Whether a broken or severely decayed tooth can be saved is a common concern. Modern advancements in restorative dentistry mean that extraction is often not the immediate option for a compromised tooth. While the severity and location of the damage dictate the ultimate prognosis, dental professionals have a wide array of tools to restore teeth that might have been considered unsalvageable. The goal of treatment remains the preservation of the natural tooth structure whenever possible.
How Dentists Assess Tooth Damage
A dentist’s first step is a thorough diagnostic process using visual examination and radiographic imaging to determine the tooth’s restorability. This assessment focuses on three primary factors: the extent of the decay, the nature of any fracture, and the health of the supporting structures. If the bacterial destruction has progressed deep enough to reach the central pulp chamber, or nerve, the tooth’s viability is significantly affected.
Deep decay that extends far below the gum line makes restoration difficult because it compromises the ability to create a proper seal for a filling or crown. Even after removing all decayed tissue, a minimum amount of healthy tooth structure, known as the ferrule, must remain above the bone level for long-term success. Dentists also assess the remaining dentin thickness, as a dentin wall less than one millimeter thick can increase the risk of failure.
Fractures introduce challenges, and the severity is classified based on the crack’s depth and orientation. Minor damage, such as craze lines that only affect the outer enamel, typically requires minimal intervention. Conversely, a split tooth, where the crack extends completely through the tooth, or a vertical root fracture, often renders the tooth unrestorable. Fractures extending into the root structure compromise the integrity and open pathways for bacterial contamination.
The long-term prognosis also depends heavily on the health of the surrounding bone and gum tissue. A tooth needs stable support to withstand the forces of chewing. Severe bone loss from advanced periodontal disease can make a tooth loose, or mobile, even if the tooth structure itself is intact. If the foundation of the tooth is inadequate, there may not be sufficient anchor points to maintain health and function.
Treatment Options for Saving a Tooth
When the assessment indicates that a tooth can be successfully saved, the treatment plan centers on eliminating disease and restoring structural integrity. If decay has reached the pulp, endodontic therapy, commonly called a root canal, is the procedure of choice. This treatment involves removing the infected or inflamed pulp tissue from the interior of the tooth and its roots. The internal canals are meticulously cleaned, disinfected, and then filled with an inert material to prevent re-infection.
Successfully treated teeth often require further steps to ensure they can function reliably over time. The tooth is naturally weakened after deep decay and the necessary endodontic access preparations. To fortify the compromised tooth, a core buildup is frequently performed, replacing the missing coronal structure with a strong restorative material. This new structure acts as a stable base to receive the final restoration.
If the loss of coronal tooth structure is extensive, a post may be placed into one of the root canals to help retain this core buildup. This post acts like an internal anchor, providing mechanical support to the core material that will ultimately secure the crown. The final step in almost all cases of saved, severely damaged teeth is the placement of a full-coverage restoration, or crown.
A dental crown is a custom-made cap that completely encases the remaining tooth structure above the gum line. This covering provides a shield against fracture and restores the tooth’s natural shape, size, and function. The crown distributes chewing forces evenly across the remaining tooth, which is especially important for back teeth that bear significant load. The combined steps of root canal therapy, core buildup, and crown placement are a successful sequence for preservation.
Alternatives When Extraction Is Necessary
If the damage is deemed too severe, such as a vertical root fracture or decay that extends too far below the bone, extraction becomes the only responsible option. Once the unsalvageable tooth is removed, the concern shifts to replacing the missing tooth to prevent shifting of adjacent teeth and jawbone deterioration. Two primary fixed options are available: dental implants and fixed bridges.
A dental implant is a titanium or zirconium post surgically placed into the jawbone, acting as a substitute for the natural tooth root. This is often considered the optimal replacement because the implant stimulates the bone, which prevents the bone loss that naturally occurs after extraction. Once the implant integrates with the bone, a custom crown is placed on top, providing a replacement that functions and looks like a natural tooth without affecting neighboring teeth.
The fixed bridge offers an alternative that does not require surgery and is generally quicker to complete. A bridge consists of an artificial tooth suspended between two crowns, which are cemented onto the healthy teeth adjacent to the gap. While effective, the bridge requires that the neighboring teeth be filed down to accommodate the supporting crowns, altering healthy tooth structure. Both implants and bridges provide a stable, non-removable solution for restoring chewing function.