Three years ago I had a Cerec onlay fitted on my left frontmost molar
(lower jaw) because the tooth had fractured. The dentist did not
remove all of the crack (my guess as a layman is that he didn't want
to go too near the pulp chamber, which would have meant RCT). Instead,
he relied on the onlay to hold things together, and warned that I
might 'still get the occasional twinge of pain'.

The tooth now exhibits all the signs of cracked tooth syndrome once
again, which probably means the crack has spread, so now I'm probably
due for RCT - if I'm lucky. If it's spread to the root, I know I'll
lose the tooth.

The reason I'm posting is, I know that dentists sometimes treat cracks
that have spread to the root with 'crown lengthening' and that this
means removing bone.

I'm worried that if he does this, and the tooth eventually fails
anyway and I have to have an implant, this loss of bone will
compromise the implant's chances of a long life.

Could anyone here comment, please?

I would NOT perform a surgical crown lengthening procedure on a tooth such
as you describe.

--
/

Amatus

/
"ken" <> wrote in message
news:bc926e05-e2cf-48b2-8203-...

> Three years ago I had a Cerec onlay fitted on my left frontmost molar
> (lower jaw) because the tooth had fractured. The dentist did not
> remove all of the crack (my guess as a layman is that he didn't want
> to go too near the pulp chamber, which would have meant RCT). Instead,
> he relied on the onlay to hold things together, and warned that I
> might 'still get the occasional twinge of pain'.
>
> The tooth now exhibits all the signs of cracked tooth syndrome once
> again, which probably means the crack has spread, so now I'm probably
> due for RCT - if I'm lucky. If it's spread to the root, I know I'll
> lose the tooth.
>
> The reason I'm posting is, I know that dentists sometimes treat cracks
> that have spread to the root with 'crown lengthening' and that this
> means removing bone.
>
> I'm worried that if he does this, and the tooth eventually fails
> anyway and I have to have an implant, this loss of bone will
> compromise the implant's chances of a long life.
>
> Could anyone here comment, please?

Amatus Cremona wrote:

> I would NOT perform a surgical crown lengthening procedure on a tooth such
> as you describe.
>

I agree.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

Actually, with the success rate of implants where it is right now. I
basically stopped doing surgical crown lengthening. If I need more tooth
exposed to be able to restore the tooth, it usually is better off being
replaced with an implant. Why spend $1K for RCT, then $1K more to lengthen
the tooth (while reducing the bony support on the two adjacent teeth), when
could basically get an implant placed surgically for that money. Then, the
money spent for the crown ends up restoring the implant rather than a
severely compromised root stump. Abutment cost is offset by the core cost,
(mostly).

To perform surgical crown lengthening properly, you have to remove a fair
amount of bone from the adjacent teeth. For all your effort, you end up
with a tooth which has a longer crown and a shorter root. The adjacent
teeth often end up sensitive to temperature, sweets, contact, etc. Not a
good combination either. The implant is much more likely to still in
service in ten years.

--
/

Amatus

/
"Mark & Steven Bornfeld" <> wrote in message
news:7hcBj.7093$hr3.197@trnddc04...

> Amatus Cremona wrote:

>
>
> I agree.
>
> Steve
>
> --
> Mark & Steven Bornfeld DDS
> http://www.dentaltwins.com
> Brooklyn, NY
> 718-258-5001

On 10 Mar, 15:29, "Amatus Cremona" <Nic...@sottovocce.com> wrote:

> Actually, with the success rate of implants where it is right now. I
> basically stopped doing surgical crown lengthening. *If I need more tooth
> exposed to be able to restore the tooth, it usually is better off being
> replaced with an implant. *Why spend $1K for RCT, then $1K more to lengthen
> the tooth (while reducing the bony support on the two adjacent teeth), when
> could basically get an implant placed surgically for that money. *Then, the
> money spent for the crown ends up restoring the implant rather than a
> severely compromised root stump. *Abutment cost is offset by the core cost,
> (mostly).
>
> To perform surgical crown lengthening properly, you have to remove a fair
> amount of bone from the adjacent teeth. *For all your effort, you end up
> with a tooth which has a longer crown and a shorter root. *The adjacent
> teeth often end up sensitive to temperature, sweets, contact, etc. *Not a
> good combination either. *The implant is much more likely to still in
> service in ten years.
>
> Amatus
>

Thank you, Amatus, for this very succinct and informative reply. But
this raises another question, and I'd be very grateful if you and
anyone else here can offer their opinions.

