Fractured Teeth: Is There More Than One Type of Fracture? Part 4

In Part 4 of our series on teeth fractures we will discuss two cases of fractures in back teeth (molars) where there were no restorations (fillings), but the fractures were significant enough for the teeth to be lost.

It’s actually much more common to see fractures in teeth that have large fillings, especially in back teeth (molars).  This is because fillings have been placed due to loss of tooth structure and this results in a loss of tooth strength.

Dentist 4-1 In the adjacent photograph, the molar tooth on the right (second molar) is involved with a significant fracture.  The patient came into our office with the complaint of sensitivity when biting on this tooth. It had been sensitive sporadically for some time, and he finally came in because the discomfort had progressed.

The fracture is seen on the right side of the photo and can be differentiated from the natural grooves in the tooth as seen on the left side of the tooth.

This fracture proved to be quite deep. It went down vertically into the roots of the tooth which go into the bone (take a look at the diagram of the anatomy of a tooth in Part 1), and essentially was dividing the tooth into a right and a left half. This tooth was not restorable because of the deep nature of the fracture down below the bone level.

Blog #4The tooth was extracted and the bone was allowed to fill as a function of healing. Then a dental implant was placed to act as a “mechanical root,” to support a full crown restoration and restore it to functionality.

The second case is very similar, in that there was no restoration (filling) in the tooth.  As described previously, the x-ray image of this tooth did not show any fracture line. So how is it determined that a fracture is even there?

Transillumination In this situation a diagnostic tool called trans-illumination was used.  This technique uses a very bright light source and the photograph is taken without benefit of any other light.

The bright light shines through the tooth to the point where the light gets blocked by the fracture, and the tooth past the fracture is dark.  A normal tooth without a fracture would allow the bright light to shine all the way through because there is nothing to stop the light.

Trans-illumination showed that this tooth had a deep fracture, and because it went deep below the bone level this tooth was not restorable, either.

After confirming this to be correct, the tooth was extracted, and a dental implant was placed, allowing the bone to heal around the implant. Once healed, a crown was placed on top of the implant to replace the tooth that was missing.

Dr. Mastrovich discusses these cases of fractures when there are no fillings here:

 

Fractured Teeth: Is There More Than One Type of Fracture? Part 1

Fractured Teeth: Is There More Than One Type of Fracture? Part 2

Fractured Teeth: Is There More Than One Type of Fracture? Part 3

 

 

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Fractured Teeth: Is There More Than One Type of Fracture? Part 3

In Part 3 of our discussion on tooth fractures we will discuss fractures that occur in a back tooth (a molar) secondary to having large restorations (fillings) in the tooth.Photo 1

This photograph shows a lower molar that has a very large silver filling which has been in function for many years. Due to the loss of tooth structure resulting in a weakened tooth and the  thousands and thousands of chewing cycles this tooth has endured, it’s highly probable that stress  fractures can begin to occur.

Recalling the diagram of the anatomy of a tooth in Part 1 the enamel is the outermost layer of the tooth, and in this photograph  the fracture in the enamel of the tooth is visible.

The important question to consider is where does this fracture terminate?  Does it track deeper or does it remain in the enamel of the tooth?

Photo 2In the close-up photograph, the fracture looks significant. However, it is only significant if it is tracking deeper into the second layer of the tooth, called the dentin, as was discussed in Part 1.

To better understand where the fracture goes, the old filling must be removed.

 

Photo 4With the filling removed, we see that the fracture is tracking into the dentin, and moving toward the center of the tooth.  Additionally, there’s another fracture that is tracking from a different direction.

This tooth was sensitive at times, which is a common finding.  Pain with biting pressure, either consistent or intermittent, is a common finding with a fractured tooth.

The remedy for this tooth was to place a full coverage crown, and the tooth then became free of discomfort.

For this situation the tooth was stabilized with a restoration, and now has a significantly improved prognosis.

The second case is very similar – a large silver filling in a molar, a fracture on the front, and what looks like a very large fracture in the back.

