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.
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.
The 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?
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: