October 2020 | Dr. Currie's Dentistry Blog

I had a crown done over 30 years ago done on my right lateral incisor. When I went in for my regular cleaning and exam, my dentist informed me that I needed a root canal. He said there was a lot of tooth decay located underneath the crown.

Don’t get me wrong, I believe him. I mean, it’s been decades. But, I haven’t had any issues with pain or any other sign of a tooth infection. So, I moved forward with the recommended treatment. The dentist started the procedure and had to give up after two hours. He said that the root canal had calcified and he couldn’t find it. So, he put a temporary filling in the crown and referred me to another dentist who specializes in root canals.

When I called the endodontist, he didn’t sound too concerned when I explained what was happening since I haven’t had any pain associated with it. So, my appointment was scheduled for several weeks away. Well, I still need to wait another two weeks for my appointment and my porcelain crown broke off. There was some of my tooth that came out with it too. I don’t know what I’m supposed to do at this point. I am an elderly person and I don’t have a big budget for dental care. I honestly think it should have been left alone because it wasn’t bothering me. Now, I’m wondering if I should move forward with a dental implant to replace the broken tooth?

I’m just not feeling really good about the endodontist doing a root canal that should have never been messed with. I have to wonder if there is even enough of my natural tooth left to put a new crown back on. I went to Walgreens and picked up some over-the-counter dental adhesive so I can reattach the crown until I’m able to get back in.

It sure seems like you are a reputable dentist in your area. What would you recommend for me at this point?

-Sylvia

Sylvia,

Well, it is difficult to provide specific recommendations without having seen your case in person. But, I can provide some general feedback based on what you have explained so far.

First off, was it the dentist’s fault that the tooth is broken? It is not common to have a dentist drilling for two hours and not having success locating the canal. You have to wonder if that compromised the health tooth structure underneath the crown. The dentist should provide you more options at this point and should have offered more information to the endodontist, instead of referring you and leaving it at that. Hopefully, he has learned from this experience. However, that doesn’t help you out at this point. If it was his fault, it seems he should help you with some of the cost to get it fixed. On the other hand, it sounds like he may be in over his head and it wouldn’t be wise to continue working with him at this point.

Since you mentioned that there is decay located underneath the crown, it would be wise to have the crown removed since you need to have it replaced anyway. Then, the decay can be removed and it should be a lot easier to locate the root canal. If there is any infection that took place under the crown (even if you don’t feel it) then the decay may have gone into the canal. With the old crown removed, there will be a higher chance of success for the endodontist if you go that route.

Another important issue that you have brought up is the fact that some of your natural tooth has come off with the crown. The remaining tooth structure may not be sufficient to re-cement a new crown. The best way to replace a missing tooth is with a dental implant. It will look, feel and function just like a natural tooth. However, it is more expensive than alternative treatments like a dental bridge. If you would like to learn more about if you are a dental implant candidate, be sure to find an excellent implant dentist in your area. Not just any family dentist will have success in placing dental implants. The surgical posts need to be placed in the proper positions in order to hold up to rotational forces. It requires extensive training beyond dental school to get it right. Find a dentist with strong credentials, ask to see cases similar to yours and see if there are reviews or testimonials so that you can hear from others who have had similar treatment plans.

The biggest takeaway here for you is that it sounds like it may be time to seek a second opinion on your case. Your current dentist doesn’t sound equipped to successfully treat your tooth.

This post is sponsored by York PA dentist Donald H. Currie, DMD

I went to see a dentist that told me he was a cosmetic dentist. He was supposed to help me fix two small ‘black triangles’ that were on the teeth located right next to my front teeth. I noticed them after I went through my Invisalign treatment. The work ended up looking terrible. I complained and went back in to have him fix it, and it doesn’t look any better.

It doesn’t sound like he is much of a cosmetic dentist after all. The work looks ridiculous. Basically, I have some whitish material smashed between my teeth. It didn’t solve the problem with black triangles.

I left so upset and he said I just need to give it some time to get used to it. And if I’m still not happy at that time, he is willing to refund me. I guess that’s a good thing. But, now what? I can’t even get dental floss between my teeth because of the botched dental bonding job.

He said he was willing to have me come back in one more time for him to fix it. But at this point, I don’t even want him to try anymore. I am so unimpressed and feel foolish. Do I have any other options? It’s obvious this guy isn’t a true cosmetic dentist. I would be happier if I had my old black triangles back instead of this mess.

-Jess in Idaho

Jess,

Here is an example of black triangles.

Black triangles are not easy to treat. They are usually caused be receding gums.

As you have discovered, not any dentist can do beautiful cosmetic dentistry, even if they say they can. It requires extensive training and experience beyond dental school. In fact, less than two percent of dentists fall into the category of an excellent cosmetic dentist. I’m sorry you have having to learn the hard way on this.

It sounds like your black triangles became visible after you got Invisalign braces. I can make some assumptions about what your options are. However, it is difficult to give you specific recommendations without having seen you in person or having seen photographs of your case.

The bonding doesn’t sound like it was done correctly. So at this point, you could simply have the composite dental bonding removed and return to how your teeth looked before. Or you could have the dental bonding redone to fill the space. But, you are correct in that you should not have the same dentist do the work. It’s time to find an experienced, excellent cosmetic dentist in your area.

As I mentioned before, filling black triangles can be tricky.

The shape can negatively affect your oral health. Adding in more bonding material may complicate things because it can create a food trap for particles to become lodged which causes plaque to build up. Then, calculus can build up too which will likely put you at risk for gum disease.

So if you go this route with the composite material being redone, it needs to be done by a cosmetic dentist that is experienced in treating black triangles. It needs to be expertly placed, polished and then tested to ensure that floss will be able to move comfortably between the teeth. If floss can be inserted and it reaches the gum tissue, and then it pulls out smoothly, then that means the shape is sufficient.

Another thing that you need to be on the lookout for is that this area is difficult to apply dental bonding too anyway. The gum tissue naturally has fluid in it. So when the bonding is placed that close to the gums, it can be compromised by the fluid in the gums. There are techniques where the gums can be retracted to minimize this issue so the composite material doesn’t stick to the gums. The process is quite tricky and again, needs to be done by an expert cosmetic dentist that is highly skilled in using this technique.

Another thing you of course will care about is how the final product looks. A reputable cosmetic dentist is like an artist. They will truly understand the color and opacity and how to manipulate it to look natural, in such a difficult area. And they want you to absolutely love your new smile. They won’t settle for anything less than that.

It sounds like your dentist is admitting he is in over his head by offering you a refund on the work. It may be wise to have him remove the bonding material, ask for the refund, and then move on. There are tools that can be used to remove and polish off the bonding so you can floss normally until you are able to get this fixed.

When you start your search for the best cosmetic dentist for black triangles, be sure to do some careful research this time around. Spend some time researching the dentist’s credentials, ask what kind of training and experience they have, review photographs of cases that are similar to yours and learn more about testimonials from other patients.

Hopefully, this will put you on the right track to fixing your smile. Thank you for sharing your story. Not everyone realizes that cosmetic dentistry is not a designated specialty area within dentistry. They trust and assume a dentist is capable of performing the treatment they say they can. Sadly, that’s not always the case and we hear about cosmetic dentistry horror stories all too often.

This post is sponsored by York PA dentist Donald H. Currie, DMD.

My tooth broke off, now what?

How do I fix black triangles?

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