[story time] I broke a front tooth – and the consequences 20 years later (devitalization, crown…)

Today, I will share with you my story, from the time I chipped my front tooth until now (20 years later).

I was very hesitant to write this article, in addition to illustrating it with my own photos. Honestly, it doesn’t please anyone to show pictures of their teeth, especially if you have a complex about it.

But it’s an article that I so, so would have liked to find 20 years ago – so if I could help someone avoid the same mistakes I made, this article is made just for that.

Sorry for the quality of the photos, I put them in very small and some in black and white to be less shocking.

Note: I’m not a dentist, so read this article, get informed and use your judgment

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When you break a tooth, and you google “broken front tooth, what to do?” you come across articles more or less well written, which rather emphasize the “aesthetic” side: how to get rid of the broken tooth, and not of the consequences that this broken tooth will have for the rest of your life.

A broken tooth is a weakened tooth, it may die, become even more fragile, may break at some point. When it is too fragile, apart from extraction, it can still be saved aesthetically with a crown, or an implant, and we must keep in mind that we will have to take care of it for life (change crowns every 20 years if you are lucky…). And any (badly made) modification related to this tooth can have consequences on other teeth, even the jaw.

I’m going to tell you about the problems I’ve encountered when dealing only with aesthetics.

My bike accident

I had a bicycle accident a long time ago. As I broke my elbow badly, with injuries all over my face, my broken tooth was really last to be treated.

I broke a front tooth (central incisor, no. 11) in 1999, 20 years ago. I had 2/3 of the tooth left.

Composite

The shock was violent, but as I was not in pain after 2 days, and the X-ray showed nothing, my dentist simply suggested that I place a composite of the same color as my tooth, but a little too thick for me

Disadvantages of this method :

• it is very fragile and fell once, during a dinner party. It was a nightmare!
• the color doesn’t change, so if you drink too much coffee and your natural tooth turns yellow, the composite doesn’t change color and it will show too much

Then I went to see another dentist (when my composite fell off) and realized that I needed a conscientious dentist actually. The composite has to be forgotten.

So if the dentist says that it has to be thicker than the natural tooth for it to hold, it’s wrong! If he does his work correctly, we can have a very nice result, he has to spend his time filing, polishing is all.

Here is a picture of me 9 years after the accident, with composite on my teeth, we couldn’t see the demarcation between the natural part & the composite

Facet

I’ve never been told about it, but you may be offered the veneer: this solution will be more aesthetic and more robust than a simple piece of composite. Do you see the teeth of Hollywood stars? They all have veneers to have perfectly aligned, perfectly white teeth.

The idea is to file the tooth and create a custom veneer that will be bonded to the filed tooth.

Disadvantages of this method :

• the veneer must be extremely well made and well adjusted to the tooth, otherwise it will create holes, allowing bacteria to attack the natural tooth (already weakened because filed)
• Even with ultra-fine veneers, you will still have to file the tooth (especially on the sides), otherwise the extra thickness on the teeth will get in the way and the result will not be very natural.
• You will wear veneers for life. Veneers have a limited lifespan, so you should change them from time to time. During confinement, some people have found themselves with fallen veneers and have had to put up with their heavily filed teeth until they can see the dentist again. The nightmare!
• On ultra-thin teeth (this isn’t the case for the two central laterals), the teeth will be as small as a mouse tooth, so if your dentist proposes to correct your smile by working on the small teeth next to them as well, think again!

For the veneer, the ideal would be if it is done in a 3D printer OR in the lab with a craftsman/prosthetist who does everything by hand.

A perfect fit must be required, and above all a perfect color and a natural result. This is an excellent solution if you have not lost too many teeth.

Devitalization or not?

At no time was the issue of devitalization raised, and I think my dentist should have told me to have X-rays taken regularly for this tooth.

At the slightest sign, it would have been necessary to devitalize right away, because :

• a tooth that has been devitalized in time – when it is still “alive”, it will keep its white color for a longer time
• a devitalized tooth when it is already completely “dead”, will become gray or yellow faster

It was only 2 years after the accident that I started to have a little bit of pain in the gum root of my broken tooth, but it was already too late. The dentist simply told me: I knew it was going to happen, the nerve is dead, we have to devitalize the tooth.

So I devitalized the tooth. I didn’t think devitalization was such an important process. But with all the compliments that other dentists have paid for the great work that my dentist had done, I figured it must have been a difficult – and important – task. Because it allows you to retain as much of the root of the tooth as possible (the root of the tooth that you need for a crown – instead of having to deal with an implant, or a bridge, which is more expensive and less attractive).

