Cracked and fractured teeth are common dental problems. As people retain their natural teeth longer (due to advances in dental technology), the likelihood of cracked teeth increases. There are many reasons why teeth may crack, for example, biting on hard objects, trauma, grinding and clenching of teeth. All of these behaviors place the teeth under extra strain and render them more susceptible to cracking.

When tooth enamel is cracked, pain can become momentarily debilitating. When no pressure is exerted on the crack there may be no discomfort. However, as the cracked tooth performs a biting action, the crack widens. The pulp and inner workings of the tooth then become exposed, and painful irritation occurs. As pressure is released again, the two parts of the crack fuse back together, and pain subsides. If left untreated, the pulp becomes irreversibly damaged and constantly painful. The resulting pulp infection can affect the bone and soft tissue surrounding the tooth.

Symptoms of a cracked tooth may include:

• Unexplained pain when eating.
• Sensitivity to warm and cold foods.
• Pain with no obvious cause.
• Difficulty pinpointing the location of the pain.

What kind of cracks can affect the teeth?

There are many ways in which a tooth can be cracked. The specific type of crack will determine what type of treatment is viable. In many cases, if the crack is not too deep, root canal therapy can be performed and the natural tooth can remain in the mouth. In other situations, the tooth is too badly damaged and requires extraction.

Here is a brief overview of some of the most common types of cracks:

Crazes – These are generally tiny vertical cracks that do not place the teeth in danger. These scratches on the surface of the teeth are considered by most dentists to be a normal part of the tooth anatomy. A craze rarely requires treatment for health reasons, but a wide variety of cosmetic treatments can be performed to reduce the negative aesthetic impact.

Oblique supragingival cracks – These cracks only affect the crown of the tooth and do not extend below the gum line. Usually, the affected part of the tooth will eventually break off. Little pain will result, because the tooth pulp (that contains the nerves and vessels) will remain unaffected.

Oblique subgingival cracks – These cracks extend beyond the gum line, and often beyond where the jawbone begins. When a piece breaks off, it will usually remain attached until the dentist removes it. Oblique subgingival cracks are painful and may require a combination of periodontal surgery (to expose the crown), and endodontic treatment to place a crown or other restorative device.

Vertical furcation cracks – These cracks occur when the roots of the tooth separate. This type of crack almost always affects the nerve of the tooth. Because the tooth will not generally separate completely, root canal therapy and a crown can usually save the tooth.

Oblique root cracks – These cracks tend not to affect the surface of the tooth at all. In fact, the damage is only apparent below the gum line and usually below the jawbone. Root canal therapy may be possible; depending on how close the fracture is to the tooth surface. However, extraction is almost always the only option after sustaining this classification of fracture.

Vertical apical root cracks – These cracks occur at the apex (tip of the root). Though the tooth does not require extraction from a dental perspective, many patients request an extraction because of the high degree of pain. Root canal therapy alleviates the discomfort for a while, but most often, teeth affected by such cracks are eventually extracted.

How are cracks in the teeth treated?

There are many different types of cracked teeth. Some can only be exposed using X-ray machines, while others are clearly visible to the naked eye. In cases where the tooth root is affected, root canal therapy is the most viable treatment option. The pulp, nerves and vessels of the tooth will be removed, and the resulting space will be filled with gutta-percha. A crown or filling will be added to stabilize the tooth and it will continue to function as normal.

When the crack is too severe for the tooth to be saved, Dr. Trujillo will perform an extraction. There are a number of restorative options in this case, such as bridges, dental implants and partial dentures. All of these structures can restore biting, chewing and speaking functions.

Call (575)526-0888 to schedule a consultation with Dr. Trujillo, she would be happy to answer your questions!

Root amputation is a specialized dental procedure, whereby one root is removed from a multi-root tooth. The tooth is then stabilized and rendered fully functional with a crown or filling. The multi-root teeth best suited to the root amputation procedure are the molars at the back of the mouth. These large flat teeth have either two or three roots depending on whether they are situated on the upper or lower jaw.

The general purpose of root amputation is to save an injured or diseased tooth from extraction. Dr. Trujillo and most dentists agree that there is no better alternative than retaining a healthy natural tooth, and the root amputation procedure makes this possible.

When is root amputation necessary?

It is important to note that root amputation can only be performed on an otherwise healthy tooth. Even in the case of a “key” tooth, extraction will be performed if the tooth is diseased, badly fractured or otherwise injured. Suitable teeth for root amputation have a healthy tooth surface, strong bone support and healthy underlying gums.

There are several problems that may lead to root amputation including:

• Broken, fractured or injured teeth and roots.
• Embedded bacteria within the structure of the root.
• Severe bone loss in a concentrated area due to periodontitis.
• Tooth decay in a concentrated area of the tooth.

What does root amputation involve?

Prior to root amputation, it is necessary to perform root canal treatment. The amputation itself involves cutting deep into the tooth where blood vessels and nerves are located. For this reason, the pulp of the tooth including these vessels and nerves needs to be removed before resectioning the roots. The root canal and amputation treatments will be performed under local anesthetic.

During the root amputation procedure, a small incision will be created in the gum to fully expose the roots of the affected tooth. The root will be sectioned off from the rest of the tooth and then removed. To kill any remaining bacteria, the whole area will be cleansed with saline solution, and then sutures (stitches) will be applied to seal the incision.

Finally, a temporary crown or filling will be placed to secure the tooth. Depending on the specific situation, painkillers, antibiotics and a medicated anti-microbial mouthwash may be prescribed. In 7-10 days, the stitches will be removed and the gum will have healed. Arrangements can now be made to place the permanent crown or filling.

If you have any questions or concerns about root amputation, please call our office at (575)526-0888 to schedule a consultation with Dr. Trujillo.

In rare cases, root canal therapy fails to work as expected. The treated tooth might not heal properly or a patient might experience post-surgical complications that jeopardize the tooth. Root canal retreatment involves removal of the previous packing material, the cleansing of the root canals, and the re-packing and restoration of the tooth. In short, root canal retreatment is almost identical to the original procedure, aside from the structural removal. The success rate for a root canal retreatment is approximately 75%.

Root canal treatments and retreatments are sometimes a better alternative than extraction. If a tooth has good bone support, a solid surface and healthy gums beneath it, it stands a good chance of being saved.

Why is root canal retreatment required?

Though the prospect of more endodontic surgery might not be pleasant, root canal retreatment is fairly simple. In general, the whole treatment can be completed in 1-3 visits.

There are a number of reasons why root canal therapy unexpectedly fails, including:

• Cracked crown leaking filling material.
• Curved or narrow canals not treated during the original procedure.
• Delay in the placement of restorative devices following the procedure.
• New decay to the tooth.
• New fracture in the treated tooth.
• Saliva entering the restorative structure.
• Undetected complex canal structures.