A root canal-treated tooth fracturing is a common event. The root canal procedure involves removing the soft inner tissue of the tooth, called the pulp. While this treatment saves the tooth from infection, the resulting tooth is structurally different from a healthy one. When a root canal tooth breaks, the integrity of the root system is compromised, requiring immediate assessment to determine if the tooth can be saved.
Immediate Steps to Take
Contact a dentist or endodontist immediately to schedule an emergency appointment. Until professional help is available, take steps to manage pain and prevent further damage. Rinsing the mouth gently with warm water, possibly mixed with salt, can help clean the area and reduce the risk of bacterial contamination.
To manage discomfort, apply a cold compress to the outside of the cheek to minimize swelling. Over-the-counter pain relievers can be taken, but do not place aspirin directly on the gum tissue as it causes irritation. If the broken edge is sharp and irritating the tongue or cheek, temporarily cover it with dental wax or sugar-free gum. Avoid chewing or applying pressure on the affected side of the mouth to prevent the fracture from worsening.
Why Root Canal Teeth Are Vulnerable to Fracture
Root canal-treated teeth are more susceptible to structural failure than healthy teeth. Removing the pulp eliminates the tooth’s internal blood supply, which causes the dentin to become brittle over time. This loss of internal moisture weakens the overall structure.
The treatment itself further compromises the tooth’s integrity, as structure must be removed to access the root canals. This reduces the amount of dentin, particularly near the gum line, which is important for distributing biting forces. A significant contributing factor to breakage is the lack of a full-coverage crown placed shortly after the root canal treatment. The crown evenly distributes chewing forces and protects the weakened tooth from fracturing.
Options for Dental Restoration
Saving the tooth depends entirely on the location and severity of the fracture line. If the fracture is localized and remains above the gum line, the tooth is often salvageable. Restoration typically begins with placing a foundation to support the eventual crown.
If a significant amount of tooth structure above the gum line is missing, a post and core procedure is necessary. A small post, often made of fiber or metal, is placed into the root canal space for retention. A core buildup material, usually composite resin, is then used to replace the lost dentin and create the foundation.
The final step is placing a full-coverage crown over the restored foundation. The crown encapsulates the remaining natural tooth structure, providing the necessary strength to withstand chewing forces. This protective restoration is considered the standard of care to ensure the long-term survival of the tooth.
When Extraction and Replacement Are Required
If the tooth cannot be saved, extraction is the only treatment option. The most severe and often unsalvageable damage is a vertical root fracture (VRF). A VRF is a crack that runs from the biting surface down to the root, sometimes extending into the surrounding bone.
Extraction is also required if the fracture extends deep below the gum line or into the bone. This deep extension makes it impossible to seal the tooth effectively, leading to chronic infection. Once the tooth is removed, the space must be replaced to maintain alignment and preserve chewing function.
Two common replacement solutions are a dental bridge or a dental implant. A dental implant involves surgically placing a titanium post into the jawbone, which acts as an artificial root and prevents bone loss. A dental bridge fills the gap by anchoring a false tooth to the two adjacent teeth, requiring modification of those neighboring teeth. While bridges are faster, implants offer a standalone, durable solution that better preserves the jawbone structure.