Help needed: Post and crown vs Implant

[pinkpotato]

Sorry for the gross photos but hopefully they will be helpful! ....
My front tooth recently broke off, much of it breaking right up to the gum line. It had root canal over 10 years ago which was successful. The root canal still looks fine and there is no infection. An emergency dentist placed a temporary cover over the tooth, and this was partly taken off to take these photos. I think that some of the temporary cover is still visible in these photos as there seems to be more there than when it broke. The photos were taken to show to a prosthodontist and hopefully it's possible (for a dentist) to tell the difference between the cover and the remaining tooth.
The prosthodontist I saw said that it would be possible to do a post and crown but didn't give any percentages of how likely this would be to succeed. He did some checks of my bite, as I have a deep bite, to see if the tooth would have enough protection for a post and crown. He said that he thinks the tooth has enough protection to do the post and crown and that there is just enough tooth at the back to make a ferrel (?).
My situation is very much complicated by my medical situation in that I cannot take most antibiotics, including the dental ones like amoxicillin, clarithromycin, metronidazole. This means that getting an infection can be dangerous. The prosthodontist I saw thought that a post and crown would be lower risk than an implant, as the infections associated with post and crown going wrong as less severe, or less likely to need antibiotics than those associated with a implant.
I trust that the prosthodontist I saw was good, but would like a second opinion as it's a complicated decision. If anyone has any opinions on any of this I would be very grateful to hear.

 

[honestdoc]

I agree with the prosthodontist, Post/core & crown would be the most conservative approach as opposed to implants. Why can't you take dental antibiotics? Could you take Clindamycin? Usually you don't need to take antibiotics for most dental procedures.

 

[pinkpotato]

Thanks for your opinion I really appreciate it. I can't take antibiotics because I had severe Stevens-Johnson Syndrome following many antibiotics. They can't work out which one caused the reaction so it would be very dangerous for me to take them again as it's not really possible to control the reaction. Clyndamycin is a possible risk - I did take it at the time of my reaction but was given it after the reaction started so some doctors think it may be OK for me to take it and others think not. I don't know if there are other antibiotics which could be given intravenously for dental infections in hospital. I can take Doxycycline but I know that's not a great dental antibiotic.

With infection risk... I was worried with the post and crown of a infection later down the line if the root cracks, but hopefully it would be possible to extract without antibiotics if this happened. With a implant I was told they would usually be used prophylactically before the procedure and also if a flare up happened after it was placed.

 

[joss]

Hi,
I have already had 2 of these done, and am working on #3 and #4. Number three is not as co-operative as I had to have that tooth scaled due to sensitivity, and the dentist found a lot of gum tissue that was not healthy that had to be removed. These are all front teeth, and all had been previously capped, and have broken off [ just like yours] I believe my teeth probably shouln't have been capped as the dentist removes quite a bit to fit the crown,leaving the structure small and weak. Veneers might have been smarter. But I digress, The two I had post and crown are doing OK, but I have given up chewing anything hard. You are lucky you already had a root canal, because that is step #1. So, a post and crown is what comes next. This is still WAY cheaper than an implant, [ at least where I live] so for all the money I have spent on my mouth, I opt for a cheaper option. I really didn't need antibiotics for the first two, but #3 requires it, and like you, have issues with taking them although I have "sensitivities" [ can't keep them down] Whereas your SJS is far more serious. As far as know, antibiotics are more commonly used in implants. I'm assuming you are young, in which case you may better weather an implant than my senior self,lol. Dental work is always a crap shoot in my long line of experience, a root canal can last 20+ years or fail in 1. If your root canal is still good, I think I'd try that first [ post and crown] Remember, once it's pulled, it's gone forever. Having to wear a partial plate in my mouth made me realize false teeth are a last resort. I couldn't talk properly or taste food. So I'm down to very little chew surface [ ditched the partial] while trying to preserve my front teeth. Good luck, thanks for the pics, makes me feel less alone, oh, and as a last thought, the rest of your teeth looks good, so be glad, maybe save that implant for later if the crown doesn't work.

regards,
joss

P.S. KFLEX is one of the very few I [ antibiotics] I can take, but everyone is different.

 

[MattKW]

1. Your deep bite makes replacement with a post and core riskier than most people, but still worth a go only because you have already had an RCT.
2. You would need a cast post and core, not a prefab post. You will get next to no ferrule effect from a tooth that badly broken.
3. There is no indication for antibiotics for extractions unless you have a significant swelling or fever attributable to the tooth.
   
4. There is no indication for antibiotics when placing implants. It should be done under sterile conditions, and anyone prescribing antibiotics as a pre-med for implants is out of order.
5. Even an implant could have problems with that deep bite. The leverage on the crown will be high.

 

[honestdoc]

1. Your deep bite makes replacement with a post and core riskier than most people, but still worth a go only because you have already had an RCT.
2. You would need a cast post and core, not a prefab post. You will get next to no ferrule effect from a tooth that badly broken.
3. There is no indication for antibiotics for extractions unless you have a significant swelling or fever attributable to the tooth.
   
4. There is no indication for antibiotics when placing implants. It should be done under sterile conditions, and anyone prescribing antibiotics as a pre-med for implants is out of order.
5. Even an implant could have problems with that deep bite. The leverage on the crown will be high.

With the deep bite, it can explain why your compromised front tooth broke the way it did.

 

[pinkpotato]

Thank you all so much for your replies, it's really helpful. I am actually booked in tomorrow morning to re-do the root canal. I was told that because the root has been exposed, when the tooth broke, it would be safer to re-do it before doing to crown. I thought this may be more than was needed but the root canal specialist agreed it would be safer to do it this way.

I have no idea if it is a cast post and core that they have planned for me, but I know that he was saying that he will be making a ferrule from the broken tooth. In the notes it says "A post crown is a special two part crown that has a gold core, which sits inside the tooth and provides mechanical support for the crown, which is cemented on top" does this give any indication of if this is the right type of crown that Matt was talking of?

I was strongly recommended this prosthodontist so hopefully he will be picking the best possible option :s

 

[pinkpotato]

If anyone strongly disagrees with this plan then I may cancel my appointment tomorrow and wait to get a second opinion after Christmas. I was rushing to get it sorted because the tooth has already been broken for 3 weeks and I'm worried about it getting infected or decaying before I've had a chance to get it treated. It does have a temporary cover back over it at the moment though.

 

[pinkpotato]

So from what I've been reading the amount of appointments gives a good indication of which approach the prosthodontist is wanting to take.

This is the treatment plan.
2 hour appointment to re-do root canal
2 hour appointment to prepare the tooth for post crown
3/4 hour appointment to fit the post crown

Then he suggests more appointments to make a night time bite shield.

Anyone know which approach this would be taking - cast post and core or prefab post?

Sorry for the long string of messages, I'm stressing a bit because I'll be committing to this plan tomorrow.

 

[MattKW]

If he's doing it in gold, then it's the preferred "cast post and core". Go for it.

 

[Escanor]

Interesting why cast post and not a fiber post solution especially if we consider the aesthetic light transluscency in the anterior sector?

 

[MattKW]

The cast post and core is one piece, rather than a fibre post with a composite core "glued" on to it. The aesthetics will not be affected and can easily be managed with opaquers. The bonding is likely to fail with a fibre post, and has been shown to offer no advantage in situations like the OP where the tooth is sheared off at gingival level. The cast post may cause more internal stresses on the tooth and lead to root fracture, but whichever way you look at it, this is a high risk case.