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The iceberg effect: broken teeth and how to save them

Surprised? What has an iceberg have to do with teeth other that the sensitivity on consuming “iced” drinks.

Well, it’s more than about cold things and the common rant about sensitivity blah blah blah…. (know about it here)

What is the “iceberg effect”?

Well, not a term generally used in dentistry. it has been used here to signify the tooth and its basic architecture. A portion of the tooth is embedded in the jaw and thus, cannot be seen in the mouth versus the portion of the tooth that can be seen in the mouth.

Similar to an iceberg, the portion inside the jaw, known as the root is larger. The root helps in stabilizing the tooth. The crown portion, seen in the mouth is much smaller and helps in chewing.

Why is this important?

It is generally assumed that because the crown is broken the tooth might require removal BUT THIS CAN’T BE MORE FURTHER FROM THE TRUTH

The root portion, that isn’t seen in the mouth might be the major factor in determining the treatment planning, especially at times when the crown portion is severely damaged.

Why is it important to preserve “only” the root?

Since the area that helps in chewing is already damaged and there is difficulty in chewing so, how does it help to save the portion which is of no “visible” use?

Well, the root of the tooth helps in maintaining the height of the bone in which it is embedded this is important because

·         The bone height determines the strength of any restoration placed on top of the bone. Lesser the bone height, less will be the amount of function that the treatment would provide.

·         The bone height of the jaws contributes to the total bone height of the face. As the height of the jaws decrease the height of the face decreases. This results in an older appearance of the face

Thus, longer the natural teeth can be preserved in the mouth, better would be the general oral health in terms of function and appearance.

Would the broken tooth not get infected or be a cause of other oral issues?

 Yes, a tooth that is severely damaged has the propensity of causing extensive infection.

Thus, the first step in treating a broken tooth is root canal treatment.

Sometimes the crown portion of the tooth breaks off years after the root canal treatment with or without the cap. In such a situation the condition and the correctness of the root canal needs to be checked before any other treatment is undertaken.

Thus, with a broken tooth the first step of treatment would be for most part be a root canal treatment

Is the tooth strong enough to sustain chewing forces?

 This is where the “iceberg effect” comes in. The general crown to root ratio is 2:3. Since the larger portion of the tooth is inside, with a healthy bone to support the root, the entire crown portion of the tooth can also be build up and provide adequate function.

The amount of crown left is thus, not as much a determinant of the treatment than the length of the root and height of the supporting bone

With 3 important factors

·         A good root canal

·         An adequate length of root

·         Healthy surrounding bone

The tooth need not be extracted

How is it done?

The treatment plan depends on

·         The amount of the crown portion remaining

·         The level the crown has broken at (above or below the gums)

The amount of the crown portion remaining

 If there is enough crown structure remaining the tooth can be restored with a special strength material and an artificial dental crown can be placed above.

If a major part or the entire crown of the tooth is broken, a “post” is attached.

A post is like a pillar, it provides strength and an area around which a build-up can be done. This provides additional support to the build-up. The crown is then placed over the final prepared build-up

The level the crown is broken at

 If the crown is broken well above the gum line the treatment only depends on the amount of the tooth structure is broken  

If the crown is broken below the gums a procedure known as “crown lengthening” is undertaken.

It is a minor surgical process that involves removing a small portion of the gums so that a greater area of the tooth(root) portion is exposed for additional support and functionality

Thus, a badly damaged tooth can also be “saved” at times, providing complete functionality as that of a normal tooth

 Cases when the tooth cannot be saved and a removal is required

 Although with newer developments, the original tooth can be preserved for an extended period of time, there are certain situations when a tooth requires removal. These include

·         If the supporting bone is severely damaged

·         The tooth root is broken

·         The tooth is moving

·         The tooth root is extremely short

·         The gums are damaged due to gum disease

A complete evaluation including x-rays would be required in order to decide the final treatment plan.

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