Crown Lengthening procedure

[pinky2514]

Back in October 2013, I broke a piece of tooth off (#19).  I had my teeth cleaned in October at the periodontists office.  He said I needed to get the tooth looked at by my regular dentist but it wasn't a rush if it wasn't bothering me.  It was just a little piece broken off the back cusp.  I went to reg. dentist and had it prepped for a crown.  He said then that I may need to have crown lengthening and that he wanted the endo guys to take a look at the tooth to determine need for a root canal.  I have not had any pain from the tooth.  Went to periodontist and he said that the prep looked good.  I questioned the need for trip to endodontist.  He said go.  I went with no need for root canal.  Have had temporary crown on since first week of Nov. with no issues.  Have researched crown lengthening and can't understand why I would need to get that done to this tooth.  It was not broken below the gum line.  It did not need a root canal.  I have spent $1200 on this tooth already and don't think taking anything else away from the tooth structure will help anything.  Any thoughts on the necessity of crown lengthening?

I feel like reg. dentist is pushing me to go other places (perio and endo) and spend money b/c of a brotherhood or ?????  I was a dental assistant for 5 years and know a (very) little about dentistry and have never had this feeling of being pushed until now.  I am not sure how to handle the situation without spending a ton more money on this tooth.  I just want to get my crown that I have paid for. Is it reasonable for me to refuse crown lengthening and ask for him to just take the impressions to get a crown made?

[Jerome Tsang, DDS]

What does the periodontist say about crown lengthening?  Do you have an x-ray?  

Its hard to say whether or not it necessary but judging by the story of how you need a crown to begin with, you may not need crown lengthening.  Usually its more common due to deep caries or a deep restoration that may be too close to the bone that causing chronic pain afterwards.

[Jerome Tsang, DDS]

Ya.  Tough situation.  I think I understood most of it.  So the periodontist you trust is saying you need crown lengthening now?  

I would say that if you trust your doctor, you should go with their recommendation.  But as far as I can tell by your story, you could take a risk by not getting the crown lengthening cause there's no symptoms but there could potentially be issues down the road.  You may need to have them explain to you why they feel you need a crown lengthening.  

[pinky2514]

Thank you for your reply!!  The perio is a guy I have known for a long time and trust -- and he looked at the temporary crown restoration and said it "looks good".  I told him that I didn't think that the tooth needed a root canal b/c of no pain or sensitivity (but dentist said I should go).  I think that they thought the tooth may be cracked deeper than just the cusp being chipped off.  Dentist said that he didn't want to see me spend a bunch of money on restoration then have to have the tooth extracted. I felt like if the tooth was cracked that bad -- it would have been evident to me in some way.  When I voiced my concerns to perio Dr., he told me to go ahead and see the endo guys. Endo Dr. took x-ray that looked to me like a perfect tooth prepped for a crown.  Then his (perio) office called a week or so later and said they needed to schedule crown lengthening....  I called back and spoke to office manager and told her that obviously the tooth needed no root canal and that I had the understanding that he (perio Dr.) did not think I needed crown lengthening (only b/c of his the way he told me it was no big deal that i had chipped the cusp off and then after he saw temporary restoration he mentioned the margins looked good.)  She said she would check with him & call back.  She called back & left message for me to call them -- that he said that the tooth does need crown lengthening and we should schedule that but if I didn't want to schedule that-- did I want to go ahead and schedule implant procedure for #18 and #15 (which I was in the healing process of - extraction and bone graft when I 'chipped the corner off' #19).  So I have not called either dentist or perio -- b/c I feel like this tooth does not need crown lengthening.  I have had the procedure done on another tooth with good reason -- it was obviously broken below the gum line.  I just think that I have already spent $1100-$1200 on the tooth and have no pains or problems even with a temporary crown staying on or being sensitive.  Also, from what I have read crown lengthening may compromise the strength of the adjacent teeth -- I could be wrong in my interpretation.  I just do not want anything done that is not necessary and I do not want to step on anyone's toes (Dentist).   I thing that I really need just to get a permanent restoration on the tooth and concentrate on implants for #18 and #15 -- but I am not sure that my dentist will agree or how to say to him that I really just want to move on and spend money on other things.  I did pay for x-ray at endo's office and dentist office before he began restoration process.  Thank you so much for taking the time to read!!  I appreciate your help.