Q: Dr. Crapo: I’m a sixty-something guy who’s had a lot of dentistry. Just about the time I get my teeth problems taken care of, something else rears its ugly head. I’ve had a couple of implant crowns done just recently, but then as the dentist was finishing them he decided to take an x-ray and found a problem that’s a whopper. He found a molar with a crown that has a split root. Go figure, just my luck! I ask all kinds of questions only to find out that my best option is probably an extraction, a bone graft, then an implant. Another big bill! I hate the fact that dental plans don’t participate in implants. I’m not in any pain but the dentist said that the tooth is weak and the forces in my mouth that caused the break will just do more damage. What’s happening under the gum, can you tell? Will I for sure need a bone graft? Are there any other solutions? I’ve got teeth on each side of the broken tooth. The dentist said it was my six-year molar that was badly cracked. I’d like your take.
A: Roots of teeth don’t crack that often, especially if the tooth has been crowned. It does happen, so there are several facts that one needs to account for before attempting a fix. First, roots that are cracked leave a definite mark on the bone that is housing it. Usually there’s a significant loss of bone all around the crack. If you extract the whole tooth, a graft to restore bone is highly likely and you’ll want a lot of bone so that a big implant is supporting the new crown.
A solution from the sixties/seventies is still possible. In this treatment, the offending root is sectioned from the tooth and extracted. Your molar at that point, becomes a bicuspid (small tooth in front of molars). If you make a bridge using the tooth behind the “new bicuspid” as an anchor and attaching it to the new bicuspid and the natural bicuspid in front of it (so three teeth in a row), you will make a good strong bridge and your plan will participate.
The other good thing about this solution is the analysis of your bite that is necessary before you start. The treating dentist should find forces that can be redistributed more evenly in that part of your mouth. Though the implant idea is a stronger, more elegant solution, it takes time, costs more, and may not exact the same analysis of your bite which should be done no matter which route you take. Ask for the analysis to be done, whatever you decide.