Broken teeth - causes, prevention, treatment options
Added: January 13, 2009 - 11:25 PM
By: Patient Email Withheld, Washington, DC
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Case Summary
Filling
Broken Tooth
Crown
Dental Implants
Teeth: 3,14,19,30
Last Full Mouth X-Ray: December 26, 2008
Last Cleaning: August 2008
Case Description
1) Causes: After I had heavy amalgams removed from the 4 teeth indicated, within a few months the lower left molar had 1/4 break off. Within a few months more, 1 week after DMPS heavy metal detox, the upper right molar cracked. There was no impact to my mouth or teeth, just regular everyday normal chewing. There is no gum disease or infection. Other than being weakened by heavy fillings, and the trauma of changing fillings, what would cause two teeth to break within a year? Any other non-dental diseases that would do this - I have had a thorough workup with my MD and he did not have any ideas. I do have hypothyroidism and diabetes. 2) Prevention: Composite fillings are not as strong as amalgams. But would replacing composite fillings with ceramic or glass prevent the other two molars from breaking? Or would changing the filling type cause even more trauma? What are the advantages/disadvantages of each type of filling (ceramic, glass, other)? Anything else I can do to strengthen the other 2 molars that will break soon? 3) Cracked tooth treatment options: Coming from the point of view that I want to save it at any cost. The crack was on one side of the upper right molar and went up to the gum line. It appeared to be Ellis II because there was no pain or sensitivity. The dentist said it did not go through to the pulp and was not infected. What are the options to save such a tooth? Can the crack be filled with filling or bonding or other material? What considerations would determine whether a tooth should be extracted? I would like to be prepared should the situation arise in the future. 4) Post-extraction treatment options: For the extracted tooth, I am leaning toward implant but would like to know advantages/disadvantages for each type of implant and each type of crown. My concern is that a traditional bridge would compromise nearby teeth, and a partial denture would not provide the chewing strenght of a normal tooth. Can you tell me advantages/disadvantages of a bonded bridge? What are the advantage/disadvantages of implants compared to other options? Are there options other than implant, bridge, partial denture?
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Reply: Broken teeth - causes, prevention, treatment options
added: January 14, 2009 - 5:01 AM
Cost Estimate: $ No Estimate at this time. Additional information required.
You probably should have had ceramic fused to metal full crowns placed on the first molars you have deliniated above. Composite restorations are not strong enough if they are large. They also will not offer as much resistance to fracture as a full crown (cap). I do not do such restorations as a periodontist, but would be happy to talk to you and refer you to a good restorative dentist if you like.Bruce Wyman DMD tel: 703-569-4040. www.washingtonperio.com
Reply: Broken teeth - causes, prevention, treatment options
added: January 14, 2009 - 6:02 AM
Cost Estimate: $ No Estimate at this time. Additional information required.
hiIf any teeth can be restored, I certainly recommend that. But sometimes it is not possible and extraction will be necessary. Once extracted a transitional or temporary prosthesis can be made, especially if it is a front tooth. Once healed in 2-3 months, dental implants can be placed which is the best option for teeth replacement.I discuss these options in detail in my website with videos: www.facialart.com. Also you can check out my recent podcast on iTunes discussing implant options and showing you a case. (in itunes, do a search for Dr. kazemi and the podcast will come up)If you would like to make an appointment for consultation, you may call us at (301) 654-7070.Thanksdr. kazemi
Reply: Broken teeth - causes, prevention, treatment options
added: January 14, 2009 - 7:39 AM
Cost Estimate: $ No Estimate at this time. Additional information required.
First, you must take care of the cracked teeth to prevent further decay/ fracture of remaining tooth structure. I would recommend a 3/4 all ceramic crown. This takes the burden of the chewing forces away from the tips of the tooth and does not remove as much tooth structure as a full crown.Second, composites contract and expand at a higher rate than natural tooth structure and even amalgam so that they may fail earlier. The best option is to have replaced large fillings with onlays or 3/4 crown which contract and expand at a much closer ratio to actual tooth structure from the start to minimize trauma to the tooth. Every procedure is trauma to the tooth.Third, Fractured teeth recover best when there is a full crown placed on top of it. 3/4 crowns/ onlays may not be enough to prevent spreading of the fracture.Lastly, implants are your most structurally sound option when replacing an extracted tooth. It does not jeopardize adjacent virgin teeth and is self supported.
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