Restoration of fractured teeth

by David A. Hall, D.D.S.
Dr. Sergio A.M. Ourique
Dr. Guilherme H. Itikawa

(Dr. David Hall is a dentist who practiced in Cedar Rapids, Iowa, and is now the
owner and president of Infinity Dental Web of Mesa, Arizona.)

(Dr. Sergio Ourique is Chairman of the Department of Prosthodontics, University of Sao Paulo, Sao Paulo, Brazil.)

(Dr. Guilherme Itikawa is an endodontist practicing in Sao Paulo, Brazil.)

This research was published in a Brazilian dental journal, Revista Paulista de Odontologia, Jan-Feb 2004, pp. 10-15.
 Click here for the Portuguese translation.

It was published in English in the Colorado Dental Journal, Fall,2004

Below, please find a discussion of this research. To read the research, please see the original article, Restoration of fractured teeth a long-term study, posted on the mynewsmile.com website.

What if you have a cracked or fractured tooth?

The following is information that is commonly circulated about cracked and fractured teeth, symptoms and treatment. This will put Dr. Hall's research into perspective.

Don't all Cracked/Fractured teeth hurt?

Not all cracked and fractured teeth hurt. It really depends on the severity of the crack and the pulps response to the irritants allowed into the tooth.  Commonly it's not until they become symptomatic that we get involved.  A crack/fracture can make the tooth sensitive due to movement of the fractured tooth pieces and/or leaking irritants into the pulp and even allow bacteria to come right in causing eventual infection of the tooth.  Let's take a closer look at a normal healthy tooth.

Inside the tooth, under the white enamel is a hard layer called the dentin, and there is the inner soft tissue called the pulp. The pulp contains blood vessels, nerves, and connective tissue.  The pulp is a vestige of what originally formed your tooth when you were a kid!

 

When the outer hard tissues of the tooth are cracked, the chewing can cause movement of the pieces, and the pulp can become irritated. When biting pressure is released, the crack can close quickly, resulting in a momentary, sharp pain. Irritation of the dental pulp can be repeated many times by chewing. Eventually, the pulp will become damaged to the point that it can no longer heal itself. The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum tissue surrounding the tooth.

 

How can you check to see if my tooth

has a crack and/or fracture?

 

No single test or technique provides the correct diagnosis 100% of the time.  In fact, if a restoration is present, it can become quite difficult to diagnose without removing the restoration or drilling a hole into the tooth.  Most of the time we use a transilluminating light and see if the light transmits from one side of the tooth to the other.  Of course, fillings don't transmit the light the same so it's even harder to tell when cracks or fractures are present in teeth with restorations.  A trained eye can spot the difference. 

 

 

Normal tooth

Probable cuspal fracture

A biting test can be performed.  We concentrate the biting forces commonly using an instrument as seen below.  This can isolate specific areas of the tooth that might be sensitive to bite, but does not tell us the underlying cause of the discomfort.

   
Tooth Slooth Biting Test on each Cusp

Sometimes some dye might be used to temporarily stain the tooth, and check to see if a tooth is fractured.  It is then washed off and evaluated.  This is most commonly done once access to root canals is obtained.

Stained Cracked Tooth

(Blue Stain Can be fully removed after diagnosis)

 

Are All Cracks and Fractures

seen on the outside of teeth Bad?

 

 

Craze lines are tiny cracks that affect only the outer enamel of the tooth. They are common in all adult teeth and cause no pain. Craze lines need no treatment. They do NOT extend into dentin.  Hence, these cracks are observed in most teeth and are considered normal.  They are the result of "wear and tear" on teeth.

Hence, the answer is no, not all cracks seen on the outside of teeth are bad.

Does my Cracked or Fractured tooth need to be Treated?

That depends.  If the crack/fracture is caught early enough, often times only a restoration that holds the tooth together will be needed.  Once the pulp begins to degenerate and/or becomes infected, it must be treated endodontically if the tooth is going to be maintained.   Like cracks in a windshield, cracks in teeth can often remain small or progress slowly over time.  I believe that the sooner a crack or fracture is detected and appropriate treatment delivered, the better the chance of maintaining your tooth.

How will my cracked/fractured tooth be treated?

The treatment of your cracked tooth depends on the

type, location, and severity of the crack.

 

All of the common cracks and fractures of the crown region start on the surface and work there way into the tooth toward the end of the root.

 

 

After treatment for a cracked tooth, will my tooth completely heal?

The conventional wisdom is that, unlike a broken bone, the fracture in a cracked tooth will never completely heal. In fact, even after treatment, it is possible that a crack may continue to worsen and separate, resulting in the loss of the tooth.

The treatment you receive for your cracked tooth is important because it will relieve pain and reduce the likelihood that the crack will worsen. Once treated, most cracked teeth continue to function and provide years of comfortable chewing. Talk to your dentist and/or endodontist about your particular diagnosis and treatment recommendations. They will advise you on how to keep your natural teeth and achieve optimum dental health.

How long will a cracked or fractured tooth last?

Good question.  I don't have a really good answer though.  It seems somewhat related to if the crack/fracture extends below the gum line a lot.  The problem is it's like a crack in a windshield, it can stay the same or spread.  This means it's difficult to predict how long a fractured/cracked tooth will be maintained in your mouth.  I've got one and have had the tooth for 13 years without any problems, but I can't say if that's what will happen in your case.  The good news is they have good success rates, typically 70% I believe.

What can I do to prevent my teeth from cracking?

While cracked teeth are not completely preventable, you can take some steps to make your teeth less susceptible to cracks.

  • Don't chew on hard objects such as ice, unpopped popcorn kernels or pens.

  • Don't clench or grind your teeth.

  • If you clench or grind your teeth while you sleep, talk to your dentist about getting a retainer or other mouthguard to protect your teeth.

  • Wear a mouthguard or a mask when playing contact sports.

If you experience symptoms of a fractured or cracked tooth, see your dentist immediately. If detected early, a cracked/fractured tooth can often be more likely to be maintained.

 

Fractures of the Root which start below the Gumline

Vertical Root Fractures or 'Split Root'

 

Signs & Symptoms

Typically symptoms are associated with a tooth that has had endodontic therapy.  If you have persistent symptoms  which do not appear on a radiograph or x-ray, you tooth may have a tiny fracture in the root but keep in mind other causes can produce the same symptom.  Also these teeth commonly present with bone loss around an entire root in more advanced fractures and often go unnoticed until surrounding bone and gums become infected. 

Causes

Commonly a complication from endodontic therapy.  Sometimes believed to exacerbated by large post placement.

Diagnosis In many cases, endodontic micro surgery allows the visualization of your root to determine the problem.  The gums are reflected to expose the root and a stain or dye used to make the fracture more noticeable.  Sometimes during the retreatment process, the use of a microscope can detect the fracture as long as it's not around a curve.  If a fiberscope can be placed, that may also be used for diagnosis of this type of fracture.
Direction of Fracture Vertical root fractures begin in the root typically near the end and extend toward the chewing surface.
Treatment Treatment for a single rooted teeth is has usually been extraction. However, recent research by Dr. David Hall shows that with prompt treatment, these teeth can be saved.

 

 

 

Return to home page - www.davehall.com
 

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