June 2, 2015
One of the common problems we see as dentists is cracked teeth. Any tooth can fracture, just like driving a truck over pavement enough times can crack the pavement, but the most commo reason is from the weaknesses caused by drilling and filling teeth. Large amalgam fillings are like a lump of soft lead in a crystal glass, slowly creeping and expanding over the years until the tooth cracks apart.
While most cracks are horizontal and a cusp cracks of the tooth, a large number are vertical cracks extending into the nerve of the tooth and splitting the root in half.
It is best to replace any metal fillings if any sign of cracking is evident, but replacement with tooth coloured fillings may not be strong enough.
The tooth should be supported with a full coverage of porcelain, or the best alternative which is gold. The porcelain has a higher strength than plastic fillings but can still crack. The gold will wear at the same rate as your own teeth and will not break but there is a cosmetic compromise.
Talk to your dentist about which option is most suitable for you.
July 22, 2013
This patient started getting sharp pain every time they bit on this tooth. It had never been filled but it started to split This can happen from grinding (bruxing) at night, clenching, eating hard foods, or often old fillings have weakenbed the tooth. In this case the patient admitted a very stressful period over the previous 6 months and an awareness of heavy clenching.
You can see natural grooves and small enamel cracks in both teeth. The pain was localised to the second premolar by biting on a hard object.
After removing the enamel a verticle crack can be seen extending into the tooth. Without support this will continue down through the nerve and root of the tooth and the tooth will need to be removed. Below is an image of a tooth where this has already occured.
A porcelain shell like a helmet is made that can fit over the tooth and protect it. We use only Australian laboratories and don’t source crowns from overseas.
Thanks to Jade Dental Laboratory in Buderim ,Queensland, for this artistic creation.
The crown is glued onto the remaining tooth to seal the crack and reinforce the tooth.
I have used eMax for this crown. As it is cosmetic and translucent, I don’t have to agressively remove tooth structure all the way to the gumline like a traditional crown. This leaves the tooth much stronger in the long term.
You can see where the tooth was reduced on the side. Traditional crowns would mean removal of tooth all the way to the gumline.
October 30, 2011
This lady had worn and chipped her upper teeth on the inside until they were so thin they were about to break. The yellow tooth on the right second from the middle is an old crown which the patient couldn’t afford to redo so we had to match it in colour and shape. Crowns are hard and durable but bonding often means less tooth needs to be removed and they are cheaper. Because all of this patients teeth had worn we were needed to build them all up (or at least 10 of them) – compare $250-$300 per tooth for bonding vs. $1500 per tooth for crowns. They may not last as long or be quite as perfect in appearance but they can be a great low cost option without losing teeth and getting dentures. It was done in one day and crowns would take weeks or even months. I would be happy to get 5 years up to 10 years for this kind of procedure. Despite the cost, in the long term I would still prefer porcelain crowns.
December 14, 2009
Not all people want perfect even teeth. This patient of mine was concerned about the discolouration and poor longevity of the resin bondings that had been done on her front teeth. While is would be possible to do orthodontics and straighten these teeth, the patients chief concern was to keep her smile looking ‘like me!’ – that is, to maintain the crowded appearance which created character that she had had all her life.
The most conservative option was new resin bonding to replace the discoloured fillings, but the two smaller lateral incisors had more extensive damage. We opted for a veneer on one and a crown on the other. You can see by the following photo that a crown is a more aggressive approach (right) than a veneer (left). The bondings had been redone at this stage.
I think the final results have been fantastic – it is very difficult to match one tooth and often people get 6 or 8 front teeth done together to make an easier colour match. Although this was more difficult, it ended up with must less damage to the mouth overall.
I thought I would share it. Happy New Year!
December 9, 2009
This patient was a pleasure to treat. As you can see there was some crowding issues with the front 2 teeth and all the teeth were quite dark. We bleached the teeth using at home tray whitening for a couple of weeks, and match full porcelain Empress crowns cemented onto the front 2 teeth. The full porcelain allows the light through them just like natural teeth so the result is very aesthetic. Traditional porcelain fused to metal crowns (PFM’s) tend to result in a more opaque ‘non-vital’ appearance.