This photograph shows a lower molar that has a very large silver filling which has been in function for many years. Due to the loss of tooth structure resulting in a weakened tooth and the thousands and thousands of chewing cycles this tooth has endured, it’s highly probable that stress fractures can begin to occur.
Recalling the diagram of the anatomy of a tooth in Part 1 the enamel is the outermost layer of the tooth, and in this photograph the fracture in the enamel of the tooth is visible.
The important question to consider is where does this fracture terminate? Does it track deeper or does it remain in the enamel of the tooth?
To better understand where the fracture goes, the old filling must be removed.
With the filling removed, we see that the fracture is tracking into the dentin, and moving toward the center of the tooth. Additionally, there’s another fracture that is tracking from a different direction.
This tooth was sensitive at times, which is a common finding. Pain with biting pressure, either consistent or intermittent, is a common finding with a fractured tooth.
The remedy for this tooth was to place a full coverage crown, and the tooth then became free of discomfort.
For this situation the tooth was stabilized with a restoration, and now has a significantly improved prognosis.
The second case is very similar – a large silver filling in a molar, a fracture on the front, and what looks like a very large fracture in the back.
Again, the x-ray image is of no help diagnosing the extent of the fracture as seen clinically. More clinical information regarding the extent of the fracture will be facilitated with the removal of the filling.
Now we can see that the back fracture actually tracks all the way toward the front. This is a very significant finding, as the tooth is causing pain with biting pressure. At this point it is critical to know how deep this fracture tracks before we can say this tooth can actually be saved.
The patient was sent to an endodontist, or root-canal specialist, where the pulp (nerve) chamber was accessed.
The endodontist felt the floor of the pulp chamber was solid and that the fractures ended there. The fracture had gone down far enough that it was involving the pulp of the tooth, but not deeper.
So despite the fact that this tooth presented with a very significant and deep fracture, this tooth could be restored and put back into service and to date has had a very functional result.
Watch this video where Dr. Mastrovich describes fractures in molars with fillings:
In Part 4 we will discuss fractures in teeth without fillings.