A cracked tooth is a common dental emergency often causing sharp pain or sensitivity. While a dentist can pull a cracked tooth, extraction is reserved for the most severe cases. The decision to save or remove the tooth depends entirely on the crack’s depth, direction, and classification. Dentists strive to preserve natural teeth, making a detailed diagnosis the first step in determining the correct treatment path.
Classification of Cracked Teeth
The prognosis and treatment for a fractured tooth are linked to the type and extent of the damage. The American Association of Endodontists classifies cracks into five main categories to guide clinical decisions. The least severe are craze lines, which are superficial hairline cracks in the outer enamel layer that typically require no active treatment.
A fractured cusp involves a piece of the chewing surface breaking off, often in teeth with large fillings. This fracture usually runs parallel to the tooth’s long axis and does not typically extend into the root or affect the pulp, making the tooth salvageable. A true cracked tooth is more concerning, as the fracture begins on the crown and runs vertically toward the root, sometimes involving the inner pulp tissue.
A split tooth is a progression of a cracked tooth, where the fracture extends completely through the tooth, resulting in two distinct segments. This condition often makes the tooth non-restorable and requires extraction. Vertical root fractures are the most severe category; they begin in the root structure and travel upward, frequently occurring in teeth that have had a root canal.
Treatment Options to Save the Tooth
When the crack is confined to the upper portion of the tooth, restorative treatments stabilize the structure and prevent the fracture from spreading. For minor cracks or chipped cusps, dental bonding may be used. This involves applying a tooth-colored composite resin directly to the crack, restoring function and sealing it from bacteria.
If the crack is more extensive but has not reached the pulp, a dental crown is often the treatment of choice. The crown, a custom-made cap, completely covers the remaining tooth structure, holding the fractured pieces together and preventing crack propagation. If the crack has extended into the pulp, causing inflammation or infection, root canal therapy is performed before the crown is placed. This procedure removes the damaged nerve and pulp tissue, eliminating the source of infection while preserving the tooth.
When Extraction Becomes Necessary
Extraction is justified when the damage is so extensive that the tooth is deemed non-restorable. This occurs when the fracture extends vertically deep beneath the gum line, making it impossible to seal the crack effectively. A crack that runs apically into the root below the cementoenamel junction (where the crown meets the root) significantly lowers the tooth’s long-term prognosis.
Vertical root fractures and split teeth most often require extraction because the fracture planes prevent effective stabilization. The crack acts as a pathway for bacteria to invade the bone and surrounding tissues, leading to severe infection or periodontal disease. Removing the tooth eliminates the source of infection and prevents further damage to the jawbone and adjacent teeth.
Restoration After Tooth Removal
Once a cracked tooth is removed, replacing the missing tooth is necessary to maintain the integrity of the dental arch. Failure to replace the tooth can lead to the shifting of neighboring teeth, changes in bite alignment, and jawbone deterioration. The most durable replacement option is a dental implant, which involves surgically placing a titanium post into the jawbone.
The implant post fuses with the bone through osseointegration, providing a stable foundation for a custom-made crown. Alternatives include a fixed dental bridge, which uses adjacent healthy teeth for support to suspend a false tooth. A removable partial denture is another option, offering a more affordable replacement that uses clasps to attach to the remaining teeth.