Treating Fractured Root
Perhaps the worst diagnosis you might want to hear about your teeth is the one that detects fractured tooth roots. And it's no wonder, since the treatments for the problem depend on the extent and location of these fractures, which, in most cases, are deep and difficult to access. And when the fractured root is not diagnosed in time, the tooth is susceptible to bacterial infiltration that can lead to resorption of the bone around these roots. The result is almost always the loss of the fractured tooth.
The causes for the roots with fractures in anterior and posterior teeth include:
- direct trauma
- bruxism
- root canal treatment
- metal prosthetic pin
- cavities
Diagnosis of fractured roots in anterior and posterior teeth
Fractures in dental roots do not cause severe pain most of the time – for some patients, not even pain is related to the problem. Others reveal a dry snap when biting into dry food. Reports of symptoms and signs that can be examined are always accompanied by radiographic examinations to prove the breakage or fracture of the root or tooth. They accurately detect cracks and fractures in the root and dental crown. If it is not mandatory for all cases of suspected teeth with root fracture, it is more than essential, since traditional radiographic exams have considerable limitations in the diagnosis of fractures – mainly in vertical fractures (which follow the major axis of teeth).
The treatment and prognosis of your tooth root fracture depends on several factors. Among them are the time between the fracture and the treatment, the degree of mobility of the tooth, the location of the fracture (the closer to the gum, the worse the recovery prognosis), the degree of development of the tooth (children have a worse prognosis for fractures in permanent teeth), age and quality of care provided. And among all these factors, the location of the root fracture and the extent of the fracture to the dental pulp (where nerves and blood vessels are located) are the ones that most influence the prognosis and treatment of a fractured root.
1. Temporary immobilization
The treatment consists of immobilizing the tooth until the fracture consolidates – the treatment idea is the same for fractures in long bones such as the radius or the femur. The difference is the way the tooth is immobilized: orthodontic wire joined by resins is the most common technique; tapes with fibers impregnated with resin are more aesthetic alternatives for the treatment. The period of immobilization can range from 45 to 90 days, depending on the degree of mobility or other technical considerations. The prognosis of success is between 72 to 100%, according to some dental research.
2. Apicectomy
When the fracture occurs very close to the apex of the root (almost at the end), surgery to remove the tip of the root (apicectomy) is a very interesting possibility – not to mention essential. And for these procedures, root canal treatment prior to or during the surgical procedure is mandatory. And in situations of fractures that reach the tooth pole, it is good to be aware of the need for root canal treatment, since research indicates that almost 30% of these cases end up with necrotic nerves and vessels over the year - and that only can be resolved with root channel treatment.
3. Orthodontic traction
The best prognosis for a fractured tooth root occurs in situations where the problem occurs close to the gums. In these cases, the objective of the treatment is to expose the fractured area above the gums, thus allowing repair techniques either with fixed dental prosthesis in porcelain or dental restoration in resin or porcelain. The technique consists of using a partial version of the orthodontic appliance attached to a few teeth adjacent to the fractured root to pull the tooth root until the tooth fracture is exposed and able to be treated. The treatment time can vary from 30 to 90 days.
4. Surgery to increase the clinical crown
An alternative to orthodontic traction is surgery to lengthen the clinical crown. Similar to techniques such as gingivoplasty and gingivectomy, the technique exposes fractures located close to the gingival margins, thus allowing recovery with dental prostheses or resin or porcelain restorations.
5. Extraction
Extraction (tooth removal) is common in several situations, mainly for fractures located in the medial portion of the root (transverse direction) or that occur in the longitudinal direction – this one, regardless of the place where it occurs. In these cases, the treatment of the fractured tooth root ranges from dental implants to fixed dental prostheses.