Cuspal Fracture Repair Homework

Cracked and Fractured Teeth

Because people are living longer and dentists are helping keep teeth longer, teeth are being exposed to years of crack inducing habits.  Particularly, clenching, grinding, and chewing hard things such as ice can result in cracks and fractures in teeth.  Typically teeth with cracks/fractures do not show on radiographs (x-rays).  Hence, cracked and fractured teeth can especially be difficult to locate.  When the outer hard tissues of a tooth are fractured or cracked, chewing can cause movement of the pieces and the pulp becomes irritated.  Often this results in a momentary, sharp pain which eventually progresses to include thermal sensitivity.  In time the cracked or fractured tooth, similar to other teeth with pulp degeneration, can begin to hurt on it’s own.

  How do I know if my tooth is Cracked or Fractured?

Does your tooth feel like it "zaps" you when bite on it?   Well, that's not enough to know it's cracked or fractured. Unfortuantely, cracked and fractured teeth exhibit a variety of symptoms.  If your tooth is cracked/fractured, you might feel occasional pain when chewing, particularly between bites as you release the pressure on your teeth. You might also feel pain when you eat or drink something hot or cold. Cracks and fractures are fairly difficult to diagnose because the pain comes and goes, and cracks/fractures only rarely show up on x-rays. Because of this, you may see your dentist several times before the crack is diagnosed.

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.

 

Common Cracks and Fractures of the Crown region

(Top Part of the tooth above the gumline)

Cuspal Fracture

Cracked ToothSplit Tooth

 

Cuspal Fracture: When a cusp or the pointed part of the chewing surface of your tooth becomes weakened, the cusp will fracture.  Part of the cusp may break off or may need to be removed by your dentist.  Depending upon the extent of the fracture, the pulp may also become damaged.  Endodontic therapy is needed when the pulp is damaged beyond repair and a crown will be placed to help protect the tooth and replace the fractured tooth structure.

Cracked Tooth:  This type of crack extends from the chewing surface of the tooth vertically towards the root and sometimes below the gum line.  A cracked tooth is not completely split into two distinct movable segments.  If caught early enough, the tooth is usually crowned but endodontic therapy may be needed at a later date (typically in the first 6 months).   Nonsurgical endodontic therapy (root canal) will be needed when the pulp becomes substantially injured or exposed.   During endodontic therapy the inside crown portion of the tooth is stained with a temporary dye and viewed microscopically for the extent of the fracture.  Prognosis depends on the severity of the crack.   A full crown is needed to hold the tooth together. 

Split Tooth:  A split tooth is a cracked tooth in which the crack has progressed so there are 2 distinct segments that can be separated from one another.  Unfortunately, with today’s technology, a split tooth can never be saved intact.  The extent and position of the crack will determine if any portion can be maintained but most of these teeth will be extracted.   In rare instances, endodontic treatment, possibly some gum surgery, and a crown may be used to retain a portion of the tooth.

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

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 alot.  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'

VRF

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.

DiagnosisIn 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 FractureVertical root fractures begin in the root typically near the end and extend toward the chewing surface.
TreatmentTreatment for a single rooted teeth is usually extraction.  Multirooted teeth may have the affected root removed in some cases.

Disclaimer: Endodovgan.com is provided for information and educational purposes only.  No doctor/patient relationship is established by your use of this site. No diagnosis or treatment is being provided. The information contained here should be used in consultation with a dentist and/or endodontist of your choice.  No guarantees or warranties are made regarding any of the information contained within this website.  This website is not intended to offer specific medical, dental or surgical advice to anyone. Hence, you should not rely on this information as a substitute for personal, medical and/or dental attention, diagnosis, and care.   Dr. Dovgan takes no responsibility for the websites that hyperlink to or from this site, and such hyperlinking does not imply any relationship or endorsement of those sites.

Maybe you fell into concrete. Or you were chewing ice or hard candy. When you first realize you have a cracked or broken tooth, it can be a scary time. But don’t worry. Your tooth and your smile can be repaired.

At Advanced Cosmetic & Family Dentistry, we see a lot of patients with broken or chipped teeth. And our trained and experienced dentist, along with our friendly staff, knows how to handle this type of situation.

We are able to use restorative and cosmetic procedures to repair damaged teeth. The right treatment for you will depend on how badly your tooth is damaged. But, you do have options, and advancements today mean you don’t have to live with unattractive teeth.

Why people get cracked or broken teeth

The enamel that covers your teeth is the strongest tissue in your body, but it can still be broken or cracked.

Teeth can be damaged in many ways. Maybe you were doing something you probably shouldn’t have, like playing football without a mouth guard or chewing on a pencil. Or maybe you suffered a traumatic fall, crash, or blow.

According to the American Dental Association, the top nine foods that damage your teeth are hard candies, ice, citrus, coffee, dried fruit, potato chips, soda, alcohol, and sports drinks.

Tooth decay or cavities can also weaken your teeth, causing them to be more likely to break when you are chewing hard food.

Types of cracked teeth

Several types of cracked teeth exist.

  • Craze lines. These are tiny cracks that only affect the outer enamel. Craze lines are common for adults. They are shallow, cause no pain, and are of no concern beyond the way they look.
  • Fractured cusp. When a piece of a tooth’s chewing surface breaks off, it’s called a fractured cusp. It usually doesn’t cause much pain.
  • Cracked tooth. A cracked tooth means a crack extends from the chewing surface vertically toward the root. Early diagnosis is important in this case to save the tooth. A cracked tooth left untreated will get worse as time goes by and can result in a loss of the tooth. Early treatment is essential in saving cracked teeth.
  • Split tooth. A split tooth is usually the result of a long-term cracked tooth. It is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact.
  • Vertical root fracture. These cracks begin in the root of the tooth and extend toward the chewing surface. Often, they show minimal signs and symptoms. Many times, they are discovered when the surrounding bone and gum become infected.

