Complete dental rehabilitation
In an emergency, the dentist will assess the depth and extent of the crack, fissure or fracture. If necessary, he or she will adjust the affected tooth to reduce the load while waiting for a permanent treatment. If a piece is loose, it can be removed and the cutting edge polished. If the crack, fissure or fracture is too deep and the tooth cannot be restored, the dentist may decide to extract the tooth immediately.
For a small crack, fissure or fracture of the tooth
The dentist may choose to polish the cutting edge for the patient’s comfort without repairing it. Alternatively, the dentist may cut out the cracked, chipped or fractured part of the tooth and rebuild the tooth with a bonded composite resin (white filling) or dental amalgam (grey filling). For health reasons, this option is not offered at our dental clinic (see mercury toxicity). It should be noted that these solutions do not strengthen the tooth and do not prevent the lesion from progressing deeper into the tooth.
For a large crack, fissure or fracture of the tooth that does not affect the vital part
As mentioned above, the dentist may choose to rebuild the tooth with a bonded composite resin (white filling) or dental amalgam (grey filling). For health reasons, this option is not offered at our dental clinic (see mercury toxicity). It is important to stress that these solutions do not strengthen the tooth and do not prevent the evolution of the crack deeper into the tooth. In order to strengthen the tooth, a ceramic filling such as an inlay or crown is best bonded to your tooth. This option restores approximately 98% of the strength of your tooth to its natural state. It is possible to perform this procedure with the CEREC technology offered at the office in one session. This means you can go home with your inlay the same day. Laboratory-made ceramic inlays or crowns are also used when the situation requires stronger thin-layer materials (gold or zircon) or when aesthetic considerations require the collaboration of a laboratory technician, such as for a rehabilitation involving the anterior teeth. In these cases, a temporary restoration will be installed at the first appointment and the final restoration will be installed at another visit 2-3 weeks later.
For a large crack, fissure or fracture of the tooth that reaches the vital part of the tooth
If a small area of the pulp is affected, the dentist may attempt to apply a sedative dressing to the exposed area. In some cases, it is possible to promote pulp healing and recovery. While waiting for the situation to evolve, the dentist may choose to put a temporary material, to rebuild the tooth in bonded composite resin (white filling) or in dental amalgam (grey filling). For health reasons, this option is not offered at our dental clinic (see mercury toxicity).
If a large area of the pulp is affected or the tooth is very painful, then a root canal will be necessary. This treatment consists of keeping the solid portion of the natural tooth and removing the soft part (the vital part) inside in order to eliminate the bacteria and toxins that are lodged there. When the remaining structure is strong enough, root canal treatment is the treatment generally recommended by the Quebec Order of Dentists and the Canadian Dental Association. However, this treatment has certain limitations (the remaining tooth may be fragile and there may be a resumption of infection in the short or long term or even an insidious chronic infection). Thus, for various considerations, it is also possible to extract the tooth at this time and evaluate replacement alternatives. (See Root canal treatments).
Reconstruction and restoration of the tooth
When the root canal treatment is complete and the tooth is comfortable, a tooth reconstruction or gold or carbon fibre pins (posts) will be placed. These will serve as an anchor for the final restoration, usually a crown.
Depending on the situation, the ceramic crown can be fabricated with the CEREC technology offered at the practice in a single session. This means that you can go home with your crown the same day. Inlays or ceramic crowns made in the laboratory are also used when the situation requires more resistant materials in a thin layer (gold or zircon) or when aesthetic considerations require the collaboration of a laboratory technician, as for example for a rehabilitation involving the anterior teeth. In these cases, a temporary restoration will be installed at the first appointment and the final restoration will be installed at another visit 2-3 weeks later.
For a cracked or fractured tooth below the level of the gum or bone
In some situations, the tooth may crack or fracture below the level of the gum or bone. In the first case, it is possible to adjust the gum level with a laser directly at the clinic (laser gingivectomy). This procedure allows the dentist to clear the tooth and repair it in an optimal way.
In cases of tooth fracture deep below the gum line or even down to the bone level, bone and gum can be removed from around the tooth (clinical crown lengthening) so that it can be repaired. For the best health of the gums, the edge of the restoration should be at least 3 mm away from the bone level. Less clearance causes gum inflammation.
Crown lengthening helps to recreate this optimal clearance between the edge of the restoration and the bone level. This procedure can be done with conventional instruments (scalpel blade and turbine) or with a laser specific to the hard tissues of the body. Once the lengthening is complete, the tooth will appear longer than before. A repair, usually a crown, can then be made to strengthen the tooth. If the tooth is broken too far under the gum and bone, it may be necessary to extract the tooth. When crown lengthening is considered, it should be assessed whether this procedure has a good prognosis. If the prognosis is not good, it would be better to extract the tooth and place an implant while the necessary bone is still present.