2 more pics 2Again, the x-ray image is of no  help diagnosing the extent of the fracture as seen clinically.  More clinical information regarding the extent of the fracture will be facilitated with the removal of the filling.

 

 

Photo 9 Now we can see that the back fracture actually tracks all the way toward the front. This is a very significant finding, as the tooth is causing pain with biting pressure.  At this point it is critical to know how deep this fracture tracks before we can say this tooth can actually be saved.

 

The patient was sent to an endodontist, or root-canal specialist, where the pulp (nerve) chamber was accessed.

The endodontist felt the floor of the pulp chamber was solid and that the fractures ended there. The fracture had gone down far enough that it was involving the pulp of the tooth, but not deeper.

Photo 10You can see the filling material that the endodontist used to seal  the canals in the roots.   There were no visible fractures seen there.

So despite the fact that this tooth presented with a very significant and deep fracture, this tooth could be restored and put back into service and to date has had a very functional result.

 

Watch this video where Dr. Mastrovich describes fractures in molars with fillings:

In Part 4 we will discuss fractures in teeth without fillings.

Fractured Teeth: Is There More Than One Type of Fracture? – Part 1

Fractured Teeth: Is There More Than One Type of Fracture? – Part 2

 

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Fractured Teeth: Is There More Than One Type of Fracture?

Dentist 1In a 4-Part series we are going to be discussing fractures in the teeth – what they are and how a dentist can repair them.

In order to best understand a problem with a tooth, we need to first understand what a healthy tooth looks like and how it is made up.

So, in Part 1 we will examine the simple anatomy of a tooth.

At the top of a tooth is the enamel, on the crown of the tooth, which we normally see. The second layer is called the dentin, and the third layer inside the tooth is the pulp, or the nerve tissue. Below this point are the roots in the bone.

1. Crown
Most of the tooth is under the surface, like an iceberg. The portion of the tooth that is above the gum line where we can see it is called the crown.

The purpose of the tooth determines the shape of the crown. For example, the crown of a molar is flat, for grinding, and the crown of a front tooth (incisor) is sharp, for cutting.

2. Enamel
The outer, top-most layer of the tooth is called enamel, and again, this is the layer that we see – it covers the crown. Tooth enamel is the hardest and most mineralized tissue in the entire body. At the same time, this enamel can be easily damaged.

3. Gumline
Where the crown of the tooth and the soft tissue of the gum meet is called the gumline.

4. Dentin

This is the layer in the tooth itself that is just below the enamel. Although it is the layer that protects the nerve, it is porous, with millions of microscopic tubes, called dentin tubules, leading directly to the pulp. These tubules are filled with cellular fluid.

5. Pulp
The soft tissue in the center of the tooth is called the pulp, and is where the nerve tissue and the blood vessels are. Tooth decay that reaches the pulp can cause a great deal of pain.

6. Root
The root is embedded in the bone of the jaw, and anchors the tooth to bone. The root makes up two-thirds of the tooth itself.

Take a look at this video where Dr. Mastrovich explains the tooth in detail:

 

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 Dental fractures can occur in various places on the tooth – they can occur in the enamel or down into the dentin, or even deeper. They can occur obliquely, horizontally, or vertically, and they all have different ramifications of tooth pain and its treatment that we’ll talk about in the rest of this series as we go through the various types of fractures.

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How do I know if I have a problem with my crown?

Have you ever thought “I have a crown, now I’m not going to have to deal with this issue again”? This is very common for all of us, until we learn there is more to the ‘care and feeding’ of your dental restorations beyond flossing and brushing.

How do I know if I have a problem with my crown? One issue may be that your floss is shredding or catching in the area of your crown. This could mean the crown cement that was used to hold it in place on the tooth has begun to wash out. This happens over time and is quite common. It’s easy to think that once a crown is placed to repair a tooth that it is there for the rest of your life. Actually, crowns have a ‘life’ or duration that depends on how well the crown was originally fabricated, how strong the cement is, how well the ‘crown owner’ cares for it (flossing and brushing), and medical factors that can affect the general conditions within the mouth.

