Have you experienced a dental fracture recently or in the past, and that’s why you’re reading this blog? We completely understand the frustration that comes with such an incident, regardless of whether the fracture is minor or severe. It can be disheartening to see one’s teeth altered due to an accident, no matter the scale, and even more so when it causes discomfort. As dental professionals, we’ve seen this situation occur among our patients and have even experienced it ourselves.
In this blog post, you will learn everything you need to do in the event of a dental fracture. It’s important to note that each fracture requires a different treatment approach, which is why I will take the time to walk you through each type and provide solutions for each case.
1. Dental fracture of enamel only (Approximately 1 to 2 mm):
These fractures tend to appear in individuals who exhibit bruxism, waking up with unexpected fractures in the morning. Additionally, those who have habits such as nail-biting (onychophagia), chewing on pencils, or have mouth piercings are also at risk of experiencing this type of fracture.
When the fractures are small, measuring around 1mm and the patient has large teeth, they can be effectively polished to restore the tooth’s original shape. However, when the patient has smaller teeth, it’s best to opt for dental resin to avoid affecting the tooth’s divine proportions. This treatment is quick, taking only about 20 minutes to complete, and yields very satisfactory results. With dental resin, the tooth can be restored to its original shape before the fracture, without requiring any dental carving.
2. Enamel and dentin fracture (Approximately 4 mm of tooth):
In cases where the tooth fracture is due to an accident, it’s not uncommon to find the broken piece of the tooth on the ground. In such situations, it’s important to take prompt action. If you happen to come across the missing tooth fragment, it’s recommended to put it in water to prevent dehydration, and then seek emergency dental care as soon as possible. In many cases, the area of the fractured tooth can be retrieved and reattached to the tooth using dental resin. However, it’s crucial to act quickly and seek professional care to ensure the best possible outcome.
Alternatively, if the tooth fragment is in poor condition or if the final aesthetic outcome would not be satisfactory, a highly aesthetic resin in the color of the remaining tooth is a recommended option. In recent years, this area of dentistry has made significant advancements, allowing for a wide range of colors and effects to be used in order to achieve a natural-looking result that blends in with the surrounding teeth. Moreover, these modern materials are much more durable than those used previously, making them an excellent long-term solution.
If you’re unable to find the missing piece of the tooth, which is typically the case in 99% of situations, there’s no need to worry. The dental professional will evaluate your case and determine the best course of action based on your specific needs and expectations.
- A highly aesthetic resin can be created, which typically takes between 20 minutes to an hour to complete, depending on the size of the restoration. This type of restoration can last anywhere from 3 to 4 years on average, although with proper care, it can last even longer. However, if you frequently consume dark-colored foods or smoke, you may need periodic touch-ups every 6 months to 1 year in the form of resin polishing in order to maintain its shine.
- Ceramic veneers offer an alternative type of restoration, which may be advantageous for patients who smoke or consume dark-colored foods frequently. The color stability of ceramic veneers is typically greater, and they do not require any gloss retouching since these are performed during laboratory fabrication. The average lifespan of ceramic veneers is around 15 years.
- In cases where there are multiple fractured teeth, we may opt for a restoration of the fractured tooth and smile design using resin. This approach helps to improve the uniformity of the aesthetics and strengthen the teeth without the need for any carving, preserving the enamel. By performing this procedure, we can prevent staining from affecting individual teeth at different times and instead maintain a consistent appearance. The decision to undergo a smile design is made collaboratively with the patient.
3. Enamel and dentin fracture accompanied by pain:
In cases where the fracture is larger and causes pain, it may indicate involvement of the dental nerve. To determine the severity of the situation, it’s important to differentiate between a sensitivity that goes away when the cold or heat stimulus is removed, and a severe pain that persists with or without stimulation and worsens in a horizontal position.
If the pain is severe, it’s necessary to seek emergency dental care to have the dental nerve removed. During the procedure, local anesthesia is applied and a periapical x-ray is taken to evaluate the extent of the damage. The nerve is then removed and disinfected to prevent any future infections that may require antibiotics. Depending on the extent of the fracture, the tooth can be restored with dental resin or a temporary acrylic crown in cases where a significant portion of the tooth has been lost.
If you have a fractured tooth, it’s important to seek dental care as soon as possible to avoid further damage and to restore the tooth to its original function and appearance. In some cases, the fracture may involve the dental nerve, which can cause intense pain and require immediate attention.
If the nerve is affected, a dental specialist known as an endodontist will need to perform a procedure called endodontics to seal the nerve cavity and prevent further infection. Once the nerve is sealed, the tooth can then be restored with a highly aesthetic resin or ceramic material, depending on your preferences and the severity of the fracture.
If the fracture is not accompanied by intense pain, it’s still important to have it evaluated by a dentist who specializes in aesthetics. An x-ray can help determine how far the fracture is from the nerve and whether endodontics is necessary. If the nerve is in good condition, the tooth can be restored with a resin or ceramic material to achieve a natural-looking and functional result.
Performing the restoration can often solve mild sensitivity, but for cases of large fractures, it is recommended to have long-term follow-up as the tooth may change color and become dark over time in a small percentage of patients. In such cases, internal teeth whitening may be a solution, which can be carried out by a cosmetic dentist or endodontist. This procedure can help restore the tooth’s natural color and improve its appearance. It involves applying a whitening agent inside the tooth, which is then sealed for a period of time to allow the agent to take effect. It is important to note that this procedure may not be suitable for all patients, and a thorough examination and consultation with a dental professional is necessary before proceeding with any treatment.
4. Large complex vertical dental fracture:
In instances where a dental fracture extends beyond the visible portion of the tooth and affects the root, it is considered a complicated dental fracture. As dental professionals, our goal is to be as conservative as possible and attempt to preserve the affected tooth. Nevertheless, in these circumstances, the situation becomes more challenging, and there may be limited options available to save the tooth.
In cases where the dental fracture extends to the root of the tooth, the options for saving the tooth become limited. As dentists, our priority is to be minimally invasive and try to save the tooth whenever possible. However, in complex cases, such as this, we must evaluate all options and consider the possibility of surgery. A panoramic x-ray or computerized axial tomography of the tooth is taken to assess the situation and decide on the best course of action.
If surgery is not an option, dental implants are the most recommended solution. In such cases, it is preferred to perform the implant placement surgery on the same day the tooth is removed to minimize bone loss and facilitate the healing process. After the surgery, a temporary aesthetic plate or an acrylic tooth supported by neighboring teeth may be placed to assist with the recovery.
The definitive restoration is usually done in 3 to 6 months when the process of osseointegration takes place. Osseointegration is a process in which the implant integrates with the surrounding bone tissue, becoming firmly attached to it. During this period, the patient should maintain good oral hygiene and attend regular check-ups with the dentist to monitor the healing process. Once the osseointegration is complete, the permanent restoration can be placed, and the patient can enjoy a fully functional and aesthetically pleasing smile.