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The sad story of a fractured tooth

March 16, 2014 | Posted in General Information | Be the first one to comment

When looking at this image, there are a few obvious problems:

The dark dark discoloration of the tooth is due to marginal leakage and subsequent recurrent decay beneath the old filling. There is a significant wear facet on the buccal cusp extending distally indicative of malocclusion and possibly parafunction (clenching/ grinding). There is a craze line in the enamel running from the buccal cusp tip distally through the isthmus, beneath the old restoration and ending on the lingual cusp. The proximal surfaces are overbulked with old amalgam giving the tooth poor contour and making hygiene difficult.

The patient was advised of the poor condition of this tooth but decided not to proceed with any treatment until there was a problem with the tooth. A discussion ensued that involved the malocclusion, occlusal wear, recurrent decay and risk of fracture. A full coverage restoration would be ideal to optimize occlusion, strength and gingival health. The patient indicated that he was not interested in treatment because the tooth has never given him problems.

A mere 4 months after our discussion regarding this tooth, the patient returned with a fractured filling. There was some discomfort when biting and the appearance of the tooth was highly suspicious for fracture.

The tooth was anesthetized and isolated with rubber dam for comprehensive assessment: the mesial portion of the amalgam was fractured and missing; there was a large gap in the cavosurface margin, the remaining filling material was mobile and the buccal cusp moved with light pressure.

The restoration was removed to reveal the source of the problem - a clear vertical fracture completely dividing the buccal and lingual segments of the tooth. Unfortunately, this type of fracture can not be repaired and the only course of treatment was immediate extraction of the tooth. 

Timely care and maintenace of existing restorations are a crucial component of comprehensive dental care. As old fillings, crowns, etc. wear down, they dramatically increase the risk of fracture to the remaining tooth structure. Also, our bite will change with time such that even regular bite forces can lead to trauma to our teeth. 

Don't let this situation happen to you. Waiting until there is a problem can often be too late and very costly - as in this case where the tooth was nonrestorable. A replacement for this tooth will cost the patient more than three times what the initial treatment proposal was. Being proactive with oral health care is the best way to save time, money and maintain your natural, healthy smile.

Contact Dr. Luke Haslam at Basinview Dental Centre to schedule your consultation today!

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