AboutMark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question QUESTION: My nine year old daughter fractured her bottom front tooth. I went to my family dentist who was going to do a composite filling but the experience was not good so I took her to a pediatric dentist. He said that she needs a crown because of the constant biting down on the tooth and it would be less likely to be replaced than a composite filling. I have done some research and I think the crown is the way to go but wanted some insight about both options. Can you tell me? thanks
ANSWER: Dear Christy,
A crown would be more durable, because it would probably resist displacement from chewing forces better. A lower incisor is a small tooth, and there is very limited area available to develop a strong bond to a composite resin restoration.
On the other hand, a composite resin would be quicker, cheaper, and a more conservative restoration which would necessitate less grinding of the tooth. It may even be possible to build the tooth slightly shorter than its original dimension so that it better avoids the chewing forces that might cause it to become dislodged. Depending on the size and orientation of the fracture, a bonded resin filling may not sacrifice all that much durability compared with a crown, so this decision very much depends on the particulars of your daughter's case. A bonded filling may even look a bit better than a crown, which almost always unavoidably makes the tooth look more bulky.
Of course, if your daughter is not fond of dentistry in general, providing a more reliable and durable result may avert the need for unwanted extra visits to fix a resin filling, and the psychological aspects of care may be a consideration when making a decision. However, a resin filling can always be followed by a crown if it fails, whereas once the tooth is prepared for a crown, it will forever after need a crown. (The crown would need to be replaced by a more "permanent" variety once she is 18 years old or so due to further tooth eruption.)
There is no one clear-cut right choice, but these are the factors that should be assessed in making a decision.
Hope this helps...
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
---------- FOLLOW-UP ----------
QUESTION: I have talked with the dentist and they are telling me that their plan is not to do a crown as I know it. They would actually do bonding over the area that has broken off. It would not involve any grinding of the tooth. They will essentially be reforming the tooth.
Is this different from the composite filling? If so, it sounds as if it is a more viable option because they are not grinding the tooth.
Can you give me your thoughts? Thanks so much for your time.
Christy
Answer Dear Christy,
A bonded composite resin is exactly what I was speaking of when I mentioned a composite resin or filling-- it is one and the same, and would be a reasonable option. It is not a crown-- not as I, you, or anyone knows it, and the fee should reflect this fact. (I only make the point because some dentists will use some references to a crown in order to justify a higher fee-- I consider this practice "creative billing") In other words, a bonded composite resin across the incisal edge of an incisor is properly billed as code D2335 (resin filling, 4 or more surfaces or involving incisal angle). Such a resin would not be considered to be anything that has the word "crown" in it-- not a crown build-up, not a provisional crown.
