetic crown which looks pretty natural. Hope this answers your question

Rouzita Rashtian, DDS
Los Angeles Dentist

Whats the best tx. ?

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Never make a diagnosis without an exam and history... however it appears from the radiograph that a root canal and then crown should work fine, it appears the fracture is close to the nerve and this why I suggested doing the root canal first.



Kevin Coughlin DMD, MBA, MAGD     CEO Baystate Dental PC

Kevin Coughlin, DMD
Springfield Dentist

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.