Treatment of Cracked Tooth

A cracked tooth is an incomplete fracture of the tooth that often manifests as “cracked tooth syndrome”. This is characterized by sharp pain triggered when chewing (biting or release) of tough, grainy foods and heightened sensitivity to hot or cold temperatures. Oftentimes, the pain is erratic and may require an Endodontist to confirm the diagnosis.

Root canal treatment may be required to remove the inflamed or infected pulp from the tooth if the tooth presents with severe and persistent signs and symptoms. Prior to the root canal treatment procedure, the Endodontist will carry out a crack assessment using a dental operating microscope to determine the severity of the crack. The deeper the extent of the crack, the poorer the prognosis of the tooth. After the crack assessment, the Endodontist and the patient can have a discussion on whether to retain the tooth and come to an informed decision together. If the patient opts to retain the cracked tooth, completion of root canal treatment will be planned, followed by a crown for cuspal protection.

Picture: A Crack on the root of an Extracted Tooth

Internal Bleaching

Tooth discoloration may be a sign of root canal infection which requires a clinical and radiographic assessment by your Endodontist. The discolouration may be caused by decay or a previous history of dental trauma. If the tooth is deemed necrotic and requires root canal treatment, internal bleaching may be a viable treatment option. It is a predictable procedure that aims to lighten the tooth colour and restore the tooth to its original aesthetics. However, effectiveness of the bleaching procedure depends on the etiology and degree of discolouration. The bleaching of the root canal treated tooth is carried out by placing a bleaching agent in the tooth cavity after root canal filling is done. It may take several visits with the Endodontist to achieve the desired aesthetic outcome.

Pictures: Bleaching of a Root Canal Treated Tooth

Dental Trauma Management

Traumatic dental injuries occur frequently in young children and adults. These may involve crown fractures or injuries to the surrounding periodontal ligament, causing loosening or locking of the teeth within their bony sockets. Crown fractures may also damage the pulpal tissues within the tooth, causing pain, sensitivity or swelling. Endodontists are well-versed in tooth injuries and can provide timely and urgent care for patients with such injuries. A careful evaluation of the clinical condition of the patient and traumatized teeth will be carried out and baseline investigations and radiographic records will be taken. Treatment intervention depends on the type and extent of injury. These may include restoration of fractured fragments, splinting of loosened teeth, vital pulp therapy and/or root canal treatments.

Vital Pulp Therapy

Vital pulp therapy (VPT) aims to preserve the vitality and function of the dental pulp after injury resulting from trauma, caries, or restorative procedures. Traditionally, dental practitioners may recommend root canal treatment for teeth with deep decay and irreversibly inflamed pulps. Today, an alternative treatment option of VPT with contemporary techniques and materials is now an accepted treatment modality which may be offered to select patients.

The main advantage of VPT is to preserve healthy pulp tissues and allow the continuation of root growth of adult teeth. This is advantageous for children and young patients whose roots are not fully formed and have the potential to develop. Post-operative sensitivity may be expected after the procedure. However, if the remaining pulp tissue becomes infected and pain persists, root canal treatment will be required. You may have a discussion with your Endodontist for further understanding of the pros and cons of the procedure.

Pictures: Demonstrating Treatment Process of a Vital Pulp Therapy

Regenerative Endodontics

Regenerative endodontics employs the modern concept of tissue engineering to restore root canals to a healthy state, allowing for continued development of the root and surrounding tissue. Endodontists’ expert knowledge in the fields of pulp biology and tissue engineering can be applied to carry out regenerative endodontic treatment of necrotic immature permanent teeth. Immature teeth have thin walls and short roots, which may compromise the longevity of the tooth. Regenerative endodontics promote root development by increasing the thickness of dentinal walls and allowing for root closure. The treatment involves disinfection of the root canal space and the placement of contemporary biocompatible materials to stimulate pluripotent.

Pictures: Demonstrating a successful Regenerative Endodontic Treatment

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