I'm due to see my dentist about this tooth in a couple of weeks, but
I'm in a dilemma. Being a layman, I certainly don't know how far the
crack has spread, and I'd have thought my dentist wouldn't be able to
tell either without at least removing the onlay (the original crack
went exactly through a the rearmost cusp on the tongue side, so what
remains of the crack may not be very accessible to the eye).

I am guessing that the onlay can only be removed by destroying it.

Even then, he may not know whether the crack reaches the pulp chamber
(indicating RCT) or goes right down to the root (indicating
extraction) until he grinds the tooth down.

My dilemma is: I don't have much money, and can (just about) afford an
implant OR root canals and a crown, but not both. Also, to complicate
matters, my dentist doesn't do implants.

So, I really don't know how this visit will proceed, and what I should
say to my dentist when I see him. I'd really appreciate any advice
anyone can give here.

(BTW, one factor here is the cost of dental treatment where I live,
the UK. Amatus mentioned RCT at about $1,000 and crown lengthening at
another $1,000, and said you "could basically get an implant placed
surgically for that money". Well, here in the UK things seem to be
more expensive - about two to three thousand pounds for an implant
(that's nearly $6,000 at present exchange rates), and about £800 for
RCT on a molar, plus £600 for the crown).

In the USA, by the time you pay for records, template, abutment and crown,
plus the surgical fee, you will end up paying $3.5K; another $600 if you
need grafting.

To treat such a tooth, you spend $1K for surgical crown lengthening, $1K for
RCT, $400 for a core, and $1K+ for the crown. That is about $3.5K for a
tooth with a questionable prognosis.

I cannot speak for fees in the UK. I understand that the NHS has messed up
dentistry for many years over there. I suppose your fee estimate might be
higher if you were quoted for sedation or general anesthetic. That can add
another $400-700 to fees on this side of the Big Pond.

Frankly,,,,,,,,, a tooth with a significant fracture which was visible
without high magnification, that subsequently develops symptoms such as you
describe, is very likely to be cracked right through the roots. If you
choose, you could ask your dentist to remove the entire onlay, and chase the
crack to its terminus. However, be prepared to have the tooth removed after
he chases the fracture below the level of bone. I *suspect* you would be
better off doing the work-up for an implant, and having the surgeon, who
will be placing the implant fixture, extract the tooth and examine the bony
socket while the tooth is out. He can determine if grafting will be
necessary, determine if an implant can be placed that day, or what the
preferred treatment plan would be.

Your dentist may not perform the surgical portion of the implant placement,
but should be well qualified to fabricate an abutment and crown over the
healed implant. If not,,,,,,,,,,,,, well,,,,,,,,,,,,,,,,,
ummmmmm,,,,,,,,,,,,,,, you might think of,,,,,,,,,,,,,,,,,,,
well,,,,,,,,,,,,,,, ummmmmmm,,,,,,,,,,,,,,,,,,,,,,,,,,,,, you know what
I am trying to say.

--
/

Amatus

/
"ken" <> wrote in message
news:b197d04b-976d-4e3d-8ffd-...
On 10 Mar, 15:29, "Amatus Cremona" <Nic...@sottovocce.com> wrote:

> Actually, with the success rate of implants where it is right now. I
> basically stopped doing surgical crown lengthening. If I need more tooth
> exposed to be able to restore the tooth, it usually is better off being
> replaced with an implant. Why spend $1K for RCT, then $1K more to lengthen
> the tooth (while reducing the bony support on the two adjacent teeth),
> when
> could basically get an implant placed surgically for that money. Then, the
> money spent for the crown ends up restoring the implant rather than a
> severely compromised root stump. Abutment cost is offset by the core cost,
> (mostly).
>
> To perform surgical crown lengthening properly, you have to remove a fair
> amount of bone from the adjacent teeth. For all your effort, you end up
> with a tooth which has a longer crown and a shorter root. The adjacent
> teeth often end up sensitive to temperature, sweets, contact, etc. Not a
> good combination either. The implant is much more likely to still in
> service in ten years.
>
> Amatus
>

Thank you, Amatus, for this very succinct and informative reply. But
this raises another question, and I'd be very grateful if you and
anyone else here can offer their opinions.

