Advice 15 year old daughter front filling

[Amanda123]

Hoping someone can give me some advice. My daughter who is 15 had a fissure in her front tooth (top incisor) when her tooth came through when she was young. (I've been told it likely formed this way as opposed to a bump to the mouth) The local dentist filled it with a filling but it has always been somewhat discoloured (it wasn't done well) and it has always bothered her as it is quite large. The discolouration has got worse over the years and now that her braces are off its time to get the filling redone. It may need a veneer later on but a filling for the time being. I have the option of seeing a Paediatric dentist (who is her usual dentist) who has offered to do it or alternatively I could go to a Prosthodontist I was referred to. I'm really concerned about doing the wrong thing as its her front tooth. Any suggestions or advice?

 

[honestdoc]

Please provide an image for a better understanding of the problem. The treatment options are 1) to redo the filling. This is more conservative both for cost and for less trauma. However, the filling is a resin material and can discolor or stain 2) Veneer. The dentist will prep the facing of the tooth and take a molding (impression). A ceramic technician will fabricate a porcelain facing (veneer) to bond to the tooth. This procedure is very costly due to a lot of labor and materials. The result is very cosmetic but very fragile. I would wait on this procedure until the last resort...hopefully years from now because this restoration does not last very long. 3) Crown. I do not recommend this procedure because it is very traumatic to prep the entire tooth and the fact that your daughter is 15, the tooth is not fully erupted and not mature mineral & pulpal wise. A crown may be indicated in the far far future.

Any of these restorations along with the tooth will be fragile and care should be taken during function.

 

[MattKW]

At her age, there is still some natural gum recession to occur, and the nerve in the tooth is relatively large. So avoid crowns as honest doc says above. I'd go for a composite with a prosthodontist as the most conservative option with best results. I've seen some composite work by a prosdo that looked every bit as good as ceramics, but without the risks.

 

[Busybee]

Be careful in choosing your dentist. Even with just replacing the filling there is a risk that a lot of tooth material could be removed. Some dentists work better with composite restorations than others and some can't seem to manage to place composite without ruining the appearance of the enamel. Make sure you make it clear that unless there is evident decay you want as little enamel removed as possible. Go to the most conservative dentist you can find. Your daughter can always choose to have a veneer when she is older but that is a highly invasive option compared to what she has now and I'd advise her to stick to composite which can be replaced numerous times by a dentist who is skilled in this type of work. There is no way back from a veneer and these can fall off and lead to crowns etc. The more tooth that is removed the higher the risk of root treatment at some point.