Treatment for a fractured crown of the second molar?
Hello, Doctor.
Recently, while brushing my teeth, I accidentally discovered that my second molar has a chipped crown (the approximate condition of the chip is illustrated here: https://i.imgur.com/AwNJvJO.jpg).
Although the visible area of the chip appears to be about 20-30%, it seems larger than expected when viewed from a vertical angle.
I am quite worried about the situation worsening, so I immediately visited a nearby dental clinic.
However, the dentist believes that this tooth may no longer be treatable through traditional filling methods and suggested extraction.
Due to my busy work schedule, I am concerned that I won't have much time for post-operative cleaning and care.
Additionally, I have heard that extracting an upper tooth may damage the sinus and that it is advisable to avoid blowing my nose for a period of time.
Since I have long suffered from allergies and sinusitis, I am worried about potentially harming my already problematic sinuses and the possibility of permanent complications due to inadequate care after the extraction.
Given these considerations, I did not accept the extraction recommendation.
I would like to ask you, is it really impossible to preserve my second molar with a moderate to deep crown fracture through restorative methods, and must it be extracted? Or is there still a chance to save this compromised tooth through other treatment options? Should I seek help from a specialist in another dental subspecialty? Thank you for your valuable advice!
Jiong Yu, 30~39 year old female. Ask Date: 2023/11/02
Dr. Lin Jiayong reply Dentistry
Hello: If you strongly wish to preserve the tooth root and do not anticipate using the damaged tooth for occlusal function in the future, it is advisable to discuss this with specialists in endodontics and periodontics.
Reply Date: 2023/11/02
More Info
When faced with a cracked second molar crown, it is understandable to be concerned about the potential loss of the tooth and the implications of extraction. The situation you described, where approximately 20-30% of the crown is missing, does raise important questions about the viability of the tooth and the best course of action.
First, it is crucial to understand that the treatment options for a cracked tooth largely depend on the extent of the damage and the health of the tooth's structure. In cases where a significant portion of the crown is missing, as you described, there are generally a few potential treatment pathways:
1. Direct Restoration: If the remaining tooth structure is sufficient, a dentist may opt for a direct restoration using composite resin. This method can be effective if the crack does not extend into the pulp of the tooth and if there is enough healthy tooth structure to support the restoration.
2. Crown Placement: If the tooth is deemed structurally sound but requires more support than a simple filling can provide, a dental crown may be recommended. Crowns can be made from various materials, including porcelain, metal, or a combination of both, and they provide a protective covering for the tooth, restoring its function and aesthetics.
3. Root Canal Treatment: If the crack has compromised the pulp of the tooth, a root canal may be necessary before placing a crown. This procedure involves removing the damaged pulp, cleaning the root canals, and sealing them to prevent infection. Afterward, a crown can be placed to protect the tooth.
4. Extraction: In cases where the tooth is severely damaged and cannot be restored, extraction may be the only option. However, this should be a last resort, especially if you are concerned about the implications of losing the tooth, such as the potential for sinus issues or the need for future dental implants.
Given your situation, it is advisable to seek a second opinion from a specialist, such as an endodontist (who specializes in root canal treatments) or a prosthodontist (who specializes in restoring and replacing teeth). These specialists can provide a more detailed assessment of the tooth's condition and explore all possible treatment options.
Additionally, if you are concerned about the time commitment for post-operative care, it is worth discussing this with your dentist. Many modern dental procedures are designed to minimize recovery time and can often be managed with straightforward aftercare.
In summary, while your dentist may have suggested extraction, it is essential to explore all available options. A second opinion from a specialist can provide you with a clearer understanding of the potential for saving your cracked second molar crown. Remember, preserving your natural teeth is always the preferred approach in dentistry, and there may be viable treatments that can help you avoid extraction.
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