Dental Trauma

Tooth fractures occur frequently in adults and children either due to pathological reasons, like tooth caries, or due to accidents or sports-related trauma. Facial trauma may result in tooth cracks or fractures, root fractures or even movement of the tooth as a whole from the bone socket (subluxation) and tooth loss (avulsion). On the other side, tooth fractures connected to caries are usually limited to the level of the gums, occur more frequently at posterior teeth and are easier to restore.
The aesthetic concerns after a tooth fracture should not be something to worry about, since nowadays aesthetic dentistry offers many solutions for smaller or more extensive tooth trauma, giving you back the desired look! Tooth fractures can be restored with white fillings, tooth build-up with glass fibers, crowns, veneers, onlays or even by reattaching the fractured piece. When the fracture is extended and an implication of the tooth nerve or tooth pulp is possible, a root canal treatment may be additionally needed. For younger patients, who eventually show ideal healing potential, pulp regenerative techniques can be applied by using bioactive materials which promote healing and proper function of the tooth nerve, avoiding therefore at that time a root canal treatment. Duration of the dental treatment depends on the extent of the fracture, and restoration may be completed in just one or 2-3 visits in Smiles Dental Clinic. In some cases of complete tooth loss, reposition of the natural tooth may be possible. Otherwise placement of a dental implant is the treatment of choice.

• Restoration with white fillings
Small or medium tooth fractures at the front or back teeth can be replaced with a white filling. Extra care is given in order to assess tooth vitality and if necessary, place nerve-protecting lining materials under the restorative composite. Especially in cases of an anterior tooth fracture, an aesthetic white filling is suggested as the most appropriate treatment, in order to restore the natural appearance of the tooth and make it look like it never broke! For posterior teeth, a white composite filling or an amalgam filling may be placed according to biological and aesthetic requirements. Treatment is completed in a single visit at Smiles Dental Clinic.

• Tooth build-up with glass fibers
Larger fractures, especially when located at the posterior teeth, need to be restored with a tooth build up on glass fibers. This modern technique offers the advantage of lower cost, in comparison to a crown or an onlay, by providing at the same time the appropriate strength and elasticity for withstanding chewing forces and avoiding future fractures. Build up is performed with aesthetic composite which matches the tooth shade and offer an excellent final result. Tooth build-up is completed in also completed in a single visit at Smiles Dental Clinic.

• Crowns
Extensive tooth fractures are restored with a porcelain-fused-to-metal crown, a ceramic crown or a zirconia crown. The appropriate choice between the three crown types is based upon the desired aesthetics (a ceramic crown looks more natural than a porcelain-fused-to-metal crown, especially for anterior teeth) and on strength (a zirconia crown can lift heavier load than a ceramic crown at back teeth area while chewing). Since crowns are manufactured by the laboratory technician, 2-3 dental visits are required. In order to keep the number of dental visits to a minimum, when more crowns are needed, longer appointments are being scheduled and the number of visits is kept the same.

• Veneers
Medium-sized tooth fractures at anterior teeth can be corrected with veneer placement, which cover the tooth loss. Minimum or no tooth preparation is needed, and this is why veneers are regarded as a conservative dental treatment. They are either made of composite or porcelain. Composite veneers offer a value-for-money choice, however porcelain veneers are able to reproduce a natural appearance of teeth and provide incomparable aesthetics! Composite veneers are placed in a single visit at Smiles Dental Clinic, while usually 2 appointments are needed for porcelain veneers.

• Onlays
Medium-sized tooth fractures at posterior teeth are restored with composite or porcelain onlays. These tooth-colored restorations resemble the appearance of a filling, but since they are manufactured at the dental laboratory, they are stronger than a traditional filling and fully customized to perfectly match the missing area of the tooth. They are then bonded with the remaining tooth structure and restore the missing tooth tissues. They are less conservative than crowns, and when an onlay is placed instead of a post and a crown, a root canal treatment can be avoided. They also offer the advantage of longer duration than fillings and easier oral health maintenance around them by tooth brushing and flossing. Onlays are completed in 2 visits at Smiles Dental Clinic.

• Tooth fragment reattachment
In anterior teeth trauma, when the missing piece is found and is properly maintained, it can be reattached back to its original place. Proper maintenance means storing the tooth fragment in water or in a moistened pad, to avoid drying or even better in specially designed containers with specially nourishing liquid, which can be found in the pharmacy. With this technique, the appearance of the fractured tooth remains 100% identical and the strength of the bonded tooth segment is at the same level with the bond strength of a white filling. Tooth fragment reattachment cannot be performed at posterior teeth, or at fractured teeth due to caries. The treatment lasts 60 minutes and initial color shade is achieved after 1-2 days of re-hydration intraorally.

• Tooth reposition
This innovative and promising technique is performed in cases of heavy tooth trauma which resulted in tooth avulsion. The tooth is repositioned to its initial place and is stabilized with glass fibers with the adjacent teeth, until proper healing of the supportive tissues is reached. Just a few minutes are needed in order to restore the appearance of the smile with this technique! Chances of successful treatment are higher when the tooth is repositioned within an hour after the trauma and when it is stored at proper storage medium designed for avulsed teeth, which can be found at a pharmacy. Alternatively, tooth can also be stored in cold milk or water, or if none of these are available, then inside the patient’s mouth, preferably under the tongue, taking extreme care to avoid swallowing, until you reach Smiles Dental Clinic for your treatment. Tooth reposition is performed under local anesthesia, is pain-free and no surgical invasion or sutures are needed. Proper medication, usually including antibiotics, is prescribed and post-treatment care advice is given until the next visit in about one week for a radiographic examination.

• Implant
When root fracture, extended tooth loss or tooth avulsion with no chances of tooth survival take place, implant placement is the treatment of choice. Following tooth extraction, an implant can be directly placed along with bone graft held by collagen membrane, in order to support the implant and stimulate bone growth. Since 3-4 months are mandatory for implant osteointergration and healing before a crown or any other restoration can be placed on it, provisional teeth are placed at the same appointment with the implant placement to ensure a pleasing aesthetic appearance of front the teeth. In most cases a provisional fixed bridge is manufactured, which is temporarily held on the adjacent teeth.

Direct seek of dental care without further delay is of high importance in cases of dental trauma or tooth fractures, since in that way more alternative options would be available for the treatment. Correct choice of proper therapy for every case of tooth trauma is the key to success and long-term maintenance of the once broken tooth, therefore the dentist’s experience and expertise are valuable.