A childhood injury weakens the tooth leading to fracture
When Elliot walked in the office his front tooth was broken off at the gum line. A childhood injury led to a crown and a root canal on his front tooth. Over time that root canal weakened the structure of his tooth until breaking off at the gum line. He was worried about the health of his mouth and was embarrassed by the way he looked. Needless to say he was eager to have this tooth fixed so he could go back to his life.
How does a tooth break?
Broken teeth are such a pain – forgive the pun. It usually happens on a tooth that has been weakened in some way but it can happen on a tooth that has never had any cavities or work performed. Where I see the most number of teeth fractures are on back teeth that have had a large filling. The metal (aka amalgam) fillings expand and contract at a different rate than your own tooth does. Over the years the number of cycles that goes through can create a fractured tooth. At first they look like this:
Over time part of the tooth will break off making it harder or impossible to fix. The following tooth had a fracture under an older metal filling and needed to be extracted.
But Doc my tooth doesn’t even hurt…
There are many times when a tooth may have a crack and the person is unaware. Slowly the crack will get larger opening up microscopically and allowing cavity-forming bacteria to invade the tooth. The bacteria will eat away at the structure of the tooth undermining it and increasing the likelihood of a fracture. I usually hear something like “but I was just eating something soft when my tooth broke.” We usually think that a harder food (like ice or hard candy) will break a tooth but many times this happens when eating normal food. This is because the tooth had been weak for years and that meal happened to be the last straw.
Options for a broken tooth that CAN be saved
There are several things to consider when a tooth is fractured. First is the tooth able to be saved? If yes, then should the tooth be fixed now or should we continue to monitor it for further growth of the crack? Sometimes a crack is small enough or in part of the tooth that when all the risks and benefits are weighed, monitoring the tooth is the best option. When a tooth has a crack and the patient and I decide that repairing the crack is the best option then we consider the following based on how much of the tooth is remaining:
- A composite (white) filling
- A partial crown
- A full coverage crown
In the picture above the patient already had a full coverage crown on one tooth but the one next to it had a crack and a cavity underneath. A filling is typically used when the volume of damaged tooth structure is small. The larger the damage to the tooth, the stronger and bigger the restoration needs to be. The tooth above was not causing any pain but it did have a crack on the side that was allowing bacteria to seep under the filling further weakening the tooth. Over time the cavity could have gotten in to the nerve which would generally lead to needing a root canal or even extraction.
Options for broken tooth that cannot be saved
There are usually only four options when a tooth is broken so bad that it must come out.
- Dental implant
- Dental bridge
- A removable appliance
- Do nothing
This leads us back to our patient Elliot.
Elliot came in with a broken tooth that could not be saved. It was too broken down to be repaired and needed to be removed. Because this was his front tooth, doing nothing was not an option and when given the options he chose to do a dental implant to replace the front tooth.
After a number of discussions to determine the proper course of action he decided that he:
- Wanted straighter teeth
- Wanted a new front tooth
- Wanted whiter teeth
- Wanted to make his front teeth as natural as possible
To reach this goal he had an implant placed, wore braces for a number of months and new crowns placed on his four front teeth. The total time of treatment was approximately 18 months. The braces took the longest at approximately one year. Without the braces he could have been done in 6-8 months.
To obtain the most ideal appearance we decided to place crowns on his four front teeth. This decision was made to obtain a more natural and symmetrical appearance. We were both very pleased with the final results! See below!
For a free consult about about your smile makeover or cracked tooth, please give our office a call today.