In any case, I spent 10 hours at this dentist for the devitalization, he is a friend of my parents, so he surely spent more time for me than for the others. I had an infection so it took more work: The idea is to remove the neurotic nerve but also to scratch the inside. The dentist will put some products inside, who will continue to clean it until the next appointment, then he will continue to remove the dirt, put the product back in and so on. I’ve never had a root canal on a tooth without infection so I don’t know the process.

Then he didn’t tell me at all about the grey color that will appear on my devitalized tooth. 6 or 7 years after the devitalization, I thus found myself with a bicolor tooth: natural part increasingly gray (after a few years), with a piece of white composite, surrounded by white teeth. The worst part is that I didn’t realize it right away, looking at myself every day in the mirror – and my relatives were too polite to notice me. Of the 3 dentists I saw during this period, only one told me about the “gray tooth”

Grey devitalized tooth, which solution?

Again, easy solution, I was immediately told about the crown, but now I know there are other alternatives.

Bleaching on a dead – devitalized tooth is quite possible. Certainly, with specific products and at least 2 appointments at the dentist, but it is possible. If your dentist has never heard of it, it is because you have to go see another dentist. If I had known, I would never have agreed to place a crown.

Crown or no crown?

be careful, the photos that will arrive may be shocking

Of course, dentists will not advise you to keep a broken and devitalized tooth, they will talk to you about a crown. Because there is a risk of breaking the tooth.

Except that, when you break your front tooth, whether the tooth is already devitalized or not, whether you have a veneer, a composite, a crown, an implant… you simply AVOID, for life, biting apples, eating sandwiches, breaking a wire with your teeth, exerting force on that front tooth. You have to be careful anyway, so there will be little risk unless you are boxing…

And what I didn’t know is that even when you have a crown on your front tooth (ceramic with gold or fiberglass post), the natural tooth is broken… by the dentist. It is cut off up to the gum, to make room for the crown… A crown has a lifespan between 8 and 20 years approximately, it must be changed regularly, it is expensive, and it is irreversible. You should always have enough money in your bank account to be able to change them. In addition, during the confinement (Covid), some people have seen their crowns fall out, without being able to go to the dentist.

So being able to keep your tooth until the end is, for me, the most desirable solution.

Note: this applies for the central incisors, for the lateral incisors it is a different story. A lateral incisor, as it is very small, cannot be left devitalized without a crown because if it breaks, it is an implant that must be put in, not a crown. This is why you must use your own judgment and not follow all my advice to the letter.

The crown

So at the time, I trusted and said yes for a crown (youthful error). Before placing the crown, the teeth must first be whitened. I opted for aligners to wear at home because my dentist reassured me that it was the gentlest solution for my sensitive teeth (and he was absolutely right). The whitening took me 2 weeks anyway.

For the crown, I was shown a diagram that looked like this: you file the tooth and then put the crown on top. OK. I felt like I was still retaining a large part of my tooth.

But the problem is that it applies to large teeth only, but for the front tooth with pivot it’s another story.

I’ll show you the x-ray of my tooth, watch your eyes.

So it doesn’t look anything like the first pattern. My natural tooth is filed (cut) down to the gum line. I have a metal pin in the middle (made of gold) and the “hat” (a ceramic crown) is placed on top.

It was when I realized what had happened to me that my tooth was already well cut. I regretted a lot..

Note: the pivot was not supposed to be this big normally, it was badly done.

The zirconia crown does not need a pivot because the material is very hard at the base. It preserves as much of the natural tooth as possible. It guarantees a thinner thickness than a crown with a metal post. It is unfortunate that my dentist did not tell me about the different techniques and materials available (pros and cons) and goes straight to do the technique he masters the most. It seems to me that in the example below, the dentist does not use a pivot for the left tooth, but has kept as much natural tooth as possible but hey, the natural tooth still becomes a mouse tooth.

So after the tooth filing, an impression was taken (with a kind of paste)

In addition, while waiting for the final crown, the dentist put a temporary crown on me. I didn’t have a post at that time because it was my very first crown, and so it was glued to the edge of my natural tooth, and so badly glued that it fell out 3 times in 3 weeks. I saw myself without a tooth in the mirror, crying

It was in the middle of August, with the dentist on vacation, I called in tears all the dentists still in Paris for an urgent appointment, I didn’t dare to go to work. Nightmare! But I was too stupid to tell myself: there is a problem with this dentist, I continued to trust him and I was even delighted when I received my final crown.

Note: The installation of the temporary tooth isn’t without risk. I have damaged the next tooth (100% healthy) by mistake during this process because the temporary tooth requires a lot of filing. A bad dentist will see me immediately at this stage.

