This tooth has a complicated crown fracture, meaning a tooth fracture with pulp exposed. The black dot in the center of the tooth is the pulp, composed of the blood and nerve supply of the tooth. When there is pulp exposure, there is nerve exposure, which is painful. The lack of clinical signs of pain does not eliminate the fact that pulp exposure is painful. From an evolutionary standpoint, if they show pain they are prey, so it is instinctual for animals to hide pain. The exposed pulp also allows a route of entry for bacteria from the oral cavity into the blood supply, leading to systemic disease.
The two treatment options for this tooth are extraction or root canal. There is no third option. Doing nothing or “keeping an eye on” the tooth is not a good option. Making firm recommendations to clients and educating them regarding the harmful effects of a fractured tooth is essential. Below is a dental radiograph post root canal of the tooth above.
We typically offer crown restoration of a fractured tooth post root canal and this client opted for a Zirconium (tooth colored) crown. The day of the root canal procedure we prep the tooth for a crown by removing a thin layer of enamel. We make impressions of the tooth and stone models of the entire oral cavity and have a crown fabricated by an outside lab. The patient returns approximately two weeks later to be briefly anesthetized for crown cementation. Below is a photo of the final crown restoration.