A cracked tooth, particularly one that has already undergone root canal treatment, presents a complex dental challenge. Saving such a tooth involves assessing the crack’s nature and factors influencing its potential for repair. This article explores preserving a cracked root canal tooth and the considerations involved in its treatment.
Types of Cracks in Root Canal Treated Teeth
Cracks in teeth are categorized by their extent and location, each type having different implications for a tooth’s prognosis. Craze lines are superficial cracks affecting only the enamel, typically not causing symptoms or requiring treatment. A fractured cusp involves a piece of the chewing surface breaking off, often due to biting stress or large fillings.
A crack extending into the pulp, the innermost part of the tooth, can cause pain and sensitivity, potentially requiring root canal therapy or retreatment. A split tooth, a progression of a crack, extends from the crown into the root, often dividing the tooth into two or more segments. Vertical root fractures begin in the root and extend upwards towards the crown, frequently occurring in root canal treated teeth due to increased brittleness.
Diagnosing a Cracked Tooth and Salvageability Factors
Dental professionals use several methods to diagnose a cracked tooth. Visual inspection with magnification and transillumination helps reveal cracks. Staining the tooth surface with a dye can make subtle crack lines visible. Biting tests, using a specific tool, pinpoint the exact location of pain. Advanced imaging, such as cone-beam computed tomography (CBCT) scans, provides detailed 3D views of the tooth and surrounding bone, detecting deeper cracks or vertical root fractures not visible otherwise.
Saving a cracked root canal tooth depends on factors including the crack’s location and depth, symptom severity, and remaining healthy tooth structure. The health of surrounding gum and bone tissue also plays a role in determining if a tooth can be salvaged.
Treatment Options for Saving a Cracked Tooth
The approach to saving a cracked root canal tooth depends on the crack’s type and extent. For minor cracks like craze lines or small fractured cusps, dental bonding with a tooth-colored resin can repair the damaged area and restore integrity. When a crack extends deeper but has not fully split the tooth, or if a significant portion of the cusp has fractured, a full-coverage restoration like a dental crown is recommended. The crown encapsulates the tooth, holding cracked segments together and preventing further propagation.
If the crack extends into the existing root canal system or if the original root canal treatment was compromised, root canal retreatment may be necessary. This procedure involves re-entering the tooth, cleaning, disinfecting, and refilling the root canals to eliminate infection and seal the tooth.
If a crack is isolated to the root apex and can be precisely sealed, an apicoectomy might be considered. This surgical procedure involves removing the root tip and sealing the root canal from the end to address localized infection or persistent symptoms. The goal of these treatments is to reinforce tooth structure, prevent the crack from worsening, and maintain the tooth’s function.
When a Tooth Cannot Be Saved
Despite efforts, some cracked root canal teeth are beyond repair. Severe vertical root fractures, extending completely through the root, make the tooth unsalvageable as they allow bacteria to enter the bone, leading to chronic infection and bone loss. Extensive tooth loss due to the crack, or untreatable infections, also make saving the tooth unlikely. Attempting to save such a tooth would likely result in continued pain, infection, or eventual failure.
When a cracked tooth cannot be saved, extraction is necessary to alleviate pain and prevent further complications. Following extraction, options are available to replace the missing tooth and restore oral function.
Dental implants, involving surgically placing a titanium post into the jawbone to support a crown, are a durable solution. Fixed bridges use adjacent teeth as anchors to support a prosthetic tooth. Removable partial dentures offer a less invasive and economical alternative.
Long-Term Outlook and Prevention
The long-term success of a saved cracked root canal tooth varies based on the initial crack type, treatment performed, and oral hygiene habits. Teeth with vertical root fractures have a poor prognosis, even after treatment, while those with less severe cracks have more favorable outcomes. Regular dental check-ups and diligent home care contribute to the longevity of treated teeth.
Preventing future cracks, especially in root canal treated teeth, is key for long-term oral health. Avoiding chewing on hard objects like ice or hard candies minimizes stress on teeth. For individuals who clench or grind their teeth (bruxism), wearing a custom-fitted nightguard protects teeth from excessive forces during sleep. Maintaining good oral hygiene, including regular brushing and flossing, keeps teeth and gums healthy.