A tooth fracture can occur in both the front and back teeth, but the causes differ for each region. The front teeth most often become fractured due to sports trauma or some other external event, and may show signs of mobility due to underlying bone or tissue damage or exhibit damage to the vital tissue known as the pulp.
Posterior teeth often crack or fraction off due to active termination or improperly placed restorations. Although these fractures may not present as urgent an aesthetic problem as those bound to the front teeth, serious damage to both the tooth and supporting structures and tissue can occur without prompt treatment. This article looks at the various type of tooth cracks and how treatment is approached for each.
Superficial Cracks in the Front Teeth
Cracks that occur on the front teeth can be privileged or implicate deeper layers of the tooth. They can occur due to external trauma or natural causes. Tooth structure on either side of the crack is still structurally secure but its integrity can disintegrate with time, evolving into a complete fraction (the sides can break off with little force).
"Craze" lines are an example of a naturally-occurring crack that is restricted to the outer enamel layer. Tooth enamel protects the interior layers of the teeth, but can be successfully restored with composite bonding or refinishing of the enamel surface. The same can be said for traumatic injuries to just the enamel.
During composite bonding, the dentist simply etches the tooth and applications a white filling-like material to the crack.
Deeper Cracks in the Front Teeth
Deeper cracks can introduce complications to treatment. If the crack extends into the second layer, known as the dentin, it can still be successfully repaired with composite bonding or an indirect restoration (veneers). The goal of treatment is to achieve aesthetic correction but to also keep the crack from propagating deeper into the tooth structure.
Cracks that have extended into or near the pulp present a cause for concern. The pulp constituents of vital tissues that facilitate the growth and regenerative processes of the tooth. A crack that exposes the pulp to the oral environment can introduce bacteria into the pulp chamber, where it can cause infection and consequent death of the tooth. Depending on the age of the patient and the amount of damage already done to the pulp, two main options exist.
The pulp or dentin immediately surrounding the pulp can be medicated after active decay is removed to stimulate new dentin growth. The tooth can then be restored with composite bonding or through other restoration methods and re-examined in several months to confirm pulpal health. This approach is ideal for immature teeth with developing roots. In instances where the pulp and / or supporting tooth structures have become infected, a root canal is recommended.
A root fraction threatens the structural integrity of the tooth and can affect both the dentin and pulp. Teeth that have received prior endodontic treatment are typically at higher risk for root fraction. Treatment may initially include stabilization of the tooth and observation of crack progress and pulpal health. If complications develop root canal therapy, partial root removal, or tooth extraction may be recommended.