Crown lengthening

[TomL]

Ok, I was looking for advice on a crown that fell out. I was told I need a crown lengthening. I waited 6 or so years to have 2 crowns done last year that had fallen out after around 7 years function. The dentist who had put them in seemed to think that was a good life span for crowns.

I am thinking there are competence levels with dentists as a fellow worker who had the same dentist last year complained about the crowns he had put in fall out and he had to go back to her. She was very nice though.

I am in SW Ct, am looking for an affordable option. As I have insurance that covers post and crown but not periodontal, are there dentists who have associates in their shop that does lengthening at a discount to make money on the post and crown?

 

[MattKW]

Crown lengthening has disadvantages. I would be wondering about why crowns fell out after only 7 years. Get copies of your records and go get a second opinion. Or post Xrays etc up here for comment.

 

[TomL]

Thanks for the advice; I went back to Newfield that did the work last year and then Shel that had done the work previously; I went to the dental school up in Farmington 5 or so years ago that insisted on doing all the cavities first, then told me I would need an implant into the jaw which I can't afford. The lengthening was mentioned by a couple dentists as an option, but one in Bridgeport said that an implant would be necessary at $3500! Can't afford so won't get that done. I would go to Breiner in Trumbull who is the best I have been to but he doesn't take my insurance.

 

[honestdoc]

Like Dr. MattKW mentioned, try to obtain a digital x-ray from the dentist and post it here. As you experienced, different dentists will give you different opinions...some more motivated by profit/production. Most of my patients cannot afford crowns, surgeries, implants, etc and hopefully I can give you options as I would give my patients.

 

[TomL]

I went to three places, here is one of the xrays; they all seem to want to do full panels but this should be enough.

 

[TomL]

 

[MattKW]

Those sort of small lower incisors with root canal therapies are very prone to fracture. So I think 7 years for that sort of tooth is reasonable. Those type of screw-in posts are risky as the roots can fracture more easily. There's no good answer here

1. Crown lengthening is only going to make the situation worse because you will take away some supporting bone of teeth that already have short and thin roots.
2. Your best chance is to do cast parallel-sided posts with gold cores (all one piece). You have pre-made posts with pre-made "cores" that are for desperate situations - I wouldn't use them. Even with cast-post-and-cores I would be worried about the longevity of those teeth, and unless you have money to burn I would probably not advise it.
3. A simpler idea is to just put in pre-made posts and build up with composite for cheapest alternative. At least when they fail you won't have spent as much as proper crowns.
4. Or extract the teeth and put in a denture. A bridge is another possibility but carries its own set of risks - careful assessment would be required.
5. Implants would be the only way to get some sort of guaranteed long term stability and strength.
6. BTW, how old are you, and do you have all your back teeth?

 

[TomL]

I'm 59, in good health, health food mineral rich diet.

Back teeth are OK.

For economic reasons implants are not affordable, $3500 was quoted. I have insurance that covers posts, crowns, fillings, etc.. So an option is just re-doing the crown where it was, only better by a better dentist this time? Frankly I would go to Dr. Breiner if I could afford him, he is the best I've seen in the area.

 

[honestdoc]

The 2 teeth with crowns (not sure which x-rays are correctly displayed) have a poor prognosis. The intact crown has root disease and possible root fracture. It is most predictable to take out the 2 teeth. I dislike most bridges because you have to drill on good teeth and when it fails, you lose those good teeth as well. Bridges can almost reach implant prices. My opinion is to consider partial denture and in the future consider implants. Downside is partial denture can feel and fit awkward.

Separate discussion is on prevention. Did you have trauma to the 2 front teeth earlier in life? My main concern is possible grinding/clenching. I noticed some incisal wear. There is a possibility that grinding/clenching has the potential to damage any restoration especially implants.

 

[TomL]

Probably right about trauma and grinding.

Is a post and crown as is possible here? I would go on a soft diet if necessary.

 

[honestdoc]

Anything is possible but I'm fairly confident it will not last longer than a month or so. No licensed dentist will attempt that. The tooth with the intact crown is infected with what looks like a root fracture. If you try to put a post & crown on the retained root, there will be no ferrule and violate periodontal biologic width. Even if the post and core remain intact (for a short period without ferrule) you will have severe gum problems. Consider a partial denture (different grades/levels/materials of partials and fees) and save for implants in the future.

 

[TomL]

With these recommendations, how much would fall into post and crown which my insurance covers?

1. Your best chance is to do cast parallel-sided posts with gold cores (all one piece). You have pre-made posts with pre-made "cores" that are for desperate situations - I wouldn't use them. Even with cast-post-and-cores I would be worried about the longevity of those teeth, and unless you have money to burn I would probably not advise it.
2. A simpler idea is to just put in pre-made posts and build up with composite for cheapest alternative. At least when they fail you won't have spent as much as proper crowns.

My insurance only covers crowns, cavities, root canal, etc..

 

[MattKW]

You would have to get itemised quotes so you could then ask your insurer directly. But as I said before, trying to hang onto those teeth in the long term is not very likely. Maybe it's time to cut your losses and extract, then place metal framework denture. The KISS Principle is always best.

 

[TomL]

Thanks for all the advice. At this point I can't afford anything the insurance does not cover more or less. I paid a lot last year to do the two crowns, one has fallen out the other is a little wobbly.

 

[John Roberts]

It's amazing you can tell all that by just looking at the xrays. My teeth have been killing me for three years. Been to countless doctors and dentists. My gp says neurological. My regular dentist says he can't see anything wrong. I have told him my bite doesn't feel right and he just seems to pay no attention. Maybe I so have some type neurological problem but when all you teeth are super sensitive and hurt all the time I think something is wrong with my teeth. I was treated for trigeminal neuralgia twice and didn't do a thing. I am going to a orthodontist next week and talk to him. I don't look for any miracles but I am hoping.

 

[MattKW]

It's amazing you can tell all that by just looking at the xrays.

Well,this is a case more about mechanical failure than neurological problems which can be much more difficult to fathom.

 

[John Roberts]

I have been to three neuroligist and one pain management doctor. The pain management doctor labeled me with tn 6 years ago. One neurologist said dental, one said tn and one said he didn't have any idea. I have way more symptoms of o occlusion type problems than a netulgia. My teeth are the same all the time. I don't have attacks or anything that sets them off. Sitting on the couch this morning my bite feels like it is more to the right putting more pressure on one of my lower right front teeth. I am 73 s d just hard headed I guess just not wanting to accept this is not a dental problem especially after it started after a cleaning at the denist hospital with no trouble before. I held my moth open a long time that day. Did I get something ever so slightly out of place.