Dentists... what is the cheaper and/or more durable option?

Question

I have a front tooth that is a crown. I guess there wasn't a whole lot of natural tooth structure left to glue it to, but it was doing OK until I started having to wear a TAP appliance at night to stop my snoring. The torque of the appliance keeps working my crown loose, and I keep having to get it re-cemented about every 6 months... Anyway, the crown is loose again, so I decided to stop wearing the appliance altogether, and just sleep in separate rooms :-(

So my question is this - IF (and it'a big "if") the dentist tells me that she can't recement the crown anymore...that it just won't hold... I know I have two options: A three-tooth crown-bridge combo, OR a dental implant. Which is cheaper, and which is more durable?

TAP stands for Thornton Adjustable Positioner. It's pretty good at eliminating snoring, but it's murder on crowns and bridges. http://www.johnsdental.com/articles/sleep/TAP.htm

And YES, of course I'll ask my own dentist too, but I just want second opinions...

Answer 1

The TAP appliance needs to be adjusted to eliminate the excessive pressure placed on this crown. The continued crown removal and leaking while it's becoming loose, is allowing bacteria to enter under the crown, exposing the nerve of this tooth to this bacteria. This will eventually cause this tooth to die. Then you will have two options, root canal therapy or extraction. The appliance should not be causing a crown to come off, if it's seated to a sound clean tooth structure with proper cementation techniques being used.

If you need to have it removed a dental implant would be your best option, then a three unit bridge if the implant isn't an option for you. But keep in mind that either of these will not withstand pressure from the appliance that your tooth is being subjected to right now. It's better to keep what you have and fix the appliance or return it and have another made that will fit correctly.

Crowns usually have to be cut off the tooth using a high speed hand piece; they shouldn't be able to be removed by the slight pressure an appliance exerts on them. So if this appliance is forcing the crown off, then either the appliance needs adjusting or the crown isn't cemented properly onto a sound tooth structure.

Hope I've been of some help with this and that you'll talk to your dentist about an adjustment on the appliance to save your tooth.

Additional information: If your crown is loose now, it's allowing the bacteria to seep under the crown and reach the unprotected tooth as I stated above. This can lead to decay of this tooth causing it to be non-restorable. Perhaps you should ask your dentist to use different cement, a glass ionomer preferably. Also we always try to save a natural tooth, which is what you still have under the crown. The root and tooth are still there, just missing the enamel so the crown would fit over it. So, to answer your question, this is the way I would put it to a patient. We are going to try a different cement this time, and let's take an impression of your mouth to send to the lab along with this appliance. This way they will have a replica of your teeth and mouth (this could have changed a little with all the recememts you've had done) which will aid them in making any necessary adjustment to the appliance. Now if she tells you the crown can't be re-cemented again, ask why? There are "reasons" they can't, not just because it's "come off" so many times. That's not a good reason, unless it's affected the margins of the tooth and it no longer seats correctly. Then she would be recommending a new crown for the tooth. No, and I repeat NO dentist will want to do an extraction and replace it with a 3 unit bridge or an implant, just because the crown keeps coming off. There has to be a reason that the tooth is non-restorable. If you can't get the answers you need from this dentist, I suggest you find someone with a little more experience with crown and bridge work and with your appliance. I've thought about your question and knew I had to add more that what I did yesterday for my answer. Sorry this is so long, I do get on a roll sometimes when it comes to something I know, and that’s dentistry. Good luck!

Answer 2

I'm no expert here, but my 8 yr old daughter just knocked out her two front teeth at school, not only knocked them out but broke them in half, what I was told by our Dentist is that the best option is to keep and cap the teeth, but even then they it will need a bridge or implants in the future, because caps don' last, they only get harder and harder to adhere, what he said is that implants are the best money can buy, there is no messing around with them no worries about them, they are better than your real teeth if you can't have your real teeth that is, having said that, they are extremely expensive, about 5k per tooth, and most insurances won't cover them.