Types of Tooth Cracks and Treatment
A tooth fracture can occur in both
the front and back teeth, but the causes differ for each region. The front
teeth most often become fractured due to sports trauma or some other external
event, and may show signs of mobility due to underlying bone or tissue damage
or exhibit damage to the vital tissue known as the pulp.
Posterior teeth often crack or
fracture off due to active decay or improperly placed restorations. Although
these fractures may not present as urgent an aesthetic problem as those
confined to the front teeth, serious damage to both the tooth and supporting
structures and tissue can occur without prompt treatment. This article looks at
the various type of tooth cracks and how treatment is approached for each.
Superficial Cracks in the Front
Teeth
Cracks that occur on the front teeth
can be superficial or implicate deeper layers of the tooth. They can occur due
to external trauma or natural causes. Tooth structure on either side of the
crack is still structurally secure but its integrity can disintegrate with
time, evolving into a complete fracture (the sides can break off with little
force).
"Craze" lines are an
example of a naturally-occurring crack that is confined to the outer enamel
layer. Tooth enamel protects the interior layers of the teeth, but can be
successfully restored with composite bonding or refinishing of the enamel
surface. The same can be said for traumatic injuries to just the enamel.
During composite bonding, the
dentist simply etches the tooth and applies a white filling-like material to
the crack.
Deeper Cracks in the Front Teeth
Deeper cracks can introduce
complications to treatment. If the crack extends into the second layer, known
as the dentin, it can still be successfully repaired with composite bonding or
an indirect restoration (veneers). The goal of treatment is to achieve
aesthetic correction but to also keep the crack from propagating deeper into
the tooth structure.
Cracks that have extended into or
near the pulp present a cause for concern. The pulp consists of vital tissues
that facilitate the growth and regenerative processes of the tooth. A crack
that exposes the pulp to the oral environment can introduce bacteria into the
pulp chamber, where it can cause infection and subsequent death of the tooth.
Depending on the age of the patient and the extent of damage already done to
the pulp, two main options exist.
The pulp or dentin immediately
surrounding the pulp can be medicated after active decay is removed to
stimulate new dentin growth. The tooth can then be restored with composite
bonding or through other restoration methods and re-examined in several months
to confirm pulpal health. This approach is ideal for immature teeth with
developing roots. In instances where the pulp and/or supporting tooth
structures have become infected, a root canal is recommended.
A root fracture threatens the
structural integrity of the tooth and can affect both the dentin and pulp.
Teeth that have received prior endodontic treatment are typically at higher
risk for root fracture. Treatment may initially include stabilization of the
tooth and observation of crack progression and pulpal health. If complications
develop root canal therapy, partial root removal, or tooth extraction may be
recommended.
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