Dental Trauma and how to fix it

Dr. Brooksby,

I was hit in the mouth this morning. I still see part of the tooth. How do you fix something like this. Please answer quickly.

Dear Quickly,

Small fractures in the tooth

When a tooth breaks it can break in a number of different ways each requiring a different approach and each with a different chance of success. If a portion breaks off and it does not involve the nerve, in other words, you do not see red in the middle of the tooth, it can often be easily repaired with a tooth colored filling material, the same day. This blends well and looks very natural and is fairly strong. The cost is usually in the $2-400 range.

Medium size tooth fractures

If the tooth breaks off and it is less than 1/3 of the tooth, but has a red spot in the middle you have hit the nerve. This will require a root canal followed by a filling. Most dentists also recommend a crown, but in my opinion, this simply removes a lot more tooth structure making it a lot weaker. The root canal can range from $800-1300 depending on whether it needs to be done by a root canal specialist or not. The filling is still in the $200-400 range.

Large size tooth fractures

If more than ½ o of the tooth breaks off, you may try the above options, but the success rate is a lot lower. Many dentists will do a root canal, post build up, gum surgery to lengthen the tooth and then a crown. This can cost around $3000-4000. Often this weakens the tooth and may reduce the longevity of the tooth. Sometimes to as little as a year or two, but sometimes a lot longer.

If the tooth is broken off at the gum line, the success rate of restoring the tooth is really low. It is usually in your best interest to consider removing the root and replacing the tooth with an implant supported crown or a fixed bridge.

Tooth fractures off at the gum line

The implant supported crown can take up to a year from beginning to end and usually you will wear a flipper for the healing time. The timing depends a lot on the size of the hole left by the tooth after it has been removed as well as the strength and amount of bone beyond the tip of the root for stabilizing the implant. Implants fail if they move at all. If the diameter of the root is 8 mm and the average implant is 4-6 mm then there will not be enough bone to support the implant. If you can get a long enough implant beyond the tip of the root with enough bone and it is strong, then you can place the implant at the time of the extraction. If the tooth has any infection around it this can kill the implant and would normally mean a wait to heal before the implant is placed.

If you decide to do a bridge, this requires cutting the teeth on either side of the broken tooth down to little stubs and then rebuilding them with porcelain or porcelain fused to metal with a false tooth connected between. Often the bone will atrophy in the area where the tooth is removed and a gap will often gradually appear under the bridge. There are ways of doing this that minimize the problem, but can take a lot more time.

For more information on broken teeth, implants or bridges call Dr. Brooksby at or if you have questions you would like answered you can e-mail Dr. Brooksby at scott@lvimplant.com.