Dental trauma is a rather widespread phenomenon. Some traumas are distinguished by a certain deceptive nature, as they are hard to diagnose during routine examination and their symptoms are capable of imitating other dental diseases, which directs the treatment in the wrong direction. Occurrences when the root of the tooth is broken refer specifically to such complex clinical cases.
Symptoms of dental root fracture
The most common symptom of broken radix is painful sensation of difficult-to-diagnose localization. The patient may feel that the pain irradiates:
to the entire jaw
or to 3-4-5 adjacent teeth.
Depending on the height of the fractured radix, the teeth position may change or remain within normal limits. So, if only the root’s apex has been traumatized:
Pathological instability is rarely observed in the injured teeth.
The main part of the radix remains intact and retains the ability to fix the teeth in a stable position.
In contrast, if a fracture occurred in the upper third of the radix, a severe instability of the crown site of the tooth and its strong deviation from the vertical axis indicates a fracture as the cause of this condition.
If the radix of pulpless tooth is fractured, such a fracture can occur unnoticeably. If only the root of the tooth is broken and the alveolar process is not affected, the pain is not strong enough to become noticeable and the patient often considers the symptom’s causes to be more ‘innocent’ and postpones the visit to the doctor.
In severe fractures, including those of comminuted nature, gingival hemorrhage manifests itself. Without treatment during the acute period, after a few days a persistent bad breath may occur caused by the rotting of soft tissues. The most common symptom of radix injury in all cases is acute pain with increasing intensity with each closing of the jaws.
Fracture in 100% of cases may be caused by a trauma (a blow in the face, a fall or an accident). There are several factors increasing the likelihood of the fracture:
Complex treatment of radix
In some cases, a dentist has to repeatedly clean the radix canals and form them, expanding their lumen. Since all manipulations are carried out blindly, with each repeated treatment the channel wall is more likely to become critically thinned. In that case, even a relatively small pressure on such a tooth can cause a fracture.
A cyst of the root apex or multiple granulomas.
These diseases weaken the radix’s bone tissues. The pathology become critical during active infectious or inflammatory process in the contents of a cyst or granuloma. Such a process ‘melts’ bone tissues of the jaw, and radix gets more instable, which often leads to its fracture.
Inadequate load distribution on the teeth.
It’s most often observed after prosthetics performed by a dentist with inappropriate qualification. The fracture of under-the-crown root in most cases is caused by excessive height of a prosthetic device. If prosthetics is performed on pulpless teeth with formed and expanded canals, a probability of radix fracture or crown part of the tooth increases drastically.
Teeth prosthetics in the presence of direct contraindications.
Sometimes a dentist may come up with a decision to install a prosthesis, despite obvious contraindications:
deficient bone volume in the area of manipulation,
active periodontitis or periostitis,
severe malocclusion, etc.
In such cases, radix fracture is a matter of time and depended on a pressure exerted on this tooth.
Methods of treatment
How to remove the root of a broken tooth by means of surgical intervention? The treatment depends on a site of fracture and that of an axis (lateral, extensional or transverse) and can be performed by the following methods:
Through a gum’s cavity.
The crown site of the tooth is removed, then the doctor makes incision of soft gingival tissue to provide instrumental access to a visible site of the root. Using special forceps, he grasps the root apex and extracts it, then he thoroughly cleans the surgical wound and stitches it up.
With access through the jawbone.
The operation is required to treat fracture of root apex, comminuted fractures or suspected destruction of the alveolar process. In this case, the doctor makes incision of soft tissues laterally in the injured tooth’s projection, then he dissects the bone tissue and remove it. Having access to the radix in this way, the doctor removes the radix and its fragments, as well as a cyst or granuloma and conducts a thorough antiseptic treatment. After this, the previously removed bone block is placed back, covered with soft tissues and stitches.
If the root of the tooth is broken or cracked under the crown:
All manipulations start with the removal of prosthetic device.
In all cases, when the doctor has grounds to suspect a trauma to the dental radix, a radiographic examination is preliminarily performed, which allows to specify the diagnosis and exclude other dental pathologies with similar symptoms.
The same examination is appointed upon the radix extraction; the doctor can trace on the X-ray if all dental fragments are removed.
During postoperative period, the patient must take antibiotics, painkillers and anti-inflammatory drugs that alleviate symptoms and reduce the likelihood of complications.