Cracked tooth is a traumatic injury to a tooth, accompanied by a violation of the integrity of its root or crown. There are various types of cracked tooth: fracture of the enamel, dentin and root of the tooth. They are manifested by sharp mobility and displacement of the injured tooth, intense pain. In case of crown fractures, the tooth can be preserved with subsequent cosmetic restoration, in case of root fracture, its removal is required. With root injury, the risk of developing periostitis, osteomyelitis, etc. is high. complications
ICD 10
S02.5 Cracked tooth
Meaning
Cracked tooth (tooth fracture) is a tooth injury sustained when exposed to mechanical force. With a fracture, the anatomical integrity of the root of the tooth or its crown is violated. The causes of a cracked tooth are mechanical injuries resulting from a blow, fall, or during chewing, when solid foreign bodies are present in the food. The frontal teeth of the upper jaw are more prone to fractures than the teeth of the lower jaw, often fractures of the teeth are combined with their incomplete dislocations.
Symptoms
When a tooth is fractured, severe unbearable pain occurs, the victim has difficulty opening his mouth and closing his teeth. In addition, a cracked tooth is preceded by any injury, bleeding gums and pathological loosening of the tooth are noted.
Painful sensations with mechanical and thermal irritation depend on the type and location of the fracture, as well as on the mobility of the tooth. During the examination, edema of the soft tissues of the oral cavity and spot hemorrhages in the skin and mucous membrane are detected. Fracture of the tooth crown is clinically manifested in the form of its defect, often such a fracture is accompanied by the opening of the pulp chamber. When the root of the tooth is fractured, the tooth becomes mobile, its percussion is sharply painful, and the crown sometimes acquires a pink hue.
Cracked tooth may be insignificant in the form of a break of the tooth enamel, or significant when there is a fracture of the dentin with or without exposure of the pulp and a fracture of the tooth root. Complete fractures are called with the opening of the pulp, incomplete – without opening the pulp.
Diagnosis and treatment
The diagnosis is made by the dentist based on the presence of trauma in the anamnesis of the disease, characteristic clinical manifestations and complaints of the patient. Before choosing a treatment method, an odontometric and X-ray examination is performed. Treatment tactics and prognosis depend on the degree of damage to the tooth enamel tissues. So, if the opening of the tooth cavity did not occur when the fragment of the crown was broken off, then the tooth is restored: the crown is to be restored using composite filling materials.
Longitudinal, comminuted and oblique fractures of the tooth root require tooth extraction, since the root in this case cannot be used as a support for the pin. After tooth extraction, it is necessary to resolve the issue of prosthetics. Modern dentistry offers an alternative way to replace the defect of the dentition formed as a result of a cracked tooth – dental implantation.
A transverse fracture of the root of the tooth allows you to restore the tooth using an artificial metal-ceramic crown.
Also, the tactics of treatment depends on the level of fracture of the tooth, if the fracture occurred in the upper part, the canal is sealed, and the apical part of the tooth remains without intervention. With a fracture in the middle part, trepanation of the tooth with pulp removal is shown, then the canal is sealed, and the fragments of the tooth are connected with pins.
In case of a cracked tooth, which is accompanied by the opening of its cavity and damage to the pulp, the damaged pulp must be removed and the root canal sealed. If necessary, intra-channel pins and filling of the crown part of the tooth are used.
Fractures of any complexity with the preservation of the root of the tooth allow you to install an intra-channel pin after cleaning and filling the canal, which allows, without resorting to dental prosthetics, to restore the integrity and functionality of the dentition.
Root canal filling is only part of the treatment, after which it is necessary to completely restore the anatomical position of the teeth. This allows you to avoid the formation of an incorrect bite and exclude injuries during the closing of teeth.
Treatment of fractures of teeth should be carried out as soon as possible, since in the absence of contact with the antagonist tooth, there is a tilt and displacement of adjacent teeth. This may require additional orthodontic treatment before prosthetics.
Literature
- Zaleckiene V., Peciuliene V., Brukiene V., Drukteinis S. Traumatic dental injuries: etiology, prevalence and possible outcomes // Stomatologija. — 2014; 16(1): 7-14.link
- Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth / Marie Therese Flores Lars Andersson, Jens Ove Andreasen, Leif K. Bakland, Barbro Malmgren, Frederick Barnett // Dent Traumatol. — 2007; 23(2): 66-71. link
- Nam O.H., Kim M.S., Kim G.T., Choi S.C. Atypical root resorption following root fractures in primary teeth // Quintessence Int. — 2017; 48(10): 793-797.
- Ain T.S., Lingesha Telgi R., Sultan S., Tangade P., Ravishankar Telgi C., Tirth A., Kumar Pal S., Gowhar O., Tandon V. Prevalence of Traumatic Dental Injuries to Anterior Teeth of 12-Year-Old School Children in Kashmir, India // Arch Trauma Res. — 2016 ;5(1) :e24596.
- Regenerative Endodontic Procedures for Traumatized Teeth After Horizontal Root Fracture, Avulsion, and Perforating Root Resorption / Tarek Mohamed A Saoud, Sonali Mistry, Bill Kahler, Asgeir Sigurdsson, Louis M Lin // J Endod. — 2016 ;42(10): 1476-1482.link
- Machado J.P., Lam X.T., Chen J.W. Use of a clinical decision support tool for the management of traumatic dental injuries in the primary dentition by novice and expert clinicians // Dent Traumatol. — 2018 ;34(2): 120-128.ссылка