Gum surgery or an implant…how to decide? For this tooth it’s pretty easy. Look how far under the gum the tooth broke off:
Without getting into too many details, the crack is SO deep that gum surgery would not be possible. For this situation, a dental implant is the best possible solution. We’ll talk about the dental implant process later.
One last thing. Why not a bridge instead of the implant?
Let’s look at some of the reasons for cracks. They can include:
1. Repetitive chewing on your teeth, day after day, which may develop cracks. Each time you chew on your teeth they flex slightly from the chewing force. This flexing over time can cause teeth to develop fine cracks (stress fractures).
2. A history of clenching or grinding (bruxing) teeth can result in cracks.
3. Chewing on hard substances or foods such as ice, popcorn kernels or candy.
4. Trauma to the mouth such as a blow below the chin or lower jaw.
5. As we’ve seen, large fillings, whether tooth colored or especially silver, can weaken the teeth resulting in tooth fracture.
If you grind your teeth or you chew on hard/chewy substances, as stated above, you have an increased chance of developing fractured teeth.
How many of your teeth have a silver filling like this one?
How many of those same silver fillings have a crack like this underneath?
Ask your dentist about replacing these fillings. And don’t be surprised if some of these teeth end up needing a crown. A new filling in a tooth like this simply isn’t enough support as a long-term restoration.
But look closer at the back tooth. The arrows are pointing to some obvious cracks in this tooth. Remember, this was just an afterthought. The filling isn’t fractured and there doesn’t seem to be leakage or decay around the area that the filling and the tooth meet. It’s not hot, cold or bite sensitive.
Here’s another view of the before and after:
With the bonding added to the centrals it becomes obvious that the laterals are too small. After the orthodontist is finished I’ll show the veneer portion of Suzanne’s case.
Let’s take a closer look at her teeth.
Both the central and lateral incisor, the two pictured above, appear slightly small. They are quite long, but not wide enough. So this gives a thin, unflattering appearance to these teeth. Also, they are not the ideal size for her face (not pictured here). There are many causes for this, including the reasons we discussed before (gum tissue in the wrong place or improperly contoured). But to keep things moving, the answer is that these teeth are simply too narrow. They have the proper tissue height/contour. They just need to be wider to fit the space and her facial characteristics.
Let’s look at another case. Suzanne was referred to me by a gum specialist. She had braces successfully, but the space between her two front teeth continued to open. The gum specialist removed a small amount of fibrous tissue from between these teeth and asked me to look at the size of her teeth before she returned to the orthodontist. Here’s the way she looked at our first visit:
Sometimes orthodontics alone can’t solve a dental misalignment. A great example is teeth that are in the wrong position AND are broken down or worn out. In this case the orthodontist will place the teeth in the correct position and then it’s up to the restorative dentist to properly finish the case. Often these are the cases a ‘cosmetic’ dentist will try and ’sell’ what is called ‘instant orthodontics’. He/she will place veneers or crowns to alter the position and contour of the teeth. Here’s the problem…often there are more teeth prepared (or ‘ground down’) than necessary. And these teeth many times have more ground off of them to change their position. This can lead to more problems later.
I’ll admit something up front…I’m a much better dentist than graphics designer! With that in mind, take a look at my rendition of what some patients look like after having unnecessary extractions before orthodontics. Yes, as I stated earlier, the TEETH are straight. But the ultimate result is a ‘caved in’ or ‘pulled back’ look to the lower face. The next time you take a look at someone who has braces or needs them, keep this in mind.
And don’t worry….I won’t be trying a new career as a Photoshop editor!
So to continue with the last post. Yes, I know I’m a Charlotte dentist, and not orthodontist. But I still find the current state of moving teeth (orthodontics) to be as much an art as science. As I discussed before, straight teeth are not the only ultimate goal. 
The final ‘profile’ of the patient is just as important. Extracting a bunch of teeth to expedite treatment ultimately only helps one person….the orthodontist. When does someone need to have teeth pulled? It sure varies on a case-by-case basis, but one thing is absolutely true…..it happens WAY too often! Here’s a ‘normal’ profile after orthodontic treatment (with NO extractions!):
