A related discussion, Shaved down crown
I used to be Dr mike but the forum changed my name... anyway, I'm not sure what you mean by an implant replacing one tooth covered by a 2 crown structure. do you mean 2 crowns on one implant? why would you want to do that? Is the space that big? I guess its difficult without seeing your whole mouth. Are you missing other teeth?
anyway, it sounds to me like #10 has somewhat of a questionable prognosis. If I now understand correctly, it had root canal, a broken instrument and an apico. Now it's had a post and has been overprepared. I'd be cautious about investing time and dollars into this tooth (it sounds like all that's left is the root) even if you do have it splinted to another tooth. If #10 becomes symptomatic, or fractures under the crown (that can happen in root canal teeth that have had so much work done on them and are thin and delicate to start with) you are in for even more expense because You'll then have to remove the #10 crown and root, place an implant, and then redo the crown that was splinted to #10 and then place a new crown on the implant. If #10 is questionable, then it may be better to extract it now and replace it with an implant and a crown. This is assuming the rest of your mouth, or at least the upper arch, is in good shape. If you need more dental work in the arch, you are better served with a more comprehensive approach to the whole arch when implants become involved. ie, What good is a mercedes Benz on #10 if you've got 1974 Amc Gremlins elsewhere in the arch. Before removing any teeth or placing any implants, you should see a dentist who will give you a comprehensive treatment plan for your whole upper arch (preferably your whole mouth) so that you can understand the ramifications of what you are doing and what may be needed later. To the better dentists, dentistry is about planning. Others view themselves as tooth mechanics and do not present or give consideration to the whole picture. My advice before you do anything is to see a dentist who will give you a complete treatment plan. good luck
one of two things can be done. in order to give an overprepared tooth enough height that it will hold a restoration (temporaries don't count-- they are supposed to come off easily and you may just have a poorly made temporary) a dentist can either lower the gum tissue with a procedure called crown lengthening (ie you "lengthen the exposed part of the tooth) or the post/core procedure can be redone so the tooth can be built up higher. Keep in mind that the dentist has to take down the tooth enough so that there is ample space between it and the opposing tooth. remember that the resotration has to have a certain thickness to prevent fracture or perforation and you have to be able to close your mouth and make all your teeth touch comfortably. for this reason, if it is a back tooth you may want to consider a cast gold crown which can be thinner and therefore requires less tooth reduction (after it is rebuult with a new post),. I have 3 of them in my mouth and would never use anything but gold on my back teeth. gold is the best way to crown back teeth and it is the most comfortable for the patient.... and it can't break like porcelain. In your case, I'd rather the post/core/buildup be redone and the tooth re-prepared for a cast (preferably gold) restoration. If you insist on porcelain and the space is tight you may need crown lengthening. good luck
Dear Dr Mike, thank you for your time and advice! I will do the two-teeth linked metal-porcelain crown. The problem is that my #10 has broken instrument in it and it is sort of unreliable (It does not disturb me - I've had an APICO-surgery two years ago and part of the br. instrument was removed). The question is is it possible to do an implant in place of one tooth covered by two-crown structure? I've heard that it is possible to cut off crown in the middle... I am just trying to find out my options, maybe it will affect my decision right now.
I just realized it is #10. sorry. If the preparation is too short, it may be able to be built up with a new post. #10 is a difficult tooth to crown because it is so small and the root is thin. Very often I used adjacent teeth to "splint" to #10 (or #7 on the right side) for strength, especially if they already have crowns or large restoratios in them. If your adjacent teeth are virgin teeth (no fillings or crowns) and #10 cannot support a crown on its own, then you may want to have it extracted and place an implant there. hard to tell without seeing you.
Thank you for your reply. I just got second opinion - doctor says that the tooth is definitely significantly OVERPREPED. By the way, the crown is off again - it does not stay in place at all. It causes me a lot of problems, this is front tooth #10.
What can I do?
It is difficult for me to comment on the amount of tooth structure that was removed without seeing it. At times it is difficult for the patient to understand what the dentist has to do to accomplish the restoration of a broken down tooth. There may be a significant amount of decay which doesn't allow the dentist much choice in how much tooth structure has to be removed. It is important that you have confidence in the doctor you are seeing. If not then get another opinion.