Kevin,
You’re referring to my research about saving fractured teeth, where I reported on four cases where I took a tooth with a vertical fracture, got the pieces of the tooth back together, fitting perfectly back together, held the pieces with a crown, and then followed the teeth long term. I actually did this successfully about ten or twelve times during my career, but had four cases documented well enough with photographs and x-rays to be able to include in the article.

There are two problems with your finding a dentist who will repair this for you. The first is a matter of timing. If you read the article carefully, you’ll notice that one factor I discovered that was critical in saving the tooth was that the fracture had to be addressed immediately, within a day or two.

I’m just guessing that if you’ve been to four dentists already that more than a day has passed since the tooth fractured.

The second problem is that my research hasn’t been accepted yet. In order for my research to be accepted, someone else is going to have to replicate it. That’s how these new ideas get established. Rarely will one researcher be able to establish that.

But any of your work in spreading the word about this research may touch some other dentist with a thirst for research to try to duplicate what I did. That will be too late to help you, but someone else may be helped.
Dr. Hall

Click here to ask Dr. Hall a question.

Do you think there is a possibility of healing the crack? Or does the tooth have to be extracted?
- Loren in Iowa

Dear Loren,
I’d have to see the crack to tell you for sure, but from what you told me it sounds like the tooth could be saved. If the crack is in what we call the furcation–between the roots–and if the tooth hasn’t yet separated into two pieces. The problem would be getting a dentist who would be willing to try that. It would need a crown, and either a gold dental crown or a porcelain fused to metal crown. If the pieces haven’t separated yet, that would be all you would need to do. When they do separate, it becomes more complicated, but if you catch it within the first couple of days, I outline a procedure in my article, “Saving Fractured Teeth,” for getting them to knit back together.

Dentists are a very cautious bunch who rely a lot on the opinion of other dentists. I’m still waiting for another American dentist to take up my research and try to duplicate it. It usually takes several independent studies for a blockbuster idea like “you can actually save teeth with vertical cracks” to become accepted. It would take a dentist who is the pioneering sort and who would be willing to stick his or her neck out in the pursuit of truth. There aren’t many like that, unfortunately.
- Dr. Hall

In Sept 2007 I had a filling in #14 which caused a lot of pain. On Oct 1, 2007, an endodontist started a root canal, but quit after removing the pulp because she detected a vertical mesial to distal fracture. My dentist doesn’t believe her, wants a second opinion including its depth, position, and whether she can “describe” the tooth.

I need an endodontist who understands your article, but your categories do not cover this problem. I have called the endodontist and requested that she remove the temporary filling and collect the data my dentist requested, but she has refused to work on it any further. She feels that “no cracked tooth is worth saving.”
- Sharon in Illinois

Sharon,
I don’t know any endodontist to send you to.

As far as my research on saving fractured teeth, this is kind of a blockbuster, revolutionary idea, and it usually takes ideas like that some time to get credibility in the dental community. I think someone’s going to need to get inspired to duplicate my research, and maybe a couple of people to do this, before the idea takes hold. When you’ve got an idea like that, people who just read the study tend not to believe that you saw what you say you saw.

And then remember, there is a stringent set of requirements for actually saving the tooth, as far as the nature of the fracture, the timing in catching it, and the methods for treating it. The article makes all of that clear. It’s a minority of fractured teeth that can be saved.

And then the other obstacle is that there is a strong sentiment among dentists to take the safe course. It’s a much safer feeling for a dentist to just extract a fractured tooth. No one would ever give the dentist trouble over that. But you start saving teeth that might not make it and if it doesn’t make it, that’s when the dentist could have trouble. That’s one of the unintended consequences of the great compassion that trial lawyers have engendered for patients who have suffered from treatments–dentists have learned that it’s smart to play it safe.

A dentist has to have enough passion for saving teeth to be willing to risk that the treatment might go bad in order to pursue this kind of treatment or research. And I haven’t found many endodontists, curiously, with a passion for saving teeth. They tend to be perfectionists and conventional thinkers. Their dental school professors told them cracked teeth can’t be saved, so they’re not going to go out on a limb. I even had one tell me a tooth was cracked and couldn’t be saved when it wasn’t cracked at all.

I’d print out the article and share it with your general dentist and see what he or she can do. It sounds like your dentist is dedicated to saving teeth, because he or she isn’t giving up easily on this. – Dr. Hall

Related information from the www.mynewsmile.com web site:
Root canal treatment
Failed root canal treatment