Trying to decide between a crown and a veneer for tooth restoration, images/xrays included

[dhaiman1]

Hello all, I am on the verge of completing Invisalign (3 more weeks) and want to restore my left front tooth so it matches my right front tooth. The history of the tooth: it had been previously chipped a couple of times, most recently about 7 years ago. At the time I had a slight underbite so the restored the tooth as much as they could with bonding so it would not make contact with my bottom tooth when I bit down. So it was short even with the bonding ( You can see from the X-ray how much of the tooth is actual enamel, I think?). I have seen 3 dentists (1 of whom is a prosthodontist) and asked a friend about it (who is a dentist). My regular dentist and my friend said they would do a veneer because it's more conservative, which I understand means keeping more of my natural tooth. The prosthodontist said it was definitely better to do a crown as a veneer has a much higher chance of popping off because there is not enough natural tooth to bond it to, and also said that he has been doing these for 20 years and has done a veneers on teeth like mine and said they dont last as long. The other general care dentist I saw (who seemed like a pretty new dentist) agreed with the prosthodontist). What do you guys think?

Also, I am considering getting a veneer for my bottom tooth for aesthetic purposes ofcourse. There is nothing wrong with the tooth it has just become discolored because the root has calcified (probably due to trauma) but the tooth has no pain. Is there any downside or further risk to the tooth if I were to get a veneer for that bottom tooth?

Thanks for your help!!

 

[honestdoc]

First off, your bite will determine success or failure. I'm suspecting your bite to be very damaging and traumatic. Hopefully after Invisalign, you will have an ideal anterior overbite and not edge to edge. If so, any restoration with fail and fracture. The prosth will have the most experience (crown specialist) and may be the best at restoring with traumatic and difficult bite (occlusion). Before any crowns, have a visit with the endodontist (root canal specialist) to eval the discolored tooth. You would want to have a root canal before the crown is placed.

 

[dhaiman1]

I’ve already had a visit with an endodontist about my bottom front tooth before starting Invisalign (they said no there is no need for a root canal), but my initial question was about my top front tooth that has already been chipped. So I’ll ask, what are the pros of a veneer in my case? Should I just listen to the prostidontist and not the other dentists? And yes I have an overbite now, I am no longer edge to edge.

 

[honestdoc]

Veneer as you know is less drilling, more conservative, but more fragile. Crowns and Veneers can look equally good and cost really similar. I had mentioned, you may have a more traumatic bite which can fracture veneers. IMO, I agree with the prosth. That chipped tooth will be more likely to chip again and needs a more solid restoration.

Another detail I didn't mention is that the chipped tooth will have a crown (I recommend) that may not match well with the adjacent front incisor. You may consider maybe a veneer on the adjacent tooth to match the crown because ceramic reflects light differently than natural teeth.

I'm suspecting the chipped tooth may need a root canal. If so, try not to have it after the crown because the dentist will have to drill through it.

 

[dhaiman1]

thanks very much for your reply. If I could ask a couple of follow up questions…when comparing a veneer or crown for my chipped tooth, how much more enamel has to be removed? Given you can already see by the X-ray a good amount of my natural tooth is gone. Other question, why do you suspect my top chipped tooth needs a root canal? I’ve never had any pain from the tooth and it’s not discolored…

 

[honestdoc]

Very good questions. For veneers, less removal of tooth structure are required that is why it is more conservative. With less tooth structure removed, the material is thinner...you can't put thicker material with no room for it. Thinner material will break/fracture especially if you have an aggressive bite that breaks previous teeth/fillings. Crowns require more drilling which can accommodate thicker material. It will be stronger. There is a balance where we dentist have to drill just right for strength of the material (thickness), retention, and avoiding too much trauma to the nerves in the root canal (pulp).

The tooth in question needs a vitality test to see if the nerve is healthy or damaged/necrotic. If it is necrotic (dead), it will be a source for infection. If you place the expensive crown and need to go back and do a root canal, you damage that crown.

I like zirconia (fake diamond) material with obvious strength to resist fracture. In dentistry, usually the stronger the material, the less esthetic. The more esthetic (E-max) is not as strong. The newer materials are zirconia with esthetic enhancements. However, it will be a weaker zirconia. Talk to your dentist/friend/prosth all these options. Again any material will reflect light differently than enamel so maybe the adjacent tooth can be matched with veneer.

 

[dhaiman1]

Very good questions. For veneers, less removal of tooth structure are required that is why it is more conservative. With less tooth structure removed, the material is thinner...you can't put thicker material with no room for it. Thinner material will break/fracture especially if you have an aggressive bite that breaks previous teeth/fillings. Crowns require more drilling which can accommodate thicker material. It will be stronger. There is a balance where we dentist have to drill just right for strength of the material (thickness), retention, and avoiding too much trauma to the nerves in the root canal (pulp).

The tooth in question needs a vitality test to see if the nerve is healthy or damaged/necrotic. If it is necrotic (dead), it will be a source for infection. If you place the expensive crown and need to go back and do a root canal, you damage that crown.

I like zirconia (fake diamond) material with obvious strength to resist fracture. In dentistry, usually the stronger the material, the less esthetic. The more esthetic (E-max) is not as strong. The newer materials are zirconia with esthetic enhancements. However, it will be a weaker zirconia. Talk to your dentist/friend/prosth all these options. Again any material will reflect light differently than enamel so maybe the adjacent tooth can be matched with veneer.

Thank you again for your reply. So I visited my prost and he did test a vitality test on the shorter top front tooth and it is healthy. He did mention that more drilling is required and there is a 15% chance that the drilling could cause trauma to the nerve which would require a root canal. This scares me a little, I guess this is why a veneer is more conservative? Less chance of trauma potentially to the nerve if I get a veneer as opposed to a crown? Also, I'm not sure if you can answer this based on my X-ray...given my actual tooth is 1/2-1/3 the size of its original...what is the difference in the amount of drilling for a crown vs a veneer for this particular case? It seems like there is a lot of variability in the dentist, what materials they use, how they go about doing the procedure, etc. The prost I chose seems to have a lot of experience (20+ years) with restorations so I want to trust he will do a good job. As far as shade matching...how concerned should I be about this? I guess you have already answered this and I should follow up with the him about what material he plans on using for a crown

 

[honestdoc]

Unfortunately crowns need more drilling. Veneers are just facings bonded. If the dentist drills minimal for veneers, the final product may appear bulky (less drilling, less room). Nobody is forcing you to have a crown on the chipped tooth. I predict if you have a veneer there, it will chip off within a few weeks if not sooner...less drilling equals less strength of the material. Unfortunately I see a lot of veneers, and E-max crowns fail. If the dentist say his/her veneers and E-max crowns never fail, that dentist wasn't around when it happened.

Most dentist do not want to drill unnecessarily. It is a difficult balance between getting a good result while inflicting minimal trauma. Many times the best treatment is no drilling, no treatment.