A broken and decayed tooth can often be saved, but the outcome depends entirely on the extent of the damage to the tooth’s structure and its internal health. Decay is caused by bacteria creating holes (caries) in the enamel and underlying dentin. A broken tooth involves a physical fracture, ranging from a small crack to a full split extending into the root. Modern dentistry provides several methods to repair and restore such teeth, but the window of opportunity decreases significantly as the damage deepens. The decision to save the tooth is made by a dental professional after careful examination.
Assessing the Damage to Determine Viability
The first step in determining if a tooth is salvageable involves evaluating three primary factors: the location of the fracture, the depth of the decay, and the health of the dental pulp. A fracture limited to the outer layers (enamel or dentin) presents a much better prognosis for repair. If the fracture line extends far below the gum line or into the tooth’s root, the chances of saving the tooth diminish considerably.
The depth of the decay is another major consideration, as extensive decay leaves less healthy tooth structure to support a restoration. If the decay progresses too far subgingivally (below the gum line), it may become impossible to clean and seal the tooth properly. The most significant factor is the status of the dental pulp, which is the soft tissue inside the tooth containing the nerves and blood vessels.
When decay or a fracture exposes the pulp, bacteria can enter, leading to inflammation or a severe infection known as pulp necrosis. Dentists use thermal testing, X-rays, and clinical examination to assess the pulp’s health and determine if the inflammation is reversible. If the pulp is irreversibly infected or necrotic, the tooth can still be saved, but it requires root canal therapy before any final restoration.
Restorative Options for Salvaging the Tooth
When a tooth is deemed salvageable, the treatment path is chosen based on the amount of healthy tooth structure remaining and the involvement of the pulp.
For minor damage, such as small fractures or superficial decay, a direct restoration is often employed. This involves using tooth-colored composite resin, which is bonded directly to the tooth to fill the cavity or repair the chip.
For moderate damage involving a larger portion of the biting surface, the dentist may opt for an indirect restoration, such as an inlay or onlay. These restorations are custom-made in a dental laboratory to fit precisely into the prepared tooth structure. An inlay fits within the cusps, while an onlay covers one or more cusps, providing greater structural support than a simple filling.
When a significant portion of the tooth structure is lost due to decay or fracture, a dental crown (cap) is the most common solution. A crown covers the entire visible portion of the tooth above the gum line, restoring its shape, strength, and function. Placing a crown requires the tooth to be conservatively shaped to ensure the restoration fits securely and can withstand normal biting forces.
If the dental pulp is infected but the outer tooth structure remains viable, root canal therapy is performed to save the tooth. This procedure removes the infected pulp tissue, cleans and disinfects the inner chamber, and then fills and seals the space with a biocompatible material. A tooth that has undergone root canal therapy is often covered with a crown afterward to prevent fracture, as the tooth can become more brittle.
When Extraction Becomes Necessary
Unfortunately, not all broken and decayed teeth can be saved, and extraction is sometimes the only viable option to protect overall oral health.
The most common reason for non-viability is a vertical root fracture, a crack that begins below the gum line and splits the tooth root. This fracture is often impossible to repair and creates a pathway for chronic infection and bone loss, necessitating removal.
Extraction is also required if the decay or fracture extends so far below the gum line that there is insufficient healthy tooth structure remaining to support any restoration. Severe, untreated gum disease that has led to significant bone loss around the tooth can also make the tooth unstable and unsalvageable. Removing the tooth prevents the spread of infection and further destruction of the surrounding jawbone.
Following an extraction, the missing tooth must be replaced to prevent adjacent teeth from shifting and to maintain proper chewing function. The primary replacement options include dental implants, fixed bridges, and partial dentures.
Dental Implants
Dental implants are considered the most durable and long-term solution. They involve a titanium post surgically placed into the jawbone, which stimulates the bone and prevents the bone loss that occurs when a tooth root is missing.
Fixed Bridges
A fixed bridge is a traditional alternative that uses the adjacent teeth as anchors, placing crowns on them to support an artificial tooth. While bridges are quicker to complete than implants, they require altering potentially healthy neighboring teeth.
Partial Dentures
Partial dentures are a removable and typically more cost-effective option, used when multiple teeth are missing. They do not offer the same stability or bone preservation benefits as implants.