Crown Root Fracture
Adult Teeth and Dental Trauma
In this section, we will cover:
- What is a crown root fracture?
- What should I do after the injury?
- Will I need treatment?
- What can I do to help the area heal at home?
- Will I need any follow up appointments?
- What should I look out for?
- What are the long term complications?
What is a crown root fracture?
This is where the tooth fractures into two or more pieces with the fracture line going through the crown and root of the tooth. The fracture line will extend from above to below the gum. The broken part of the tooth is likely to be wobbly and displaced (in a different position to normal).
What should I do after the injury?
It can be very distressing if you/your child has suffered trauma to the teeth. The first thing to do is not panic.
Dental trauma is very common and there are a few steps you can follow to get the best outcome after the injury.
You should:
- Take a second to collect yourself and check you/your child hasn't blacked out.
If you/your child has hit their head and you think they may have lost consciousness (even for a few seconds) or they feel nauseous or dizzy, you should get this checked out by your doctor or local A&E department to rule out a concussion (head injury). - Call your dentist as soon as possible so they can arrange to check the teeth and provide any necessary treatment.
- Pick up any broken fragments of the tooth if you can find them. You should take these to your dentist's appointment so they can check the fragment hasn't been accidentally swallowed and no tooth fragments are in any cuts in the soft tissues.
- If there are any cuts in or around the mouth, clean them with warm salty water. If there is any bleeding, dampen a clean handkerchief in salt water and press it firmly on the bleeding area.
- If the injury happened in a place thought to be unclean, and there has been a cut to the skin/lip/gum, you should check all tetanus vaccinations are up to date with your GP. You may need a tetanus booster vaccination.
Will I need treatment?
Your dentist will take some xrays of the teeth to check for any other injuries and to compare any future xrays against.
If there is a broken fragment of tooth which was not found and there is a cut in the soft tissue (e.g. lip), your dentist will take an xray of this area to make sure the missing fragment is not in the soft tissue.
The options for treatment depend on whether or not the tooth can be saved. Whilst assessing if the tooth can be saved and confirming a long term treatment plan, the loose fragment should be splinted (held in place with a flexible metal wire).
Scenario 1: Tooth can be saved
- If the nerve has been exposed, treatment will be needed for the nerve. Type of treatment depends on whether the root is fully formed or not. The root normally finishes forming about 3 years after the tooth has erupted.
A) Root not fully formed: partial pulpotomy is required (see here)
B) Root is fully formed: root canal treatment is required (see here) - The long term aim is to provide a restoration which seals the tooth properly (not too bulky, sits flush with the tooth). Treatment will be needed so the fracture is above the gum
- To do this, a specialist can:
- extrude the tooth with braces (use braces to pull the tooth until the fractured part of the tooth is above the gum)
- surgically reposition the tooth
- recontour the gum (gingivectomy - LINK)
Scenario 2: Tooth cannot be saved
- If the fracture runs very deep under the gum, the treatment options are:
A) The whole tooth will need to be removed (see dental extraction here), or
B) The crown of the tooth can be removed and the root is then covered by the gum (this maintains the bone for an implant in the future). This procedure is called a decoronation and root burial (LINK) - The gap can be replaced with a denture, bridge or implant in the future.
- For children under 12 years old, a highly specialised and complex treatment can be performed called "autotransplantation" under specific circumstances. You can find out more about it here (LINK)