Thursday July 2, 2009.

Dear Dr. Mady: A little over a year ago I fell and hit my front tooth, breaking it in a rather odd manner according to my dentist. The tooth was still attached but fractured from the front up toward the gum line in the back. My dentist bonded it for a temporary fix and said that even though the fracture was bad, it just barely missed the root and nerves. He then advised me to have a crown lengthening procedure and after that place a porcelain crown so it would look the best and be strong. Do you believe that this is the best way to repair the tooth? I am concerned that excessive grinding down of the natural tooth will weaken it. Also, the crown lengthening concerns me if they take some of the bone, then it could long term affect my entire front row of teeth. My dentist advised against a veneer since it adds no strength and assured me that the crown lengthening will expose a sufficient amount of the break to be covered by the crown enough to give all the strength needed for the future. He also advised me against having it pulled and an implant inserted since the tooth seems to be in good shape. I'm a little freaked out by all this given that I have never damaged or lost any teeth yet. Please advise me if my dentist of 13 years is correct in what he is telling me. Thank you. Hope B. in Spartanburg, S.C.

Dear Hope, Picturing it but not seeing it, I can say that he is correct. Even though an extraction/implant is a treatment option, always trying to save the natural tooth is the best option. It can be extracted and replaced down the road if needed, but usually this is the proper mode of treatment.
You have to trust your dentist if you have been with him that long, but just keep in mind that the tooth may need a root canal in the future. It is not uncommon for a nerve to die days, months or even years after trauma. If this happens you will usually notice the tooth turning darker or grayish in color, even with a crown placed.
There will not be excessive grinding performed but just enough so that a thickness of porcelain can be placed to bring the tooth back to its proper size and shape yet strengthened. Make sure to have your dentist test the vitality of the nerve in the tooth or refer you to an endodontic specialist so that if a root canal is needed now, it can be completed prior to crown fabrication. This is always best because doing the root canal after the fact can cause damage to the crown and make it more difficult to place a retentive post that may be needed after endodontic treatment (root canal therapy).The crown lengthening procedure will only affect the tooth in question and give your dentist more structure to work with. I am sure he will only prescribe this if absolutely necessary.

            Any questions for Dr. Mady can be e-mailed to and also visit his blog at (dental education network)
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5


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