Potential Tooth Root Fractures: Diagnosis and Treatment Options

Q: Potential Tooth Root Fractures: Diagnosis and Treatment Options

Hello： Based on what you described, it is indeed possible that there is an issue at the junction of the two tooth roots. <br>1. <br>A cone beam CT scan can be performed to confirm if there is a fracture (this will also incur additional costs). <br>2. <br>After removing the crown,

Suspected root fracture?

Hello Doctor, in April 2022, I had root canal treatment and a crown placed on my second-to-last lower right molar.
I had no issues eating until October 2022, when I started experiencing soreness when biting down.
I consulted a specialist in microscopic endodontics, who noted some shadows on the X-ray but couldn't confirm the cause.
The crown material and fit were good, and there were no cracks.
We ruled out cavities, but it was possible that residual bacteria were left from the initial root canal treatment or that there was a fracture in the tooth root.
I was shocked, thinking that I had been careful with my crown.
The doctor advised me to observe for three months and then get another X-ray for clarity.
After that, I suddenly no longer felt soreness, but about two to three weeks ago, a blister (abscess) appeared at the junction of the tooth and gum.
During my follow-up appointment for the X-ray, the doctor noted that the shadow had increased in size, coinciding with the area where the abscess was located (the red area in the shadow).
He estimated an 80% chance that there is a fracture in the tooth root.

The first option is extraction and dental implant (since the adjacent teeth are in good condition, he recommended an implant to avoid grinding down the neighboring teeth).
The second option is to remove the crown and perform a microscopic examination to see if there is indeed a fracture in the root.
If there is no fracture, a second root canal treatment would be performed.
However, the doctor mentioned that the likelihood of a root fracture is high.
If the microscopic examination reveals a fracture, I would return to the first option of extraction and implant.
Additionally, there is a cost of $5,000 for the microscopic examination, and he recommended that I consider spending the $5,000 to check for a root fracture.
Should I proceed with the examination, or go straight to extraction and implant? Are there any other options to save the tooth? Thank you.

tony, 30~39 year old female. Ask Date: 2023/02/06

Dr. Lin Jiayong reply Dentistry

Hello: Based on what you described, it is indeed possible that there is an issue at the junction of the two tooth roots.
1.
A cone beam CT scan can be performed to confirm if there is a fracture (this will also incur additional costs).
2.
After removing the crown, we can check if root canal therapy or periodontal treatment is still feasible.
3.
If treatment is not possible, we can then decide whether to proceed with reconstruction (extraction/implant) or to coexist with the issue (root fracture/root remnant) for a period of time before making a decision.

Reply Date: 2023/02/06

More Info

Tooth root fractures can be a complex issue, especially when they occur after root canal treatment and crown placement. The symptoms you describe, including pain when biting and the presence of a fistula (the "water bubble" you mentioned), suggest that there may be an underlying infection or structural issue with the tooth.

Diagnosis of Tooth Root Fractures
1. Clinical Examination: A thorough clinical examination by a dentist or an endodontist (root canal specialist) is essential. They will assess the tooth for mobility, tenderness, and any signs of infection or abscess.

2. Radiographic Evaluation: X-rays are crucial in diagnosing root fractures. However, they can sometimes miss subtle fractures. The presence of a dark shadow on the X-ray, especially if it has changed over time, can indicate a problem with the tooth's root or surrounding bone.

3. Advanced Imaging: If the X-ray results are inconclusive, a Cone Beam Computed Tomography (CBCT) scan may be recommended. This 3D imaging technique provides a more detailed view of the tooth and surrounding structures, allowing for better assessment of fractures.

Treatment Options
1. Observation: If the tooth is not causing significant pain and there are no signs of acute infection, your dentist may recommend a period of observation. This allows time to see if symptoms resolve on their own.

2. Retreatment: If the root canal treatment was not adequately performed, retreatment may be necessary. This involves removing the existing filling material, cleaning the canal system, and sealing it again. This option is viable if the tooth structure is intact and there are no fractures.

3. Surgical Intervention: If a fracture is confirmed, surgical options may include:
- Apicoectomy: This procedure involves removing the tip of the root and any infected tissue. It is only applicable if the fracture is at the root tip and the rest of the tooth is salvageable.

- Extraction: If the fracture is extensive or if there is significant bone loss, extraction may be the only option. Following extraction, dental implants can be placed to restore function and aesthetics.

4. Dental Implants: If extraction is necessary, a dental implant is often recommended, especially since your adjacent teeth are in good condition. Implants do not require the adjacent teeth to be altered, preserving their integrity.

Considerations for Decision-Making
- Cost vs. Benefit: The cost of advanced imaging and potential retreatment should be weighed against the likelihood of saving the tooth. If the probability of a successful outcome is low, extraction and implant placement may be more cost-effective in the long run.

- Second Opinion: If you feel uncertain about the recommendations, seeking a second opinion from another endodontist or oral surgeon can provide additional insights and options.

- Personal Comfort: Consider your comfort level with the procedures. If the thought of surgery or extraction is daunting, discussing your concerns with your dentist can help you feel more at ease with the decision-making process.

Conclusion
In summary, diagnosing and treating a potential tooth root fracture involves careful evaluation and consideration of various factors. While the possibility of saving the tooth through retreatment exists, the likelihood of success must be balanced against the potential need for extraction and subsequent implant placement. Consulting with your dentist about your options and possibly seeking a second opinion can help you make an informed decision that aligns with your health needs and personal preferences.

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