It is a common experience that a patient breaks a tooth. It can be a simple tiny chipped piece of tooth enamel to a major crack or fractured portion of the tooth. It is our opinion that one should try and keep their natural teeth and receive the normal longevity that is inherent. Therefore, this discussion is in regards to the variety of treatment modalities that are available to you.
First, a careful diagnosis needs to be developed. This is accomplished by a clinical evaluation and some dental images. You may have just a small chip. An example of this occurs on lower front incisors. Commonly these teeth become very thin over time and sometimes chip. It is very annoying to the tongue and can be simple treated with delicate polishing and a small resin placed on the polished edges. This simple treatment can be done without anesthesia. This area of your mouth does not demand great esthetics.
Many times a small portion of back tooth chips away and is also rough to the tongue. It maybe a cusp of a molar or premolar (bicuspid) that has fractured off. This type of emergency also needs to be carefully examined and new images are made. This type of tooth trauma usually needs a more substantial treatment-a crown restoration.
As a dentist, it is our duty to determine if there are potentially more areas of this tooth that have cracks or potential problems. Does this tooth have a history of an occasional past response when chewing crunchy or firm foods? The response is comparable to a quick but slight electrical like jolt.
A simple pulpal test is done with CO2! A bite test is prescribed. If the tooth pulp is healthy you will feel the cold and have no response to the bite test. Thus, if there are no other cracks, a healthy pulp and good gum and bone support, a new crown should give you approximately two decades or more of service and ideal esthetics. You now understand a little more about your broken tooth that does not involved the nerve (pulp) of your tooth.
Yes, sometimes due to costs of this type of broken tooth (fractured cusp) a sustaining filling (restoration) can be done however it is much wiser to have the crown done and not loose the tooth and spend money for a temporary fix and then have to work on the tooth again for the crown and the additional expense.
There are fractures that occur commonly where the entire front, back or side of the tooth is fractured off. It has been our experience that this type of fracture can also be successfully treated with a crown. Again, one must carefully diagnosis the health of the pulp, the bone and gum supporting this tooth. This type of broken tooth needs even more care in diagnosing.
If your pulp of this tooth is involved, then you come to a different cross road in treatment planning. To keep this tooth, a root canal treatment is necessary.
A treated molar or premolar (back tooth) with a root canal treatment is much more involved treatment. The treatment takes more time and it is necessary to remove all the internal tissues that are not healthy. The canals of this type of tooth must be thoroughly cleaned and all affected tissues remove. A build up internally is needed, finally a crown and its delivery of the crown. This type of treatment gives one comfort, health, function and esthetics.
Our job as dentists is to determine if the cracked tooth is structurally strong enough to hold a crown and give you good longevity. If the tooth is not structural strong and the prognosis is poor or hopeless then removal is the treatment plan.