Options After Root Canal: Can You Save a Cracked Tooth Without Extraction?

Underwent root canal treatment without a crown, resulting in a fracture while eating?

Hello Doctor: A couple of years ago, I had a root canal treatment done on one of my posterior teeth (likely near the molars), where the nerve was removed.
The cavity was not small, and at that time, I did not get a crown.
I have been very careful while eating and cleaning, and everything has been fine until recently.
A few days ago, I accidentally bit into something hard and noticed a small crack when I looked in the mirror.
The tooth feels a bit loose, but I don’t feel any pain unless I touch it.
There are no signs of it falling out, and if I don’t bite or touch it, I don’t feel anything.
I tried to apply some pressure to the tooth, and it didn’t hurt.
I am considering whether it’s possible to fill the crack and then get a crown.
The next day, I visited the dentist, who recommended extraction.
They suggested waiting one to two weeks for the surface wound to heal, and then two to three months for the internal healing before considering either an implant (70,000 TWD) or a bridge (21,000 TWD).
I would like to ask the doctor if extraction is the only option.
On one hand, extraction is a significant decision that would sacrifice healthy adjacent teeth, and on the other hand, the financial burden is considerable.
I respect the dentist's expertise, but I believe extraction should be the last resort.
After discussing this with friends, they suggested seeking additional opinions, as I have heard of some unpleasant experiences from others.
My friends hope to know if extraction is the only solution or if there are other alternatives available.
Thank you, Doctor, for taking the time to respond and assist with my questions.
I appreciate it and wish you peace and well-being.

Xiao Wei, 30~39 year old female. Ask Date: 2016/03/14

Dr. Zeng Guanghui reply Dentistry

Teeth that have undergone root canal treatment are generally more fragile and cannot withstand significant occlusal forces.
Even if the cavity was filled initially, they still struggle to bear large biting pressures.
If a tooth with a crack is bitten down on, the extent and direction of the crack need to be assessed.
If the crack is limited to the crown and is horizontal, there may still be a chance to save the tooth.
However, if the crack extends to the root and is vertical, the tooth will likely need to be extracted.
In such cases, options include dental implants or bone grafting.
It is advisable to consult a dentist for further evaluation and treatment.

Reply Date: 2016/03/14

More Info

When faced with a cracked tooth after a root canal treatment, the decision to extract or save the tooth can be challenging. Your situation, where you have a cracked tooth that has some mobility but does not cause pain unless provoked, presents a unique set of considerations.

Firstly, it's important to understand the nature of the crack. Cracks in teeth can vary significantly in severity and location. If the crack extends below the gum line or into the root, it may compromise the tooth's structural integrity and increase the risk of infection. In such cases, extraction may be the only viable option. However, if the crack is limited to the crown of the tooth and does not involve the root, there may be alternatives to extraction.

Your dentist's recommendation to extract the tooth may stem from a conservative approach to prevent future complications. However, it is essential to seek a second opinion, especially if you feel that the tooth can be salvaged. Many dentists are willing to explore options such as bonding, crowns, or even root canal retreatment if the crack is manageable.
In your case, since the tooth is still functional and does not cause pain when not disturbed, you might consider the following options:
1. Bonding or Composite Fillings: If the crack is superficial and does not extend deep into the tooth, a dentist may be able to use a composite resin to fill the crack and restore the tooth's integrity. This option is less invasive and can be a temporary solution while monitoring the tooth's condition.

2. Crown Placement: If the crack is more significant but does not involve the root, placing a crown over the tooth can provide additional support and protection. A crown can help stabilize the tooth and prevent further cracking, especially if you are careful with your diet and oral hygiene.

3. Root Canal Retreatment: If there is a concern that the initial root canal treatment was not successful or if the crack has led to new infection, a dentist may recommend retreating the root canal. This involves cleaning out the tooth again and sealing it properly, followed by placing a crown.

4. Monitoring: If the tooth is stable and not causing pain, your dentist may suggest a watch-and-wait approach. Regular check-ups can help monitor the tooth for any changes that may necessitate further intervention.

5. Extraction and Replacement Options: If extraction becomes unavoidable, you have options like dental implants or bridges. While implants are more expensive, they offer a permanent solution that does not affect adjacent teeth. Bridges are less costly but require altering the adjacent teeth.

In conclusion, while your dentist's recommendation to extract the tooth may be based on their assessment of the situation, it is crucial to weigh all options. Consulting with multiple dental professionals can provide you with a broader perspective and help you make an informed decision. Remember, preserving your natural teeth is always preferable when possible, and advancements in dental technology offer various solutions that may allow you to save your tooth. Always communicate your concerns and preferences with your dentist, as they can tailor their recommendations to fit your needs and financial situation.

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