Broken tooth: causes of fracture and restoration methods

Author: Brodsky Sergey Evgenievich Deputy Chief Physician, Candidate of Medical Sciences in the specialties: dentistry and medical microbiology A broken tooth is the cause of discomfort during eating, which can lead to the development of inflammatory processes in the hard and soft tissues of the tooth, root and gum . Therefore, if a defect is detected, you should immediately consult a dentist, who will select the correct method for restoring the tooth.

Causes of tooth fracture

Part of a tooth can chip or break as a result of exposure to internal and external factors. The first group of reasons include:

• pathologies associated with disruption of intrauterine development of surface and hard tissues of the tooth;
• metabolic disorders associated with impaired absorption of calcium, magnesium and phosphorus, provoked by rickets suffered in childhood, the use of diuretics, and poor nutrition;
• diseases of the digestive tract, accompanied by changes in the acidity of saliva, which has a destructive effect on tooth tissue.

A tooth in the gum can break under the influence of a number of external factors, including:

• injuries to the skull and jaw during a fight, road accident;
• tooth injury during dental procedures;
• eating solid foods;
• thermal injury due to the simultaneous consumption of cold and hot food and drinks;
• advanced carious processes;
• incorrect structure of the dentition.

Hidden caries (both under a filling and on a “healthy” tooth)

As a rule, such caries develops asymptomatically, for more than one month or even a year, it does not manifest itself in any way, but destroys the tooth tissue from the inside. And at some inopportune moment, a part of the tooth, thinned by caries, breaks off.

What to do?

Treat the tooth at the dentist: remove all tissues affected by caries and restore the tooth (with a filling, ceramic inlay or crown, depending on the degree of its destruction). And be sure to check all other teeth for hidden caries!

How to avoid?

See your dentist for preventive examinations more often in order to promptly detect hidden caries at an early stage, when treatment is easier, faster and cheaper.

Signs of a fracture

It is almost impossible not to notice that the crown is cracked. After all, at the moment of its damage, severe pain appears. The unit soon ceases to be sensitive, as its layers are deprived of adequate nutrition.

To see the location of the defect, you need to carefully examine your smile in the mirror. A crack will be noticeable on the surface, running along or across. It also happens that a large fragment breaks off immediately. Then a sharp break line is formed, which injures the mucous membranes of the inner surface of the lips and cheeks, and the tongue.

Incorrectly restored tooth

• Poor performance of the filling , violation of technology and methodology during restoration (we will not dwell on this).
• The type of restoration is inadequately selected, in a word, “too big a filling” (i.e. they put a filling in cases where it can no longer be placed, but there are all the indications for “more serious” ceramic restorations (inlays, crowns).

I would like to dwell on the second reason in more detail.

Competent dentists know that there is an index of tooth surface destruction (DSI), which must be taken into account before restoring teeth in order to do it correctly. For you, dear patient, I will describe it in a simplified way. If the tooth is not severely damaged (conditionally up to 40% of the surface), a filling is an excellent way to restore it. Destruction of 40 to 70% of the surface requires the manufacture of a ceramic inlay or strengthening of the tooth with various pin structures.

If there is a significant degree of destruction of the tooth surface (more than 70%), the tooth should be correctly restored with a crown. In a word, the type of tooth restoration depends on the degree of destruction.

What's wrong with a filling?

Each recovery method has its own indications. So, a filling is necessary and can be placed in cases of small and medium degrees of tooth decay. If the decay is significant, a large filling can split the tooth in half.

Let's find out why!

Any material (even metal) expands when heated (remember the temperature of the tea you drink!). Temperature changes are a fairly common occurrence that our teeth encounter (from hot tea to ice cream). The coefficient of thermal expansion of filling materials is still higher than that of tooth tissue. That is, when hot food is consumed, the filling expands more than the tooth tissue that surrounds it. The larger the volume of the filling, the greater the expansion (this is why a large volume of the filling is so undesirable).

Of course, this expansion is minimal, not noticeable to any eye and not perceptible. However, add to it a chewing load (which far exceeds temperature deformations), a large filling, thinned tooth tissue, and the likelihood of chipping increases many times over.

Unlike filling materials, ceramics (from which crowns and inlays are made) have a closer coefficient of thermal expansion to the tooth tissues, and therefore do not contribute to its chipping. In addition, it is stronger. That is why it is correct to restore severely damaged teeth not with fillings, but with ceramic restorations. There are other physical phenomena that affect the change in the size of the filling and, as a result, the splitting of the tooth.

All of the above, of course, is true only with an adequately completed restoration (even fillings, even crowns). An inaccurate hand of a master can lead to chipping even with ceramic restorations, and on the contrary, a skillful hand can place a large filling so that it will last a long time. However, there is a limit to everything and it is better not to go beyond the indications for restorations if you want to get guaranteed and reliable work.

