Case Report: Tooth Structure Broken Under A Crown


A long-term patient of mine had a crown come off, one of her upper central incisors. Normally I could cement this back, but all of the tooth structure was sitting inside the crown and all that was left was the root. There is no way to get this to work.

Our conversation included whether or not to do an implant with a crown or a bridge. To complicate the matter this patient had the same thing happen to one of her lateral incisors which was then restored with a fixed bridge and has been doing fine for the last 10 years. So, to replace this tooth with a bridge, the old 3 unit bridge would have to be removed, a crown of the other side of the broken tooth would have to be removed, and she would then have a 5 unit bridge. This is fine as long as she doesn’t break the tooth structure under any of these abutment teeth (teeth that have crowns that hold up the bridge). As one gets older, and this patient is in her mid seventies, there is a greater risk of tooth breakage from just using your teeth (like the rest of the body for most people).

An implant is considered the best option as long as there are no surgical complications. Surgical complications include not enough bone on the ridge, a sinus that is too low also has less bone, gum tissue that is unfavorable, for example. Also the cost of implants are significant.

After reviewing these choices with the patient she is leaning toward an implant. Strictly from a dental standpoint this is much preferred since she can leave her other dental work untouched. If she should break another tooth, she would simply go through the same procedure.

I found a picture of this patient’s smile before her crowns about 20 years ago. The teeth were pretty beat up – large fillings, substantial decay on one tooth with a lot of tooth missing. So, these teeth have been structurely compromised. Is 20 years a good success rate to keep these compromised teeth? I personally like to think that you’ll keep your teeth for a life time. When you have to lose a tooth, I am glad that we have more options to restore your mouth back to a fully functional form.