Therapy
If an incisor is broken, the choice of the most appropriate therapy depends on various factors. Above all, the extent and type of tooth fracture play a decisive role in this context. In addition, a distinction must be made as to whether the impaired incisor is a milk tooth or a permanent tooth.
In the case of an anterior trauma of a milk tooth, the affected incisor is usually extracted. In this way, any pain that may accompany it can be relieved and the permanent tooth can be prevented from being impaired. However, when treating a milk tooth that has broken off, it must also be taken into account that if the tooth is lost too early, there may be less room for the tooth that breaks off later.
For this reason, keeping the tooth gap open with a temporary denture can be useful. In case of an incisor that has only broken off in the area of the crown, the defect can usually be treated with a filling or with an artificial crown. In these cases, however, it must be absolutely excluded that the dental nerve has been affected by the trauma.
If the broken incisor leads to an opening of the pulp, a root canal treatment should be performed as a rule.In this way, the development of inflammatory processes is effectively prevented. The affected incisor can be used as an anchor for a crown after a short healing phase. If an incisor has broken off in the upper or middle root area, it is usually not possible to assume that the affected tooth can still be saved.
If an incisor has broken off in the upper or middle root area, tooth extraction is usually necessary. Only in this way can the development of inflammatory processes and an impairment of the bony jaw be prevented. An incisor that has broken off in the lower root area, however, usually has a much better prognosis.
The impaired incisor can often be preserved by the timely removal of the root tip (so-called apicoectomy) or root canal treatment. If an anterior tooth trauma results in complete tooth loss, an attempt can be made to reinsert the incisor into the jaw (so-called reimplantation). In order to increase the chances of success of this treatment method, affected patients should urgently pay attention to proper positioning of the incisor.
For this reason, the broken incisor should be stored as moist as possible until the visit to the dentist. In the case of an incisor that has broken off in the lower part of the crown, the fracture fragment cannot usually be easily reattached. The reason for this is that such a pronounced anterior trauma often leads to the opening of the pulp.
In this way, even the smallest nerve fibers are affected. If the broken crown would simply be reattached to the tooth stump, it can be assumed that inflammatory processes will develop in the area of the root canals within a very short time. For this reason, a so-called root canal treatment must be performed on an incisor whose crown has broken off particularly deeply.
In this way the development of inflammatory processes can be effectively prevented. In addition, this therapeutic procedure allows the tooth stump remaining in the jaw to be used as an anchor for an artificial crown. In many cases, a plastic pin must be placed in the tooth during the root canal treatment.
This plastic pin is also used to stabilize the artificial crown. In principle, different types of crowns can be made for an incisor that has broken off. These are among the most common types of crowns in dentistry: – All-cast metal crowns – metal-ceramic crowns (short: VKM crown or veneer crown) – all-ceramic crowns For aesthetic reasons, all-cast metal crowns are not used in the area of the incisors.
As a rule, a crown to restore a broken incisor is made of metal-ceramic or all-ceramic. The costs for the adjustment and insertion of the crown are usually partially covered by the insurance companies. In this context one speaks of the so-called basic care.
Any additional wishes of the affected patient, for example the choice of an all-ceramic crown, lead to special costs that have to be paid by the patient himself. In such cases, supplementary dental insurances often guarantee complete coverage of the difference between the invoice amount and the insurance company’s share. If an incisor has broken off only at the upper part of the crown, the dentist can often glue the fragment.
In order to assess whether gluing the tooth fragment can be effective, it must first be checked whether the pulp has been opened. An incisor that has broken off in a particularly unfavorable way may, under certain circumstances, cause damage to the smallest nerve fibers. This often results in the formation of inflammatory processes in the area of the root of the tooth.
In these cases, sticking the broken-off tooth fragment would not bring any treatment success in the long run. Even if the incisor has broken off without opening the pulp, the bonding of the tooth fragment is only successful if it has been properly stored in advance. Affected patients must keep the broken tooth fragment moist until the visit to the dentist if possible.
In case of an incisor that has broken off in the lower part of the crown, a so-called root canal treatment must usually be performed. In this treatment method the nerve fibres inside the tooth root are removed. Then the root of the tooth can be closed with a special filling material.
Since large parts of the incisor are affected in such a pronounced anterior trauma, an artificial crown often has to be made.However, no guarantee of success can be given for a root canal treatment. In some cases, inflammatory processes may occur despite the removal of the root canals. For this reason, it is recommended to make the artificial crown only after a waiting period.
Since a tooth gap, especially in the area of the incisors, is considered unaesthetic, a so-called temporary denture should be made until the crown is completed. A temporary denture is an artificial imitation tooth that is intended to temporarily replace the broken incisor. As long as the patient’s own tooth root can be used as an anchor, it is possible to attach the temporary restoration with a special adhesive. In case of anterior trauma with complete tooth loss, a removable temporary denture can be fabricated until the permanent denture is completed.