Conclusion : you should not expand the indications for conventional fillings too much; they are not capable of qualitatively restoring a badly damaged tooth. But in case of minor tooth decay, fillings have proven themselves to be excellent!

Let me give you a photographic example.

The patient complained that it was painful for her to bite on one of her teeth, that something “crunched” in it.

Upon examination, we determined: tooth 4 on the upper jaw: it has a medium-sized filling (at first glance). And a movable, broken tooth wall, which is held together only by the gums. This wall is no longer attached to the tooth.

The broken fragment of the tooth is mobile, easily moved to the side, but has not yet been removed.

View of the tooth after removing the broken wall: the cheek wall was chipped under the gum. A large filling and a thin remaining tooth wall on the palatal side are visible. Some doctors may try to restore such a tooth using a crown (with preliminary extension); some doctors will offer a perhaps more predictable option: removal and subsequent implantation.

Why are teeth restored incorrectly?

It’s absurd, but often the dentist follows the patient’s lead. The patient, not fully understanding all the subtleties and features of the distribution of the load when chewing, refuses the inlay or crown and asks the doctor to “put a filling”, they say, I’ll work with it a little more, and only then the crown! As a result, at the most inopportune moment, a “piece” of the tooth breaks off. As a result, such “pity” of the doctor for the patient turns out to be a bigger problem for the patient than timely adequate tooth restoration.

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How to properly restore teeth?

When treating a tooth, the doctor must remove all carious tissues, old fillings, movable walls, if any, completely clean the tooth and only then assess the degree of destruction (which walls and cusps have survived, whether they are able to bear the load, how the load on this tooth will be distributed during different methods of restoration, whether chips of any wall are possible, whether its restoration will lead to a split of the root, etc.). After such an assessment, it is determined how to properly restore the tooth: is it possible to put a filling, or does it need to be “strengthened with a pin,” or would it be more correct to use a ceramic inlay or a crown.

Conclusion: a properly selected restoration will preserve the tooth for many years, protect it from further destruction, and the patient from having to redo the work in a few years.

Common Causes

In addition to the factors mentioned above, it is also worth noting unqualified treatment. For example, when removing a lower jaw tooth with forceps, you can damage one of the upper teeth with the instrument. If a tooth is weakened by various diseases or is in poor condition, the likelihood of a fracture is very high. Of course, such cases are very rare, but they do happen. Another reason for a fracture is an error at the stage of selecting the size of the holes in the pins. It is important to note that the lack of treatment for caries also negatively affects the condition of the enamel, as a result of which sometimes eating solid foods can provoke a crown fracture. Do not forget about the anatomical features of the jaw. If its structure has certain defects, the pressure will be distributed incorrectly.

Injury

Single or chronic - the third reason for possible tooth chips

A single injury occurs when there is a blow, an accident, or accidentally biting on a hard object while chewing.

There are three types of chronic injury

• Due to malocclusion (when the teeth do not close correctly, some teeth may receive excessive load, close in the wrong areas, at the wrong angle, or with an opponent that is not their power). For example, a powerful fang of the lower jaw can be positioned in such a way that when closed, it will severely injure the incisor on the upper jaw, which is much inferior to it in size and power. As a result of such long-term closure, the incisor can get into big problems, and the patient will face the need for treatment or removal.
• Due to the absence of other teeth (when a number of teeth are missing, their work is performed by the remaining ones; excessive load may one day result in a fracture of the tooth, a break in its wall, or a split in the root).
• Due to bruxism (“idle” teeth grinding) or other parafunctional manifestations.

How to avoid?

• Be sure to restore missing teeth (there are a lot of ways today, there are even temporary prosthetics if for some reason you need to postpone dental treatment).
• Consult an orthodontist, orthopedist or periodontist about bite problems and undergo orthodontic treatment if indicated.
• Get advice from an orthopedist/gnathologist and psychotherapist about the possible causes of bruxism and take possible measures that the doctor recommends.

When you have to remove a broken tooth along with the root

Tearing out a broken unit is the most undesirable scenario for any patient, because artificial units, no matter how high-quality and beautiful they are, are still inferior to natural ones. Unfortunately, it is not always possible to save a damaged tooth. Removal is indicated when:

• root damage;
• putrefactive processes in the deep tissues of the gums and jawbone;
• root fracture.

Since the crown is broken, it is impossible to remove debris from the gums using the classical method. The doctor administers anesthesia. Then he cuts through the gum and gets access to the roots. Removes them one by one.

When the wound heals, discusses with the patient how to close the dental defect. In some cases, a decision is made to perform simultaneous implantation with immediate loading. Then, immediately after the operation, the patient goes home with a pin and a temporary crown implanted into the jawbone. The latter will soon be replaced with a permanent one.

What to do if your tooth chipped?

See a dentist.

