Diagnoses

Figure 1a: A tooth with obvious fractures that did not have symptoms. Some of the fractures in this tooth had been present long enough to develop dark pigment in the fracture lines. The one at the bottom of the photograph is newer and lacks pigment. The tooth developed decay either before or after the newer crack occurred and required treatment to save it.

Figure 1b: Although the tooth appeared badly cracked, a bonded filling was able to repair the decay and stabilize the fracture long enough for the patient and dentist to consider the best long term option for restoring the tooth's contours and protecting it against propagation of the crack. These would typically include an onlay or crown.

Figure 2a: Another (rather extreme) example of a tooth with extensive damage, which was able to be repaired with composite bonding resin for a significant length of time. Although a crown or onlay would provide a tooth such as this with significantly more protection against subsequent fractures, better chewing anatomy, and smoother contours for oral hygiene, success with the bonded filling was made possible by the fact that a significant amount of enamel remained around the circumference of the tooth, and the initial silver fillings were not particularly deep.

Figure 2b: The dentist had recommended a crown as the best long-term restorative option, which is consistent with current standard of care recommendations. However, due to financial constraints, the patient did not elect that option. At the time this X-ray image was exposed, the bonded filling had been in place several years, with no visible signs of breaking down and no symptoms. Depending on many factors, which can only be evaluated by a dentist this type of ultra-conservative treatment may or may not be successful long-term, and can place the tooth at greater risk of fracturing irreparably.

Figure 3: How you use your teeth helps determine whether or not they will crack. This tooth broke in half (vertical fracture) when the patient bit down hard on a popcorn kernel. Note that it had never been decayed or restored, demonstrating that it isn't just teeth with fillings or those that have had endodontic (root canal) treatment that are susceptible to cracking. This tooth required extensive procedures to be saved, including crown lengthening surgery, a pin-retained core buildup, and a crown. This patient was lucky in one respect. Frequently a tooth injury this extensive would have necessitated another significant procedure—endodontic (root canal) therapy. It is possible the tooth will require endodontic treatment in the future. Options may have included removal of the tooth and replacement with a fixed bridge or implant.

Figure 4a: An apparently serious horizontal fracture of an 8-year-old boy's permanent upper central incisor, sustained while playing street hockey. The photograph illustrates the importance of wearing an athletic mouthguard for sports involving physical contact. Although it appears that most of the visible portion of the tooth is gone, the fracture did not extend into the pulp, as the tooth was not yet fully erupted. Fractures exposing the tooth's pulp (i.e. blood vessels and nerves) will require root canal (endodontic) treatment.

Figure 4b: The tooth was restored to proper shape, shade and function with bonded composite resin filling material, and monitored on three month intervals for signs of abscess. The procedure took about an hour, and was done under local anesthetic. At a seven year follow-up, the tooth had remained vital (i.e. "alive"). Orthodontic brackets had even been placed on the tooth successfully, and no crown had yet to be done, although a future crown will likely be required for this patient.