Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

October 13, 2015

I have a split tooth – can it be saved?

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Dr. Hall,

I have a split tooth. It’s one of my upper teeth, near the front. A dentist in Ft. Myers, Florida, recommends extracting all of the tooth and then doing a bone graft and then a dental implant to replace it. The tooth is identified as tooth #4 on the dentist’s chart/treatment plan. The dentist stated that there is no possibility to save the tooth.

I want the tooth repaired, if possible. It is a tooth otherwise healthy, however, the tooth is completely split, right down into the root or gum. Causation is unknown to me.

I request any suggestions that you have about repairing the tooth, or about a dentist. l live in the Kissimmee, Florida area. I have the basic Humana dental PPO plan.
Thank you for your attention to this letter.
– James from Florida

 
James,

As you may have seen on the website, I was the one who did the research showing that it is possible to save a tooth with a vertical root fracture. I published that research in the Colorado Dental Journal in 2004, and a Portuguese version of what I wrote was published in Brazil. This is totally contrary to conventional thinking, as almost everywhere else in the dental literature you will read that these teeth are not savable.

One problem with research that goes directly against the grain of the consensus of thought in a profession is that it takes more than one researcher to change that consensus. The feeling is that the research needs to be corroborated by a second, independent party. So you are very unlikely to find another dentist who would try to save a tooth like this. However, just this July, 2015, a research team in India duplicated my research and was able to also save a tooth with a vertical root fracture. So I am hopeful that we’re on the way to getting my research accepted. If these publications will prompt an American researcher to corroborate what we have done, this could begin to become generally accepted.

Having said all of this, one of the things I discovered when I did my research was that in order to save a tooth with a vertical root fracture, it was necessary to get the parts of the tooth back together perfectly and then stabilize the tooth in that condition. If the fracture was several days old, it was impossible to get the two parts of the tooth back together perfectly, so the repair became impossible. I am assuming that with you writing to me and you have already had a dental visit, that this fracture isn’t something that happened today or yesterday. Unfortunately, that does make this tooth unrepairable and extraction would be necessary.

Luckily, dental implants have become a very predictable treatment option, and if that’s what your dentist recommends, that’s what I would do.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 17, 2012

Why you have to be able to trust your dentist

Dr. Hall,
I have a split tooth but the x-ray reveals a healthy root…my doc want to extract and I want him to save it! How do I convince a dentist to try something new like that described in your paper? Dentists seem to want to extract to solve all problems, use scare tactics and it’s hard to believe they are not doing it for the money since much more expense is involved in an extraction and insertion of a new tooth….I want to keep as much of me together as long as I can!!!

thanks
Mike from West Virginia

Mike,
This is one thing I worry about when I give patients these answers to their dental questions, that they will take this information and go back to their dentist and try to “convince” the dentist of one thing or another, or tell the dentist how to make their cosmetic dentistry more beautiful, or tell the dentist what type of filling or crown they want, different from what the dentist recommends. That will not work. The purpose of this website isn’t to help patients educate or change their dentist. What you need instead is to find a dentist with a philosophy that you are more comfortable with.

You aren’t going to convince your dentist to save this split tooth if he has told you that he wants to extract it. It would be misguided of us to even have me personally call your dentist and convince him to save it. I couldn’t do that because I haven’t examined you and for all I know maybe that is the only option here. But there are dentists who are strongly inclined toward saving teeth, and other dentists simply don’t want to do that. And this philosophy permeates their practice at many levels. If a dentist wants to save teeth at all costs, for example, he or she will need to spend focused study on the techniques for saving teeth, dealing with cracks in teeth, what to do for failed root canal treatments, advanced periodontal techniques, and a whole host of things. At the other end of the spectrum, if a dentist just wants to take out problem teeth then they won’t go through all that extra trouble. What point is there, then, trying to convince a dentist to save this tooth when he probably doesn’t even know how?

But it is not true that “dentists” in general just want to extract teeth. There is a wide variety of inclinations here. And I firmly believe, from my experience with the dental profession, that the vast majority of dentists are highly ethical people who honestly try to do the best for their patients. They have varying levels of skills and different philosophies. And if you have cause to believe that your dentist is just in this for the money, then you need to find a different dentist. There is no way to work around this trust issue. There is no way, as a patient, that you can check up on your dentist to make sure he is making the right decisions for your teeth. In this situation of yours, even I, as another dental professional, don’t know enough about your case to be able to say if your dentist is doing the right thing or not. You HAVE to be able to trust him. If you don’t, then find another dentist.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 20, 2010

Can a dentist repair my fractured tooth?

Filed under: Fractured teeth — Tags: — mesasmiles @ 1:46 am

Dr. Hall,
Would you know of a dentist that is willing try and repair a split tooth? I would like a dentist to try to save the tooth first before extracting it but I’ve been to 4 dentists and all of them want to extract the tooth. Are you still praticing dentistry? I would fly to another city to get the procedure performed. Your help is greatly appreciated.
Kevin from Texas

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

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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