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Treatment provided by Dr Andrew Nixon (implant-restorative dentist) and Dr Paul Coceancig (oral & maxillofacial surgeon).
When you first knocked your front tooth, the delicate blood vessels and nerves that entered the apex of the root tip became broken, and the nerve inside the tooth died.
To treat this type of injury, root canal therapy removes the decaying pulp tissue before it has a chance to penetrate and discolour the overlying crown, or to lead to a peri-apical abscess.
The process of nerve death, or of subsequent root canal treatment weakens a tooth, and so your dentist will strongly advise on procedures designed to strengthen the crown. These procedures usually require placing a metal post down the centre of the root filled tooth, and of surrounding the crown aspect with metal based porcelain jacket to provide a ferrule.
Such teeth often function for many years without ill effect, but forces gradually build up, micro-fractures arise, and eventually the tooth often fails catastrophically and unexpectedly many years after the initial treatment success.
When a root filled tooth fractures, it is often impossible to restore. Usually a patient will present with multiple crown recementation episodes, until they realise that the situation is hopeless, and the tooth requires formal removal.
Definitive tooth removal is an urgent requirement. Fractures in the root often follow the line of the internal metal post, so cracks propagate into the actual tooth ligament. This sets the patient up for acute deep infections, and in the most disastrous case, frank surrounding bone loss.
This 55 year old mother was biting into a biscuit at home, when her front crown first fell onto the dinner plate. She then started a series of multiple trips to the dentist to re-cement the crown, but nothing seemed permanent.
The tooth had been treated many years previously with first endodontic therapy, then a post and core, and then finally with a dental crown.
When she presented, the dental crown looked normal, but it was very loose, and the gum above the crown was very inflamed.
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Artificial upper left central incisor crown, fractured slightly forward on left, with slight overlying gum inflammation above crown. |
Teeth are first normally treated with a root canal therapy, and then a central post is placed down the centre of the root.
Although considered a tooth strengthening exercise, the metal post can direct abnormal forces down the centre of the of the now brittle root, leading to catastrophic root fracture.
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Healing abutment in place 3 months after tooth was removed. |
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The tooth was immediately removed, and although there was a small amount of bone loss alongside the root fracture, an immediate implant was able to be placed.
The implant heals over 3 months, and the photo shows the very top surface of an attached healing abutment. |
After 3 months, the implant had normal bone osseointegrated with the implant surface, and an implant-restorative dentist was able to provide a zirconia based porcelain crown that was permanently fixed into the implant base. |
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X-ray showing normally integrated implant, with fixated zirconia based porcelain crown. |
Final tooth colored porcelain/zirconia crown, with perfect gingival health. Tretament provided by Dr Andrew Nixon, implant restorative dentist.
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