The final crown is fixed with a super super strong glue and the “void” is filled with antiseptic, antibacterial, anti je ne sais quoi products. Frankly, this cement is really strong, because 8 years later, another dentist couldn’t remove my crown by pulling on it, and had to destroy the crown in order to remove it.

It was my first experience with a crown so to go from a bicolor tooth to a tooth as beautiful as a natural tooth, for me, at that time it was a great success. We exchanged very little about what I wanted. I was just asked: do you have a natural space between your teeth, do you want to keep it, or do you want a larger crown to fill that space. Basically, I could be Vanessa Paradise (or not), depending on what I wanted, but that’s it. I chose not to be like Vanessa.

Luckily, the dental technician who made my crown by hand did a great job and was able to give it a texture and color almost identical to my natural tooth. With a light, it was really believed that my tooth had dentin etc.. In addition, the crown was somehow made to go under the gum. So, at one point, when my gum shrunk, I didn’t have any esthetic problems in that area.

A crown much too thick & too long

The work was almost perfect, EXCEPT for the thickness behind this tooth. I don’t know if it’s the prosthetist’s job, or the dentist’s job, to file the tooth down to the best possible thickness. Or it’s the type of crown that was chosen wrong, but I ended up with a much thicker tooth than my natural tooth because the post was huge.

I read somewhere that the brain is able to detect 0.09 mm of excess thickness. It was bothering the occlusion, the bottom tooth was touching my crown a bit too much. I talked to several dentists about it and they filed a little bit before telling me, all of them “but I can’t file any more, it will damage the crown” and so on.

… leading to bruxism

The discomfort for the occlusion & too much length triggered in me: bruxism . In the evening, I started to grind my teeth to avoid touching my crown (for fear of breaking it). And with bruxism comes a lot of problems: a lot of people lose teeth because of bruxism. And the X-ray shows, many years later (yes, because I didn’t know right away that I had bruxism), very damaged back teeth. The tray that was made for me had a metal part that damaged the enamel of my two lower teeth. The tooth next to the crown, because I was afraid to push it too hard, had a large cavity and was accidentally damaged by the dentists when the temporary tooth was put in place. In short, because of an awkward crown, I created serious problems on 3 other teeth + the molars.

I’ve discussed bruxism in more detail here if you’re interested. Once again, dentists looked at me dubiously: a crown that causes bruxism??? loool but I know one who seems to agree with me (read comments on this blog)

Crown made in Canada

Recently, while doing a check-up x-ray in 2019, I also learned that the fit (between the crown & the final tooth) was a problem. I sincerely think that my dentist did a good job anyway (except for the thickness) because the crown held for 8 years, I surely also had bone loss, which created an opening between the root and the crown. Note: anyway, a crown only lasts between 8 and 20 years.

It’s really lucky that I discovered this quickly, because with this opening for bacteria, because I was risking the loss of my tooth, and in this case it would have been an implant to put in, and not a crown => even more expensive and unstable.

So, in 2019, I had a crown done at a Canadian dentist (I was in Canada for 2 months) equipped with a 3D machine. I am delighted with the result even if aesthetically, it isn’t perfect (the crown was made by the 3D machine and not by hand by a “prosthetic artist”) but I just wanted a healthy tooth.

I paid $1800 for this tooth, if I had to redo it, I would have asked that the crown be made by a hihihi prosthetic artist

Crown in Italy

One year later, September 2020, I had a routine check-up in Rome, Italy for my gums, and the X-rays showed a small infection at the root of the crown (whereas my French dentist told me in June 2020 “everything is fine”, even if there was a weird white halo on the gum). The crown has to be removed anyway to get access to this infection and heal it, and redo the crown. My dentist wanted to go on a fiberglass post, even smaller than the gold post, but after several attempts, he couldn’t remove the post put in 9 years ago (the Canadian dentist couldn’t succeed either). I think this post will stay with me until I die. The dentist tells me that if he tries to force it, he might break my entire tooth and have to put an implant in its place. So the infection, if it gets worse, will have to be treated in surgery mode at the gum level, under the nose (case to follow). So, we stay with my old gold post.

This time I am entitled to a luxurious treatment: a prosthetist-artist on site. That is to say, he didn’t settle for the mold that was prepared for him, but came by to see the color, drew the shape of my tooth on hisn’tebook, took the photos himself to measure the color and even when the crown is ready to be cemented, the prosthetist looks with the dentist if there are things to improve. I came across the cream of the crop of Italian dentistry. My dentist has 50 years of experience, is a specialist in implants and has written 5 books on implants so if he screws up my crown, I don’t know who can make it work lol. Even his temporary crown (to be supported for 2 weeks during the fabrication of the permanent crown) is too pretty and too thin.

