Mexican dentist suggests trying to reattach crown - any chance of success with this x-ray? Also, creative removable winged crown idea?

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Jun 6, 2020
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A Mexican dentist suggests removing the broken fiber post inside tooth #20, replacing the post for my old crown, and re-cementing inside the tooth canal. He makes no promise it will last, but the price is very low.........
Before an implant, I want to try anything that might work.
Is it worth a try or is it a waste of time? Maybe the post needs to be long?
Maybe after 5 years since last crown, decay has created more space under the crown?
It's been 2 months since it broke off. x-ray is from a month ago.

I did not understand that the cement within the post held the crown in place.
I thought it was the bone structure above the gum line.
There was only a thin bone shard was above the gum line when attached 5 years ago, and that now has broken off with the crown.

The crown fell out 2 month ago.
I discovered it stayed in place without cement.
After 2 weeks the post broke. Maybe using it without cement damaged the post.

CREATIVE REMOVABLE WINGED CROWN
Alternatively, what if a no-post crown is made with wings on the backside with a snug fit on teeth #19 and #21?
Since my old crown stayed in place with no cement unless hard bread stuck to it, a crown designed with more contact points should with ease.
#20 gets more natural side support than any other tooth.
I have heard this idea would work better in acrylic than porcelain if using dental cement.

I have heard the point against this idea, that anaerobic bacteria would accumulate inside the wings and teeth 19 and 21.
No solution is perfect.
Would temp dental cement fill this space so the bacteria would not get in?
I could remove this every week or so and give a complete cleaning.
Any decay would be slow, and if idea doesn't work then at least I tried.
INVENT A FLUORIDE IMPREGNATED DENTAL CEMENT TO KILL THE BACTERIA TRAPPED IN THERE HAHA.

I have heard that the 'circular motion' of chewing would not keep it in place.
Backward is the only direction it could possibly fall. (The wings stop it falling forward.)

I have heard that it would 'irritate the gums' but I don't understand how it would anymore than the original crown since both would sit atop the gum.

Ideas with a 30% chance of success are worth trying before an implant.
Some dentists say a Maryland bridge won't work on tooth #20 and others say it will.

Thanks so much for helping with creative solutions before an implant!
 

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Dr M

Verified Dentist
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Good day

When looking at the radio-graph it seems that the above mentioned tooth is already broken down to about bone level. There is a small chance the the remaining tooth structure that is left, might already be compromised due to a previously loose crown. If this is the case, you have to clean the tooth until sound structure is met, and this can lead to the tooth structure being below bone level, which is no longer restorable with conventional methods. There would also be a serious lack of Ferrule effect, which would most likely mean the crown would not be stable and most likely either leak or come loose again in the future.
In my opinion, it would be best to rather go for an extraction of the relevant tooth with immediate implant placement in the socket. In the long term, this would be a better solution.
As for your option 2, I would not recommend this, since firstly you have to drill on adjacent vital or healthy teeth in order to create space for the clasps. This could lead to nerve damage on those teeth.
Secondly leakage might occur with bacteria leaking into the open root canal, resulting in abscess formation.
And with the temp dental cement, it might result in additional tooth structure loss as it comes loose, resulting in too little tooth structure left to restore again, as mentioned above.

In my humble opinion, I would rather opt for something that is more long term. It is not good to go for a cheap temporary option, that might lead to more problems later, and then end up compromising the area for future implant placement.
If price is an issue, and there is other teeth also missing in the lower arch, maybe consider a removable partial denture.

Kind regards
 

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honestdoc

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I agree with Dr. M. Since the retained root is contaminated with oral fluids, it is best to remove it as soon as you can. Implants are elective so you can get by without it. The back molar may tip slightly forward until it bites stable against the top teeth reducing the space slightly. Usually people won't notice that particular gap during normal interaction unless you point it out to them. You may get food stuck in-between and many times if the undercuts are not significant, your cheek and tongue can remove most debris. I would avoid a bridge if possible due to the need to drill on adjacent teeth (less drillin and less trauma the better).
 

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