I'm due to see my dentist about this tooth in a couple of weeks, but
I'm in a dilemma. Being a layman, I certainly don't know how far the
crack has spread, and I'd have thought my dentist wouldn't be able to
tell either without at least removing the onlay (the original crack
went exactly through a the rearmost cusp on the tongue side, so what
remains of the crack may not be very accessible to the eye).

I am guessing that the onlay can only be removed by destroying it.

Even then, he may not know whether the crack reaches the pulp chamber
(indicating RCT) or goes right down to the root (indicating
extraction) until he grinds the tooth down.

My dilemma is: I don't have much money, and can (just about) afford an
implant OR root canals and a crown, but not both. Also, to complicate
matters, my dentist doesn't do implants.

So, I really don't know how this visit will proceed, and what I should
say to my dentist when I see him. I'd really appreciate any advice
anyone can give here.

(BTW, one factor here is the cost of dental treatment where I live,
the UK. Amatus mentioned RCT at about $1,000 and crown lengthening at
another $1,000, and said you "could basically get an implant placed
surgically for that money". Well, here in the UK things seem to be
more expensive - about two to three thousand pounds for an implant
(that's nearly $6,000 at present exchange rates), and about £800 for
RCT on a molar, plus £600 for the crown).

ken wrote:

> On 10 Mar, 15:29, "Amatus Cremona" <Nic...@sottovocce.com> wrote:

>
> Thank you, Amatus, for this very succinct and informative reply. But
> this raises another question, and I'd be very grateful if you and
> anyone else here can offer their opinions.
>
> I'm due to see my dentist about this tooth in a couple of weeks, but
> I'm in a dilemma. Being a layman, I certainly don't know how far the
> crack has spread, and I'd have thought my dentist wouldn't be able to
> tell either without at least removing the onlay (the original crack
> went exactly through a the rearmost cusp on the tongue side, so what
> remains of the crack may not be very accessible to the eye).
>
> I am guessing that the onlay can only be removed by destroying it.
>
> Even then, he may not know whether the crack reaches the pulp chamber
> (indicating RCT) or goes right down to the root (indicating
> extraction) until he grinds the tooth down.
>
> My dilemma is: I don't have much money, and can (just about) afford an
> implant OR root canals and a crown, but not both. Also, to complicate
> matters, my dentist doesn't do implants.
>
> So, I really don't know how this visit will proceed, and what I should
> say to my dentist when I see him. I'd really appreciate any advice
> anyone can give here.
>
> (BTW, one factor here is the cost of dental treatment where I live,
> the UK. Amatus mentioned RCT at about $1,000 and crown lengthening at
> another $1,000, and said you "could basically get an implant placed
> surgically for that money". Well, here in the UK things seem to be
> more expensive - about two to three thousand pounds for an implant
> (that's nearly $6,000 at present exchange rates), and about £800 for
> RCT on a molar, plus £600 for the crown).
>

You sound very informed, but just to be sure, make sure you know what
that 3 thousand pounds is buying you. Hard to believe there would be
such a differential in fees. It may include the fixture, the abutment
and the crown, in which case it's probably not an unusual fee for (say)
a good dentist in Manhattan. For just the implant fixture I don't know
how that can be justified by the market. I'd think that with the
national health, those competing for the (relatively few) private
patients would drive fees down, not up. But what do I know.
In any case, we don't know where the crack goes, and as it's quite
possible the tooth is impossible to save, we don't know what the real
options are at this point. Yes, the dentist will almost certainly have
to remove the onlay to find out what's going on. Once you know what is
possible, the options open to you will be clearer.

Good luck,
Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001