Fracture of the crown of the tooth is a problem with which a huge number of people come to the dentist. It implies an injury in which the destruction of the bone tissue of the molar occurs. As a rule, tooth fractures (ICD S02.5) occur in children and people involved in extreme sports. However, ordinary people can also experience this kind of injury as a result of mechanical damage, for example, during a fight, a fall, or due to a strong bite while eating, when strong pressure is applied to the molar with metal cutlery.
Features and localization
In dental practice, a tooth fracture is one of the most difficult cases, since it often causes a violation of the anatomical structure of the alveoli. With very strong mechanical damage, a fracture of the entire jaw can even occur in its weakest place.
Depending on how strong the fracture of the tooth was, this type of injury is divided into the following types:
- split - enamel damage;
- bone damagetissue that does not expose the pulp;
- dentine fracture with soft tissue exposure;
- injury to the area of the tooth root.
In addition, the classification divides fractures into two main categories:
- incomplete;
- full.
When a molar is damaged, a crack forms on it, touching all its important parts. At the same time, it can be not only longitudinal, but also transverse, or even pass diagonally along the crown. In some cases, the root can be damaged simultaneously on both sides. In dentistry, such a case is called a comminuted fracture of the tooth. Most often, the integrity violation is localized in the middle of the molar or in its upper part. Much less often - in the central region and near the root collar.
Main reasons
Let's take a closer look at them. As mentioned earlier, tooth fractures in children and adults most often occur as a result of mechanical impact. In this case, cracks can be multidirectional. It is generally accepted that vertical ones pose practically no threat to the integrity of the molar, but only worsen its aesthetics. However, in the absence of proper treatment, they can gradually grow and, as a result, lead to the complete destruction of the tooth. Therefore, it is better not to postpone the visit to the dental clinic.
In addition to trauma, the main causes of fractures include the following:
- provision of unskilled medical care;
- poor-quality extraction surgerytooth from the alveolus;
- strong blow to the jaw area;
- prolonged lack of therapy for various pathologies;
- anomalies and congenital pathologies in the development of molars.
There are some other reasons behind the violation of the integrity of the dental crown, but they occur in isolated cases and are more an exception than a significant factor.
Clinical manifestations
It is very difficult to determine the presence of a fracture on your own, since there are no pronounced symptoms as such. Therefore, if you have any suspicions of damage to the molar, then you should go to the hospital. However, there are several factors that can help diagnose a root fracture.
Symptoms in this case may be as follows:
- severe pain that occurs during palpation of the gums or while eating;
- mobility and gradual loosening of the molar;
- swelling of soft tissues in the area of the damaged tooth and periodic bleeding;
- changing the normal color of the enamel, it becomes pinkish.
It is worth noting that the severity and intensity of symptoms depends on the severity of the fracture, as well as on the location of its localization. But, as a rule, even with a mild injury, a person begins to experience discomfort when opening and closing his mouth. This is due to damage to the pulp and the onset of the inflammatory process. It is worth noting that if a person has a tooth fracture, the symptoms make themselves feltimmediately, so this problem will not go unnoticed.
Diagnosis
What is she like? With a high degree of probability, only a qualified dentist can say whether there is a fracture of the tooth crown or not, since the clinical manifestations and their form can be very different. They depend on a number of factors, among which there are individual anatomical features of the structure of the jaw and bite of each person. Therefore, if, based on the symptoms described above or due to various other reasons, you suspect a fracture, then you should immediately go to the hospital.
When examining patients, the doctor pays attention to the following factors:
- degree of soft tissue injury;
- fracture severity;
- occlusion violation;
- is there any damage to the alveoli;
- tooth color;
- intensity and degree of damage to the structure of the injured area.
The main and most effective diagnostic method is palpation performed with a special tool.
It allows the dentist to determine the following:
- the presence of mobility of the tooth or its individual parts and its degree;
- bulging;
- molar displacement level;
- puffiness.
If palpation of the injured area of the gums does not allow an accurate diagnosis, and in some other cases, an electro-odontometry or transillumination examination may be prescribed. They let the doctordetermine the viability of the loose fibrous connective tissue located under the molar. Both types of laboratory studies are based on the illumination of the tooth, thanks to which it is possible to determine the presence of even microcracks.
In addition to this, an x-ray of the jaw is mandatory. This is one of the most accurate diagnostic methods that provides a complete picture of the he alth of the human oral cavity.
Therapy
If the dentist confirms a fracture of the tooth root, treatment begins immediately. Regardless of the severity of the injury, if the molar root was not damaged, then in almost all cases, doctors manage to save the tooth without prosthetics.
Treatment features are as follows:
- In case of a fracture, when the pulp was not exposed, the doctor places a filling made of a special material for the patient.
- If the hard dental tissue is exposed, then first an insulating pad is placed on the molar, and only after that the filling and installation of the pin is performed.
