The detection of a root crack is one of the most difficult problems that a dentist may face. It can be difficult to diagnose and to treat. There are several clinical and radiological signs, on the basis of which the clinician may suspect this type of pathology.
The prognosis of treatment depends on many related factors. For example, incomplete vertical fractured tooth root occur under the influence of a strong masticatory load, trauma, as well as during the fixation of pins or tabs for tooth extension. The crack can be detected only with a thorough examination of the tooth using a magnifying glass or a microscope. After a few months or years, cracks can turn into a complete vertical fracture, which will lead to undesirable consequences. It should be borne in mind that there is a constant seepage of microorganisms through the resulting defect that lead to resorption of bone tissue, which in the future can significantly complicate the process of implant installation or even make it impossible.
In clinical practice, vertical fractured tooth root occurs most often there. The highest percentage of cracks in the roots of teeth occurs in the teeth, which were previously subjected to endodontic treatment. But sometimes they occur in an intact, previously untreated tooth. The crack can pass through one or both walls of the root. For example, in molars, the crack/fracture line most often follows in the buccal direction. Less common is the mesio-distal direction. In the area of the front teeth, it is more often located in the buccal direction. The crack can originate both from the crown and from the apex.
Vertical Root Cracks
This type is a longitudinally oriented cracks passing through the root wall, penetrating from the root canal into the periodontal pathology. Vertical fracture may occur during treatment, in the postoperative period or due to injury.
Note!Diagnosis of fractured tooth root canal is often complicated, because there are no clinical signs indicating it. Valuable auxiliary means of assessing the crack line are the fiber-optic light source and the use of a dye.
Possible causes of tooth root crack formation:
- Pin structure fixation (during or after the procedure): the diameter of the pin is larger than the diameter of the channel;excessive thinning of the walls of the root; deviation from the axis of the root canal during the preparation. For example, there is a danger of cracking and splitting of the root after fixing the pin structure as a result of redistribution of chewing pressure from the crown to the root through the pin. Modern studies have confirmed that only elastic, namely carbon and fiberglass pins, made with modern technology, have physical properties similar to the structure of the tooth, and can create a reliable construction.
- Endodontic treatment: excessive pressure when using spreaders and plug-ins during endodontic treatment; condensation of gutta-percha pins; excessive channel expansion in the middle third, on the internal curvature of the root; mismatch of the selection dimension of the endodontic instrument with respect to the root canal of the tooth;
- Injury: inaccurate extraction of teeth; domestic injury, etc.
- Pulpless tooth power is susceptible to chips and cracks under load as a result of the lack of supply.
Clinical Manifestations of Tooth Root Crack
Clinical manifestations of cracked tooth root have different symptoms, and the symptoms vary depending on:
- localization of cracks;
- tooth type;
- the time elapsed since the crack;
- the state of the periodontium and the architecture of the bone adjacent to the fracture slit.
Teeth with vertical root fractures often have a history of prolonged discomfort or pain, usually detected near local foci of chronic infection. Usually the pain is moderate or medium, there is pain when biting. The patient complains of pain when chewing or when any load on the previously treated tooth, unpleasant taste, discomfort. Sometimes the patient remembers the feeling of “clicking” during the condensation of gutta-percha or pin fixation. In this case it is possible to suspect the possibility of fissures in the root of the causative tooth. Bleeding during condensation, a clear decrease in the resistance of the root walls leads to the fact that a large amount of gutta-percha can be introduced into the canal, which may indicate the presence of a crack/fracture.
You can see a slight swelling of soft tissues in the oral cavity in the area of the causal tooth. The swelling is usually spilled and is projected in the middle third of the root. Palpation reveals swelling and tension along the root with little involvement in the periapical region.