This time, he reduced the pivot to the maximum, both in thickness and length, because he saw how well it fit. Reducing the pivot considerably allows half the tooth to have the same thickness as a natural tooth (before, it was 1/3 of the tooth). Then, at the gum level, this part is a bit thicker, but it doesn’t bother the occlusion at all, I can’t feel it anymore. A big part of the adjustments (thickness, width) was done before the crown was cemented: I had to chew a blue paper while the crown isn’t yet fixed, it allows the dentist to file a maximum out of my mouth, so I don’t have any pressure on a freshly placed crown. As for the color, he told me that the colors will be more realistic in 2-3 days. My mouth being open too long, the natural teeth are dehydrated and look whiter so I will upload the picture to you in 2-3 days.

And out of the 3 crowns I have had, this is the only one where, when put in my mouth, without anesthesia, it does not bother and does not hurt the gums. I think it’s a guarantee of quality because it fits so well. After the crown is placed, the excess cement is removed, it hurts a little, but it allows to clean the area under the gum and not create a bacteria source. Of course, he redoes the adjustments (length) and occlusion but it is minimal because a big part was done before.

How you can see, we continue to maintain the space between the teeth. My dentist offered to cover the other tooth with composite (this tooth was truncated by the incompetence of other dentists) to completely fill the space but I refused. But it’s safe if perfection is what you’re aiming for.

More about my experience in Italy here, I paid about 3800€ for a crown, and it took me 2 weeks (the time the prosthetist works). If you have devitalization and whitening to do in addition, add another 2500€ (and add 2 weeks to the time it takes for your teeth to whiten and recover from the devitalization).

Checklist for the perfect crown

For me, here are the clues to help you know if your dentist is the right one for you and if it was a quality crown:

1. dentist specialized in implants
2. dentist trained outside of France
3. dentist who first tries to save a large part of the tooth
4. dentist’s office with a prosthetist on site, who makes crowns by hand (this is very rare, but it is so important because a dentist isn’t a prosthetist. It’s important that he or she be on site to adjust a few details if the crown doesn’t fit well with the rest, at least he or she can make adjustments and not send the crown back to the lab, or worse, have the dentist try to adjust the blow) OR at the very least, the crown is hand-made
5. there isan exchange on your expectations: the thickness, the color, the teeth next door, the material used for the pivot but also for the crown: the metal pivot, according to my dentist, isn’t the best because it is too big and too conspicuous. Unfortunately I have to live with it because it stuck to my root
6. x-rays to see everything. We take care of your gums before we put a crown on you
7. you are shown a realistic diagram (perhaps with a pivot) and not a diagram on a back tooth, then you cut the whole tooth like a butcher
8. the temporary tooth does not fall out
9. when the dentist removes the temporary tooth, the post does not go with it
10. we offer you a bleaching before a crown placement
11. the dentist uses a cement that isn’t too strong for the post, so that it can be removed later if there is an infection
12. the dentist who uses a strong cement for the crown to hold it in place
13. when the final crown is placed in the mouth, there is no pain in the gums
14. the dentist lets the patient validate the crown (with a mirror) before cementing the crown instead of working alone in his corner
15. the dentist removes excess cement after fixing the crown
16. the dentist takes an x-ray after cementing the crown and tells you to redo it often

No dentist is like that, it’s just my wishlist, so I put in bold the important criteria.
The rest is also up to you to ask questions (you can show him this article to ask him if I’m right) or make the request (“can I have an x-ray of the crown”?)

Next steps

From now on, for

• to better clean my crown (especially the part under the gum, which is very difficult to access), I use a water repellent
• having learned from my mistakes, to limit bone loss, I also drink Quinton water
• to avoid cavities and to keep my teeth for the rest of my life, I make a mouthwash with salt water (you have to keep the salt water in your mouth for 20 minutes every night, I know I know)
• to keep my teeth white and make sure that the crown matches the color of the other teeth, I use Marvis Whitening toothpaste, which is non-abrasive, but whitens the teeth daily
• i don’t bite anything anymore, I don’t use my front teeth anymore, I cut everything in small pieces
• i take x-rays every year

You see, it takes a lot of maintenance. A crown, a broken tooth, you maintain it for life. So you have to think about the thickness of your wallet before you decide on a solution, because it has consequences for the rest of your life. At all times, you must be able to afford to pay for the replacement of a new crown, or an implant.

Anyway, I break a front tooth, what can I do?