- If the blow was of great force, as a result of which the tooth crumbled and the pulp was exposed, then it is removed surgically. Next, the channels are cleaned and sealed. Very severe injuries may require a crown.
- If the molar is completely destroyed and cannot be restored, then in this case a prosthesis is installed in its place.
It is worth noting that if the treatment of dental fractures involves the installation of a crown, then in this case, therapy should be performed as soon as possible. Delay maycause misalignment of the dentition, which is a very complex case requiring long and expensive therapy.
Poorly treatable violation of the integrity of the incisor, in which the root was damaged. To get to it, the doctor will have to remove the molar even if the crack is minor. This is due to the fact that the root is no longer able to perform the function of a support, so it is impossible to install a pin on it. After extraction, it takes time for the gums to heal completely, after which the prosthesis is already placed. This also should not be delayed, as the dentition may shift.
In some cases, it may be necessary to splint the teeth in case of a jaw fracture. It involves the installation of a special orthopedic apparatus on the molars, combining them into a single monolithic structure. This procedure preserves the chewing function and the attractiveness of the smile.
Crown fracture
What is he like? This fracture of the tooth is classified as transverse and is very common in medical practice. For its diagnosis, no examination is required, since it is visible even to the naked eye. The therapy program for trauma to the crown is selected based on the clinical picture of the patient. If only the enamel of the molar is damaged, when the bone tissue remains intact, a filling will be sufficient.
If the damage has also affected the dentin layer, then in this case the doctor cleans the canals, puts an insulating pad, and then restoresthe anatomical shape of the molar using modern composite materials. In very severe cases, in which the roots of the tooth were damaged, a pin is installed, which acts as the basis for the prosthesis.
Molar neck fractures are also very common. The elimination of this problem does not require surgical intervention, since the root remains intact and can be used for the installation of the pin and subsequent prosthetics.
Root fracture
When making this diagnosis, the therapy program is selected based on where the root was damaged. Localization can be located in the neck area, between the middle and upper part of the molar, or at the very base. Most often, the crack has a transverse direction, but it can also be at a slight angle.
This fracture of the lower tooth is also very easy to determine. It is accompanied by pain during palpation, in the process of chewing food or when closing the jaws. In addition, the molar tends to wobble from side to side. Very often, injury is accompanied by rupture of blood vessels, due to which the enamel acquires a pinkish tint. Cracks are clearly visible in the x-ray.
Fractures of the alveolar processes
This kind of injury occurs with a direct blow to the jaw during a fight, when it falls on several molars at the same time. In this case, in addition to violating the integrity of the tooth, wounds are also formed on the mucous membrane of the oral cavity in the area of the damaged area. The process becomes mobile, since it is held only by softfabrics.
Fractures of the alveolar processes occur only with a very strong impact, so they are often accompanied by traumatic brain injuries. Nausea, migraine and dizziness are added to the main symptoms. The main diagnostic method is X-ray, which allows you to really assess the patient's condition. If the viability of the root is maintained, the most effective treatment program is selected. With critical damage, the only way out is the complete removal of the broken tooth.
Possible Complications
In dentistry, it is critical to identify damage to the integrity of the tooth in a timely manner and begin treatment. This is the only way to minimize the likelihood of developing various complications.
Otherwise, the following pathological processes may begin in a person:
- purulent inflammation of soft tissues;
- phlegmon;
- periodontitis;
- pulpitis;
- root offset.
In addition to all of the above, if the teeth are not splinted in time for a fracture accompanied by their strong mobility, then there is a high risk of molars falling out.
When a tooth cannot be saved?
In most cases, dentists manage to save the molar in violation of its integrity. However, in some cases, fractures of a high degree of complexity may require surgery to extract the tooth from the alveolus. Therefore, it is very important not to delay the visit to the clinic too much.
Removal is performed under anesthesia,therefore, the patient will not experience any pain or tangible discomfort. Most often, the procedure does not last too long, but with a strong fracture, when there is practically nothing left of the molar and the doctor has nothing to grab onto, the operation can be delayed. In this case, the gum is first cut with a scalpel and the remnants of the root are removed, after which sutures are applied. When the fracture of the tooth is completely cured and the rehabilitation period is over, they are removed and the implant is installed. If necessary, the dentist can prescribe a set of physiotherapy procedures.
What to do if the fracture is accompanied by severe pain?
As you might guess, the most correct solution for pain syndrome would be to go to the hospital to receive qualified medical care. Self-medication is not recommended, because the longer you delay, the higher the risk of infection in the soft tissues becomes. This is dangerous not only because the molar can no longer be saved, but various serious pathologies can develop. Therefore, if you have had an injury, then you should immediately make an appointment with the dentist in order to undergo an examination and, if there is a problem, start treatment on time.
