A Patient’s Story: A Cracked Molar Tooth and a Better Alternative
A woman in her forties came to our office with severe cold sensitivity in her upper right first molar. She had been experiencing discomfort for about two weeks and was concerned about the possibility of losing another tooth. She had already lost multiple teeth in the past due to fractures and extractions, which made her eager to explore alternatives.
She had seen a video on our Instagram page VisionaryDentist about biomimetic dentistry and wanted to know if this approach could help save her tooth. During our conversation, she revealed a past experience with another dentist that had resulted in the loss of one of her molars. Two years earlier, she had a similar situation with a cracked molar tooth on the opposite side of her mouth. She had visited a dentist who recommended a full-coverage crown. After the crown was placed, she continued to experience discomfort and reported this to the treating dentist. The dentist then referred her to an endodontist for a root canal. However, when the endodontist began the procedure, he discovered that the fracture in her tooth had already extended into the root. As a result, he determined that the tooth was beyond saving and recommended extraction. The patient was devastated by this outcome and was now wary of aggressive treatments that might lead to a similar result.
Clinical Findings: A Deep Amalgam Filling and a Visible Fracture
Upon examination, X-rays and photographs revealed a large, deep amalgam filling in her upper right first molar. Most concerning was a visible vertical fracture on the back (distal) side of the tooth, extending down to the gum line.
Because the amalgam covered much of the tooth, we could not determine the full extent of the fracture without removing it. Cold and percussion tests confirmed that the tooth was vital and highly sensitive, indicating nerves of the tooth could be affected.
Traditional Dentistry vs. Biomimetic Dentistry
A traditional dentist would likely have recommended a full-coverage crown and possibly a root canal. While this might seem like a straightforward solution, it comes with significant risks:
· A crown requires the removal of substantial healthy tooth structure, making the tooth weaker.
· Crowns do not bond to the tooth structure, which can allow cracks to propagate.
· If the crack extends further after placing a crown, the tooth may eventually require extraction.
Instead, we proposed a biomimetic approach to preserve as much of her natural tooth as possible. Biomimetic dentistry strengthens the remaining structure and prevents further fracture propagation, significantly extending the lifespan of the tooth.
Step-by-Step Biomimetic Treatment
1. Removal of Amalgam Filling
o We carefully removed the existing amalgam, allowing us to assess the depth of the fracture.
o The fracture extended toward the gum line but did not reach the root, meaning the tooth was still salvageable.
2. Fracture Management and Pulp Protection
o We removed the compromised tooth structure along the fracture line without unnecessarily sacrificing healthy enamel and dentin.
o A bioactive material called Mineral Trioxide Aggregate (MTA) was applied to the deepest part of the tooth to protect and stabilize it.
3. Porcelain Overlay Restoration
o Rather than placing a crown, we restored the tooth with a porcelain overlay.
o The overlay was bonded to the tooth structure, reinforcing the weakened areas and preventing the fracture from extending further.
The Lifecycle of a Tooth: Why Crowns and Root Canals Shorten Tooth Longevity
A natural tooth, when healthy, can last a lifetime. However, common dental treatments can significantly shorten its lifespan:
· Root Canals: When a root canal is performed, the tooth loses its internal vitality, becoming more brittle and prone to fractures. Over time, the lack of blood flow weakens the structure, making it more susceptible to breaking under pressure.
· Crowns: Crowns do not reinforce the tooth but instead require extensive removal of healthy enamel and dentin, making the remaining structure weaker over time. When a tooth is significantly reduced, it is more likely to fracture again in the future, which may ultimately lead to extraction.
· Extractions and Implants: Once a tooth is extracted, the jawbone in that area can begin to shrink, leading to further complications. Neighboring teeth may shift into the empty space, affecting bite alignment and potentially causing additional dental issues.
Biomimetic dentistry aims to preserve natural tooth structure as much as possible. By using advanced bonding techniques and materials that mimic natural tooth mechanics, we can extend the functional life of a tooth and prevent unnecessary extractions. This approach helps maintain overall oral health and allows patients to keep their natural teeth for a longer period.
Patient Outcome and the Importance of Early Intervention
The patient was thrilled to learn that her tooth could be saved without a crown or root canal. She immediately noticed relief and felt confident in her treatment choice.
We recommended follow-up care, including:
· Wearing a nightguard to protect against further grinding-related fractures.
· Regular check-ups to monitor the tooth and ensure long-term success.
Patients with large amalgam fillings or early-stage fractures can greatly benefit from early intervention with biomimetic techniques. Addressing cracks before they extend into the root can prevent the need for extractions and implants.
Considering Biomimetic Dentistry? Here is What to Do Next
If you have been told you need a crown or root canal, biomimetic dentistry may offer a better alternative. By preserving more of your natural tooth structure, we can help extend the life of your teeth and prevent future complications.
Schedule a consultation today to explore biomimetic alternatives that can save your natural teeth and improve your long-term oral health.