Take a look at this video below where Dr Mastrovich shows magnified photos of actual crowns to give the viewer first hand visual experience as he shows what it means to have leaking crown margins due to failing dental cement and how that leads to the need for replacement of a crown.

[youtube http://www.youtube.com/watch?v=mrx3vjvFBMY]

It is important to have your crown margins checked at your annual dental exam and if you are unsure if your dentist performs this check, don’t hesitate to ask them. At our office, this is one of many areas Dr Mastrovich checks at least annually, so that we can find any problem areas as soon as possible. If you are wondering about your crowns, give us a call to schedule an initial exam.

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Get major restorative under control, then dental maintenance can be easy

Dental exam and treatment options

Restorative dentistry is our specialty and people often wonder what their experience might be with dental implants and reconstruction.  Every case is different, and we strive to give every client an experience in our office that is personally tailored to their specific dental needs.

During the examination process, we go through a very detailed dental history with our patients, explain all their options and provide our recommendations regarding the most effective restorative solution. We want our patients to be involved in their treatment process and we give a variety of solutions within the range of excellent treatment options.

We use the dental acronym of BARC to help patients evaluate each option based on their individual values and needs.  For each treatment option, each of the following are discussed:

  • B – Benefits to the patient of the treatment being considered
  • A – Alternatives to the treatment, which always includes the option of not progressing with treatment
  • R – Risks involved with the treatment being considered
  • C – Complications that could be possible for the treatment being considered

After helping patients regain dental health by treating their restorative needs, patients are typically able to maintain their dental health more easily with their regular dental hygiene and dental check up appointments.

Our patients say they are very happy with their experiences and highly recommend Dr. Mastrovich for others considering this type of dental treatment because of his expertise in both the Escondido area and the dental community in San Diego.  Patients repeatedly thank Dr Mastrovich and his entire team for taking the time to help them understand their options and the pros and cons of each, while recognizing each patient’s uniqueness and specific needs.  Again and again, patients talk of how they feel like they’ve found their dental home and can feel comfortable and confident coming to Dr Mastrovich’s dental office.

[youtube http://www.youtube.com/watch?v=taNTCI_8I40]

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TMJ pain, implants, and dental occlusion, Oh My!

TMJ orthotic appliances
TMJ orthotic appliance

Dr. Mastrovich is an expert at seeing the dental restorative ‘big picture’ and envisioning the patient’s end goal. He quarterbacks the patients through the process of initial diagnosis and final resolution. Patients can present with one problem, like TMJ pain, and ultimate long term resolution of that problem can involve a series of steps or phases. Initial resolution of TMJ pain may be accomplished by orthotic appliance therapy (custom fabricated acrylic mouth piece) to better support the jaw joint function. Once stable and pain free while wearing the appliance, the next step is diagnosis of restorative dentistry needed to support the joint long term (which may include crowns, dental implants or orthodontics, depending on the case).

These sisters share their diverse needs and experiences that brought them to Dr. Mastrovich: TMJ dysfunction pain, implants, and the need for a dentist with the expertise in occlusion (how teeth fit together when biting) that would implement the treatment to bring long term comfort. Ultimately, these sisters say they smile a lot, thanks to Dr. Mastrovich.

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Look no further for artistic dentistry in Escondido

artistic dentistryLearning from the masters has been a life theme for Dr. Mastrovich, and it is a foundational piece in how he helps every patient achieve his or her desired goals for the appearance (smile) and function (chewing) of their teeth. This ‘universal’ principal, referred to since Greek and Roman times by many different names, the Golden Proportions, Golden Ratio, Divine Proportions is the vertical to horizontal ratio that makes a face, a smile, a piece of architecture or art unconsciously pleasing to the human eye. An everyday case in point: pull out your wallet and look at your credit cards. They utilize this principal, in order to be both visually and tactilely appealing to use. Dr. Mastrovich utilizes this principal as he plans dental cases for the best possible results, and even incorporated it into his prior logo 15 years ago. The calipers in the logo represented his measurements for these esthetically pleasing smiles.