So, in summary, to really avoid all the mistakes I have made these 20 years, I recommend, as soon as you break a piece of front tooth (I am not talking about the other more hidden teeth, because the difficulty isn’t the same)

• Radiography, non-negotiable
• If you are offered :
  • a composite: demand that everything be smooth, that the color be perfect, that it does not interfere with the occlusion. Insist on perfection, otherwise change dentist
  • a veneer: prefer those equipped with CEREC type machines to measure and make a perfect dental impression. But I admit that I don’t really like veneers.
• Ask the question of devitalization very early on
• Ask for regular x-rays of this broken tooth, ask your dentist to send them to you by email (or take pictures of the screens), it is important to keep track and follow the evolution. In a lifetime, you can change dentist often, it is important to keep the X-rays
• If the tooth needs to be devitalized, choose a highly reputable dental surgeon, this is very important. Wouldn’t a maxillofacial surgeon or dental implant specialist be more suitable? (ask for more information)
• Ask about the liquid that will be used to fill the root of the tooth (after devitalization). I think my dentist, perhaps for lack of means, used a product containing a gray metal, which then gave my tooth a gray color years later (this is my interpretation, I couldn’t ask him the question).
• If the devitalized tooth turns gray or yellow, you should know that it can always be whitened with specific products (internal bleaching), and this is the easiest and least traumatic trick of all the treatments offered to devitalized teeth.
• If you have to choose a crown, ask your dentist:
  • are you sure, are there other alternatives?
  • teeth whitening before any crowning (at the dentist or at home depending on the sensitivity of your teeth. The option at home will be gentler, less expensive but longer)
  • do you intend to go down under the gum: the result will be more natural but at the same time you will lose more natural tooth
  • what type of equipment will you use? Ceramic with pivot, or zirconia without pivot? Which material best imitates the thickness, color and transparency of a natural tooth? Thickness is the most important criterion in the world.
  • if he has a CEREC-type machine, the measurements will be better than a manual impression. But the crown will always be more natural if it is made by an “artist” prosthetist who makes it by hand
  • exchange on the thickness, width, shape, color of your tooth.
  • if a temporary crown is needed, ask how long it will take (10 days would be ideal), and avoid making a crown in the middle of July/August
  • if you have problems with bone or gum loss (red gums or bleeding when you brush your teeth), treat the gums first because if the gums shrink, the root of the crown will show a lot and you will have to redo everything. The good news is that periodontists are often specialists in implants, so by consulting a periodontist, normally he will be able to tell you if you have periodontal problems and make your crown afterwards (I say normally)
  • x-rays to be done frequently on this crown to detect any problems before infection occurs
  • there are dentists who are more “cosmetic surgeons” than dentists, who will suggest retyping the 4 front teeth so that the result is homogeneous and more beautiful. Making such a visible crown among natural teeth isn’t an easy task. Don’t make it easy by damaging natural teeth that have not asked for anything. This is completely stupid. If he feels unable to check the shape and color of the crown to make it blend in with the natural teeth, change dentists.

In any case, keep in mind that dental care has reached a very, very high level. It is possible to achieve perfection, so don’t demand less. Natural teeth will always be the best, so try to get as close to them as possible. I would never have known, for example, that the thickness of my crown could have caused a problem as serious as bruxism.

Secondly, when I made mistakes, my intuition always told me that something was wrong. And I preferred to listen to dentists instead of listening to my intuition. With time, I now know that my intuition is more important. Even though I’m not a dentist, I’m in the best position to know if a crown is right for me, if something is wrong. I look at myself every day so I know if something is normal or abnormal.

Disclaimer: I am neither against devitalization nor against crowns. I am against the lack of transparency of our dentists who explain ONLY STEPS. Hence the many pictures in this article, shocking though they may be, you have the right to know what is being done on your tooth.

Don’t hesitate to ask for a second or third opinion until you find the dental surgeon who meets your requirements. And above all, listen to yourself!

Note: I am not a dentist. I understand that you need to be reassured and comforted in your decisions but please do not ask me medical questions. I am not here to help you make a decision or to be consulted as a 2nd or 3rd opinion. I’m like a person you pass in the street, you know? lol Just because I wrote a 3000 word article doesn’t mean I have science infused in my front teeth. Devitalization and crowning is an irrevocable decision and I have no desire to be responsible for your choice.
If you are unable to make an appointment quickly in your city or region, do not hesitate to take the train and find other dentists in other regions for a 2nd, 3rd opinion. Limit, even go abroad if your wallet allows it (USA, Canada, Switzerland).
Take your destiny and your health in hand, there are solutions to everything now.