Knowing When to Call it Quits……A Case Study

A large filling fell out of a patient’s front tooth. Ideally, it should receive a crown, because it is such a large filling. However, the tooth is too compromised (weakened) to consider placing one.

Recently a patient came to my office presenting with a front tooth that had very little tooth structure left (see image).

There was a large area of decay (cavity) where the gingiva (gum) had grown into the tooth.

In addition, this tooth had a root canal.

Due to both the root canal and considerable amount of tooth structure missing, this tooth was considered to be very weak.

The question was how to proceed with treatment for this tooth ?

Under normal circumstances, the best treatment is to place a crown (cap) on a tooth with a large filling especially if it has had a root canal. However, I felt the tooth was too compromised to consider placing a crown on it.

The fact is, due to the advanced decay that was present, this tooth had a poor prognosis…The patient was quite discouraged when I told her this.

The Ideal Treatment
The ideal treatment would have been to extract the tooth and place a dental implant at the site of the extraction at the same time the tooth was being removed. However, at this time, the patient was not able to afford this treatment. So the way we dealt with the situation was to build up the tooth with filling material and try to hold onto it as long as possible.

The patient was advised that with a large filling, the tooth was quite fragile. She was told that it would be best to stay away from eating food like corn on the cob or apples with her front tooth…Basically the tooth was now ‘just for show’ and should be considered a ‘temporary fix’.

This case is a good example of ‘knowing when to call it quits. We will stop at this point with this tooth…..the patient will not put any more of their time and finances into a tooth which has a guarded prognosis.

This may be a good time to check out a previous blog, “Dental Implants……A Great Solution for a Missing Tooth,” posted on October 9th, 2011…..Until next time!

Dr. F. Keshavarz Dentistry

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