As if falling, getting into a car accident, or being hit in the face by some unexpected, flying object weren’t upsetting enough, the experience could leave you with a broken tooth which may lead to problems in your mouth. There are two difficult to treat fractures that can result from such an occurrence: crown-root and cervical root fractures. Both fractures involve dentin, the bony material forming the tooth, and cementum, the bony material connecting the tooth to the jaw. Crown-root fractures also involve the enamel, which covers the surface of the tooth and is the part you can see. Cervical-root fractures also involve the dental pulp, which is the tissue inside the tooth. Both types of fractures extend below the gum line and can lead to inflammation, recession, or bleeding of the gum tissue, loss of the attachments between the tooth and jaw, or bone loss if the fracture is not treated. All this trouble for mere accidents!
So how are these fractures treated? It was mentioned earlier that these fractures are tough to treat. Treating doctors must take into consideration the location and severity of the fracture and its proximity to the supporting bone. Since sometimes the fracture happens in children, in whom the tooth has not fully developed yet, the developmental stage of the tooth and its level of eruption are important. These many factors make crown-root and cervical-root fracture cases rather complex. Many dentists opt to remove these front teeth and replace them with a bridge or an implant-supported crown, but a grand number of these fractured natural teeth can be saved with modern, cutting-edge dentistry.
One treatment option is surgical extrusion. Years of development and modification have made the procedure simpler, and improved the outlook for saving and reconstructing teeth with crown-root or cervical-root fractures as opposed to removing the tooth or using implants. Surgical extrusion involves severing the ligaments attaching the root of the tooth to the bone around it to pull the tooth upwards. Then, a splint is applied to use the adjacent teeth to reposition the fractured tooth with the damaged part above the gum line. The surgically extruded tooth needs to be treated endodontically either conventionally with a root canal or with regenerative endodontics, where the neurovascular bundle is regrown back into the tooth since surgical extrusion of the tooth tears the neurovascular bundle on the interior of the tooth. Unlike the neurovascular supply to the exterior of the tooth that heals and gets reestablished, the interior bundle in adult teeth with a closed apex does not, leading to an infection inside the tooth. Bhaskar Das and Satta Muthu of the Department of Periodontics and Preventive Dentistry at Saveetha University reviewed many case studies and concluded that surgical extrusion reduces overall procedure time, it is less expensive than other options, it looks good, patients tend to be more open to it, and it doesn’t tend to involve later issues.