Having her dentist be both clinician and artist is very important for Lynn, who is both a mathematician by education and an artist and painter by passion. She happily relates her experience as his patient, recognizing his unique skill set and expertise in artistic and highly functional dentistry.

If a beautiful smile is important to you, call us to learn more.

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Dental Implant: an alternative to a dental bridge

Dental implants can be a solution for a number of problems surrounding loss of a tooth or teeth, such as fractured teeth, extensive decay, accident trauma, or genetically missing teeth. Dental implants are an especially attractive single tooth loss solution, in terms of esthetics, function and finances. In these cases, the dental implant option can remove the need to restore two or more neighboring teeth to support a bridge across the site of the lost tooth. This can be more cost effective because one crown restoration is needed instead of three to create the bridge. In terms of function, a single tooth implant is cared for similarly to a single tooth, which alleviates the extra effort/floss care around a bridge.

When the lost tooth is in the ‘esthetic zone’ (the teeth that show when a person smiles), often the papilla has a chance to grow back and allow for more natural appearance. An additional consideration is the lifespan of a bridge (until it will need repair or replacement) versus that of an implant. This is individualized based on what types of stressors a person puts on their teeth when chewing, grinding, biting, etc. There are many considerations for each individual case and the best options for each one are best explored and discussed in a comprehensive exam and follow up consultation.

One example is Diane’s situation. She had a difficult experience following an extraction with her previous dentist and really wasn’t sure of her options or possible restorations. When Dr. Mastrovich and Diane had completed her initial examination appointment they scheduled for a follow up consultation for a more in depth discussion of her options, as it was clear to Dr. Mastrovich that a team approach would be needed with several additional specialists brought in to restore the area to full function. Dr. Mastrovich and his team thoroughly laid out the advantages and challenges of each of her options:

  1. Creating a bridge between the two teeth on either side of the extraction site
  2. Placing an implant in the site and fabricating a single restoration on it, thus leaving the two teeth on either side untouched
  3. Or do nothing (which is always an option to consider)

After careful consideration of her options, and having the dental education support, she chose to schedule with the periodontist (the specialist in implants) to surgically place the implant and then returned to Dr. Mastrovich for the final restorative crown fabrication, which is Dr. Mastrovich’s area of expertise. Dr. Mastrovich ‘quarterbacked’ her case through each of the phases and referrals to specialists, in order to optimize her final restorative and esthetic results.

[youtube http://www.youtube.com/watch?v=4Y2TfWJZWtw]

If you, or someone you know, is considering implants and needs to know more, or has an implant that needs to be restored and is looking for an expert who can see the ‘big picture’, we are here to help.

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Escondido Dentists Giving Back: Needed Dental Restorative Care

UEI Dental Day

We had an opportunity to partner with UEI to provide their students in the Registered Dental Assisting program with needed dental restorative care for their improved health. This will better prepare them for interviewing and hopefully… getting hired in the dental profession once they graduate and pass their board exams.

Five dentists (Dr Charlie Mastrovich, Dr Larry Buss, Dr Gary Paluso, Dr Doug Christianson and Dr Joe Nguyen) volunteered their time at our office. Our team (Debra, Sally and Sheila) volunteered their time supervising the assisting students as they took turns assisting the dentists during each others’ treatment.

For many of these students, this was much needed care that they had not been able to receive up to this point, and for some the need extended back to their childhood. It was one of those life changing days for all who shared in it, as it was difficult to say who felt it more deeply: those who received or those who gave treatment. Those volunteering felt very moved by the difference that was made in each student’s life and appearance.

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What does A.P.C. after the dentist’s name mean?

We are often asked “What does the A.P.C. after Dr. Mastrovich’s name mean? Is it a designation for his restorative dental expertise?” It would be a lot more exciting to be able to say that it indicates the high level of confidence patients and colleagues have in him! Or for it to mean “Always Painless and Caring”. Both of which are true. But the reality is simply that it means “A Professional Corporation” and once a dentist incorporates the choice is between APC and PC, and it must be on anything representing the business (signage, stationary, websites, etc).

Dr. Mastrovich building sign
Dr. Mastrovich street sign
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