A tooth fractured at the gum line can be a concerning dental issue, presenting unique challenges for dental restoration. Understanding the factors involved in assessing such a tooth and its treatment options is helpful.
Assessing the Tooth’s Condition
When a tooth breaks at the gum line, a dentist first evaluates the damage to determine if a crown is a feasible solution. A significant factor is the amount of healthy tooth structure remaining above the gum line. For a crown to adhere and provide stability, approximately 1.5 to 2 millimeters of healthy tooth structure, known as the “ferrule effect,” is needed. This ensures the crown can grip the tooth securely and distribute chewing forces effectively.
The health and integrity of the tooth’s root and surrounding bone are also assessed. A healthy root, free from fractures or significant decay below the gum line, is necessary to support any restoration. If the pulp, the innermost part of the tooth containing nerves and blood vessels, is exposed or infected due to the fracture, a root canal procedure may be required before considering a crown.
The condition of the supporting gum tissue and alveolar bone also plays a role in restorability. Healthy gums without deep pockets or active periodontal disease are important for a crown’s long-term success. Adequate bone support ensures the tooth remains stable in its socket after restoration. All these factors dictate whether a crown is a viable option.
Preparing for a Crown
If the assessment indicates that a crown is a viable option for a tooth broken at the gum line, several preparatory procedures may be necessary to create a stable foundation. One common preliminary step is root canal treatment, especially if the tooth’s pulp has been exposed or infected by the fracture. This procedure involves removing the damaged or infected pulp, cleaning and shaping the inside of the root canal, and then filling and sealing it to prevent further infection.
Another procedure that might be required is crown lengthening, a minor surgical intervention. This involves carefully reshaping the gum tissue and, sometimes, the underlying bone to expose more of the natural tooth structure above the gum line. Exposing additional tooth surface ensures enough healthy tooth for the crown to fit and seal, improving its longevity and reducing the risk of future decay.
For teeth with insufficient remaining tooth structure, a post and core buildup provides the necessary support for the crown. A post, often made of metal or fiber, is placed into the root canal space to provide retention, and then a core of restorative material is built around it to replace the missing tooth structure. After these preparatory steps, an impression of the prepared tooth is taken to create a custom-fit permanent crown, and a temporary crown is placed to protect the tooth in the interim.
Alternative Treatment Options
In situations where a tooth broken at the gum line cannot be saved with a crown due to extensive damage or insufficient healthy structure, extraction becomes the necessary course of action. This involves removing the entire tooth, including the root. After extraction, various options are available to replace the missing tooth, helping to restore chewing function and maintain the alignment of surrounding teeth.
One common replacement method is a dental bridge, which consists of one or more artificial teeth held in place by crowns on the adjacent natural teeth. The adjacent teeth are prepared to support the bridge, and the prosthetic teeth fill the gap left by the extracted tooth. This option provides a fixed solution, preventing neighboring teeth from shifting into the empty space.
A dental implant offers another durable alternative for tooth replacement. This procedure involves surgically placing a small, screw-shaped post made of titanium into the jawbone where the tooth was lost. Over several months, the implant fuses with the bone in a process called osseointegration, creating a stable foundation. Once integrated, a custom-made crown is attached to the implant, providing a natural-feeling and aesthetic replacement that does not rely on adjacent teeth for support.