The doctor will remove the broken wall, take x-rays of the tooth, and evaluate its safety. If the tooth is not broken much, the root is not damaged or almost not damaged, then it can be restored. Then the tooth is prepared (if necessary, dental canals are treated, caries and old filling materials are cleaned), how badly it is damaged is assessed and the best way to restore it is selected (filling, inlay or crown). If the tooth cannot be saved, it is removed and replaced with an implant or other available method.

How to avoid a fracture

Preventive measures seem very simple, but many people ignore them. And absolutely in vain, since their effectiveness has been confirmed by dentists.

To reduce the risk of damage to the root unit, you must:

1. Visit your dentist once a year. The doctor will check for diseases. If any pathologies are detected, they will be treated. At the same time, he will carry out professional oral hygiene. Thanks to it, soft plaque and hard stone will be removed, the condition of the gums will improve, and the enamel will begin to better absorb nutrients.
2. Close carious cavities in a timely manner. Caries is a gateway for the penetration of pathogenic organisms into the deep structures of the tooth. It leads to the fact that the corinca part becomes completely weak and splits.
3. Eat a balanced diet. Your daily diet should include fresh vegetables and fruits. They are natural “trainers” for the jaws and provide the body with minerals and vitamins.
4. Pay special attention to hygiene measures. It is important to use a high-quality fluoride-containing toothpaste when cleaning. The brush should not be too hard.
5. Limit the amount of sweets. They harm not only your teeth, but your overall health.

Anyone can experience a crown or root fracture. This is a state that cannot be delayed. Do your best to never run into him. If the unit does break, go to the doctor immediately. Do not self-medicate under any circumstances.

Diagnostics

If a tooth is fractured, you must consult a dentist. Of course, if the problem does not cause discomfort, which occurs in rare cases, there is no need to rush. But delay can cause even more serious damage, resulting in the tooth having to be removed. Fracture of the anterior elements of the dentition has an extremely negative effect on the beauty of the smile.

A specialist can easily diagnose a tooth fracture. You just need to establish the extent of the fracture and understand whether the remains of the tooth can be saved. To do this, an x-ray is taken, with which the doctor checks for displacement, damage to the root, adjacent tissues and the direction of the fracture. The specialist examines the injured area, analyzes the presence of external damage, swelling, and changes in the color of the enamel. The latter may be a sign of soft tissue necrosis or damage to the neurovascular bundle and filling of the dentinal tubules with blood.

If during percussion a person experiences painful sensations in the damaged tooth and nearby elements of the dentition, this may be a sign of injury to the periodontal and periapical tissues or tooth dislocation. Electroodontometric diagnostics may also be necessary, with which the doctor checks the viability of the pulp in the event of a serious fracture, so that in some cases it can be preserved.

Recovery methods

Qualified dentists, who have a wide range of modern technologies, strive to save the patient’s tooth in any situation. If the root has received minor damage or remains intact, there is always a chance of restoration of the dental unit.

Restoration methods are divided into two large categories - with and without root removal. The choice of technology depends on:

• general condition of the damaged tooth;
• square hemp;
• the presence or absence of an inflammatory process at the root;
• volume of hard tissues;
• gum conditions;
• the presence of chronic diseases in the patient.

If caries, inflammation in the root canals, or dentin rot are detected, the remains of the stump are removed. The unsatisfactory condition of the external tissues inevitably leads to damage to the internal segment of the tooth located in the gum. Softened fragments of dental tissue, damaged by caries and injured, crumble easily. It makes no sense to leave such problematic roots and use them as the basis for recreating a tooth; they must be removed.

Often, the removal procedure is complicated by the incorrect position of the root (crooked, horizontal) or the small size of the stump with the impossibility of grasping it with surgical forceps.

The process of removing the root of a broken tooth includes:

• opening of the gums;
• removal of remaining hard tissue. The treatment is carried out using a gentle method using ultrasound (trauma is reduced, the recovery period after the procedure is shortened);
• dividing the root into parts in complex clinical cases. Such an operation may be accompanied by complications (in particular, alveolitis - post-traumatic infection and inflammation of the tooth socket), and long-term rehabilitation.

Indications and contraindications for the procedure

Extension is indicated in the following cases:

• Chips and cracks on the tooth surface.
• Destruction of enamel or its discoloration, which cannot be eliminated with bleaching.
• Partial tooth loss due to injury or caries.
• Malocclusion.
• Interdental gaps.
• Age-related wear of enamel, in which the dental unit darkens and becomes sensitive to external influences.

However, restoration is not suitable for every patient. It cannot be performed if one of the contraindications is present:

• Untreated caries or gum disease.
• Severe systemic diseases, such as blood diseases or diabetes.
• Some mental disorders.
• Bruxism.
• Bruxism. Individual intolerance to the components of the filling composite.

There are also technological limitations: if it is impossible to protect the restored surface from contact with moisture (for example, saliva), then the extension will have to be abandoned - the filling will not harden. Also, some methods cannot be used for dental treatment in children - for example, they do not have pins installed. For most patients, augmentation remains the optimal solution for restoring a lost tooth fragment.