Saving a tooth broken below the gum line

Saving a tooth broken below the gum line

Jan 05, 2021

Q: I broke my front tooth crown clear down to the gum line over the holidays. My dentist said it cannot be saved and I will need the tooth removed and replaced with an implant. If I send you aniPhone picture and the x-ray, can you tell me if you can save it? How will you save it?

A: Boy I sure learned my lesson. Never give a critique of any political figure’s teeth. Although I received only two hate emails for my piece on “Biden’s teeth”, they were both a doozy. One lady wrote: “I am going to tell all my friends in Palm Beach not to go to you!” Another asked me: “Why did you not critique the president’s orange hair?” I merely paraphrased an article written by another doctor on Biden’s teeth and discussed how we use technology to make dental work look natural. No political angle at all.

I will say, people these past four years were at each other’s throats. I never had one complaint when for 15 years on my live weekly radio show, Tooth Talk, I had a segment called: “Teeth go to Hollywood” where I critiqued a public figure’s smile and used it as a segway into various dental topics. Every four years I did an Election Day special comparing the candidate’s teeth. No nasty calls or emails. Ever. (Until 2020.)

If a tooth or crown snaps off below the gum line, we can often save the tooth if it is not chock full of soft, rotting decay:

  • Remove the nerve via root canal treatment; painless in today’s world of endodontics.
  • Drill a space in the canal that can accommodate a post. This re-bar type serrated post sticks up above the gum line and allows us to build up a stump called a core. This is what the new crown will be cemented to.
  • Use a diode laser to move the gum and/or bone away from the edge of the future crown so as to allow more of the non-broken part of the tooth to protrude from the gum line; this is called crown lengthening surgery.
  • If too much decay has destroyed the tooth, or the tooth has fractures below the level of the bone, an implant or permanent bridge might be the best plan B.

Ok, I hope I did not stir up more trouble amongst the population. Feel free to email or call me for advice.

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