Here are five procedures that can repair your cracked or broken tooth

Our dentist will determine which of the following treatments is best for you and your mouth.

1 Dental bonding


Composite bonding is a way to repair chipped, cracked, decayed, discolored, misshapen, and gapped teeth. Composite bonding can last up to 10 years. During the procedure, anesthesia won’t be required unless bonding is being used for cavities.

Our dentist will roughen your tooth and put on a conditioning liquid. Putty will be applied, molded, and smoothed. Then, an ultraviolet light is used to harden the composite. When the tooth bonding has dried, it will be shaped and polished to match the rest of the tooth.


2 Veneers


Veneers are covers for a tooth. At our dentist office, we use porcelain veneers because they provide the most attractive and realistic results possible.

The veneer is bonded to the front of the tooth, transforming the tooth’s appearance. With good care, veneers can last up to 30 years, so you won’t have to worry about getting it replaced regularly.

You can have veneers placed on one tooth or a few. And it’s up to you how you want your veneer to look. This cosmetic treatment is truly a wonderful option for many people. But, if you grind your teeth, veneers may not be recommended for you because you will wear them down.

How veneers are placed on your tooth

  • First, the teeth need to be prepared for veneers. This means a dentist will need to gently remove some of the tooth structure so that the tooth doesn’t look bulky.
  • Impressions will need to be taken. At this time, you will have the chance to make decisions about the size, shape, and shade of your veneer.
  • The veneers will need to be created in a lab, so you will wear temporary veneers for a while.
  • At a later appointment, the temporary veneers will be removed, and the new veneers will be bonded to the front of the tooth.

3 Crowns


If your tooth is chipped badly or you have pain when chewing or drinking, you may need a crown. Crowns are one of the most common restorative treatments.

A crown is a cap that covers the tooth and protects in and approves the appearance. It acts as a strong covering for your tooth. When you get a crown, this prevents you from losing your tooth. Without a crown, a damaged tooth won’t be able to withstand the pressure of chewing.

At our dentist office, we use crowns created from tooth-colored porcelain to create a natural, uniform look. Our crowns are created for each patient and made to match your tooth perfectly.

Here’s how crowns are placed on your tooth:

  • First, the tooth must be prepared. Some tooth structures will likely need to be removed to make room for the crown.
  • After the tooth is prepared, the dentist will take impressions, which will be sent to a lab and used to make the permanent crown. A temporary one will be provided in the meantime.
  • When the permanent one is ready, it will be cemented to the remaining tooth structure.

4 Root Canal


If you have a crack in your tooth that has extended into the pulp, the tooth can be treated with a root canal. Some time after the root canal, a crown can be placed to protect the crack from spreading. Until then, you will be given a temporary crown to wear.

Getting a root canal involves clearing out the decayed tooth matter and removing the nerve. This procedure has a bad reputation for being painful. But if it’s done right, you should feel no pain or only minor discomfort.

If you have a toothache, sensitivity, or swelling, you may need a root canal. Left untreated, infection can spread, causing abscess, bone loss, and other serious problems.

here’s how root canal therapy works:

  • Our office will take x-rays to determine if your tooth is infected.
  • Next, you will receive an anesthetic to minimize discomfort.
  • We will then drill into the tooth and remove the tooth’s pulp and the nerve.
  • Then the tooth is sealed to prevent further infection.
  • If a tooth’s strength has been compromised, a crown will be placed on top.

The entire therapy will most likely take more than one dental appointment.


5 Dental Implant


If you have a crack in your tooth that extends below the gum line, your tooth is no longer treatable, and the tooth won’t be able to be saved. You will need a tooth extraction, which means your tooth will need to be pulled. And then, you can get a dental implant to replace your natural tooth.

Dental implants take the place of your missing teeth. They act as your tooth’s new root and are placed securely in your jawbone for a lasting fit.

Here’s how a dental implant procedure works:

  • Biocompatible titanium screws are surgically placed into the jawbone and act as the new root of your tooth.
  • Some time will need to pass so the bone fuses with the titanium screws, allowing for a tight, lasting foundation.
  • After about 12 to 16 weeks, we will take an impression of your teeth to make sure your treatment is running as it should. During this treatment, our dentist, Dr. Silverman, will customize the abutment and create the dental crown, which will be placed on top of the implant.
  • During another appointment, Dr. Silverman will place your permanent crown and ensure a comfortable, secure fit.

If you don’t have enough bone to place dental implants, Dr. Silverman can perform a bone graft procedure.


Why you should get your broken or cracked tooth examined immediately

If you think your tooth might be cracked or broken or you know it is, you need to see a dentist right away.

Why? So you can avoid further damage and possible infection. And maybe even save your tooth.

If you have a broken or cracked tooth, come see Advanced Cosmetic & Family Dentistry in Alpharetta, GA.

At our dentist office, we treat our patients they way we want to be treated. We want to impress you and go beyond your expectations.

Don’t wait! Call 678-245-6816 today and make an appointment to get your tooth repaired. We’d love to help you achieve a beautiful smile you can be proud of.

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