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Tooth fracture: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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The most common type of traumatic dental injury is a tooth fracture at various levels. A distinction is made between: a tooth fracture at the level of the mantle dentin (without pulp exposure), at the level of the peripulpal dentin (the pulp is visible) and a crown fracture with pulp damage.
As a result, various forms of pulpitis, periodontitis and (subsequently) radicular cysts occur. This depends on the force and direction of the blow, the level of damage to hard tissues and pulp, the age of the child, the degree of root formation, the integrity of the vascular-nerve bundle, and the time that has passed since the injury.
[ What causes a tooth to fracture?
Most often, acute trauma to permanent teeth occurs at the age of 8-13 years (79%) with the maximum frequency at the age of 9-10 years (32%). The main causes of tooth fracture are: an accidental fall or blow on the street during play (30%), domestic trauma at home (16%), at school (15%), sports injury (14%), injury during a fight (14%), a car accident (6%). Sometimes (5%) patients cannot remember the exact cause of the injury.
Symptoms of a tooth fracture
The front teeth of the upper jaw are damaged more often (93%); the teeth of the right half of the upper and lower jaws are slightly more often subject to injury than the teeth of the left half (53% and 47%, respectively). Oblique tooth fractures (76%) predominate over transverse ones; fractures of the medial angle of the crown (84%) occur significantly more often than distal ones.
A tooth fracture causes a lot of suffering to children, since the fracture gap either passes close to the pulp or crosses it, causing the development of acute pulpitis.
Diagnosis of tooth fracture
The diagnosis of a particular nosological form of a disease that occurs as a result of trauma is made on the basis of anamnesis data, an objective examination of the oral mucosa and teeth, and a clinical examination.
When a root is fractured, a picture of acute traumatic pulpitis and periodontitis develops, and when a crown is fractured, pulpitis develops.
On an intraoral contact radiograph, the fracture plane is visible as a narrow line or a flattened oval. In rare cases, fusion of the root fragments is observed, which is determined on serial radiographs as a gradual "disappearance" of the fracture line; after several months, a cuff-shaped thickening of the root is visible at the fracture site. Fusion of the tooth root fragments is usually prevented by an infection.
Treatment of a tooth fracture
Untimely or irrational treatment tactics for acute dental trauma in children can lead to morpho-functional changes in the dental pulp and periodontium, and the loss of the injured tooth.
The prognosis and indications for choosing a treatment for a tooth fracture depend on many factors. It is necessary to determine the functional capacity of the pulp, the condition of the tooth root and periodontium. Radiography is performed to assess the condition of the periapical tissues, the stage of root development, to exclude its fracture, and to subsequently monitor the results of treatment. Electroodontodiagnostics is performed to determine the viability of the pulp in dynamics. It is necessary to take into account that its indicators depend on the degree of formation of the tooth root. In intact teeth with unformed roots, they are 20-60 μA.
In traumatic pulpitis, it is important to preserve the functional dental pulp (especially in teeth with incomplete root and periodontal formation), which ensures the prevention of destructive changes in the periapical tissues. Therefore, special attention should be paid to the biological method of treatment in children. For this purpose, after antiseptic treatment of the injured tooth with a sterile turbine bur, a groove is created along the entire plane of the fracture (for better fixation of the medicinal substance and hermetic dressing). In order to improve the plastic function of the pulp and the formation of replacement dentin, the fracture line is covered with a biological agent of odontotropic action. The medicinal paste is fixed with evicryl without preliminary etching of the enamel. In the absence of spontaneous pain, pain from cold stimuli, negative reaction to percussion, normalization of electroodontometry indicators, the restoration of the tooth crown with a composite material is carried out. If there are contraindications to the biological method, vital amputation or vital extirpation is performed (taking into account the stage of root development).
When treating traumatic periodontitis of a tooth with incomplete root formation, it is necessary to perform a 2-stage root canal filling. At the first stage (unformed root and periodontium), a paste containing calcium hydroxide (Calxil, AH-Plus, Sealapex) is used as a root filling. After the complete formation of the root and periodontium (second stage), which is determined radiographically, the root canal is re-filled with a permanent filling material.
If the root of a gangrenous tooth is fractured, it is removed and the defect of the dental arch is replaced with a temporary removable plastic denture. If an intact baby tooth is injured, the question of its removal is decided depending on the degree of displacement of the fragments: if the displacement is significant, the coronal fragment must be removed immediately, and the apical fragment must be left, since it is very difficult to extract. In the case of a fracture of a permanent tooth, as well as if there is a desire to preserve a baby tooth, plastic mouth guards (for baby teeth) or a Shelgorn bandage (for permanent teeth) are used.
In case of a tooth fracture in the upper third of the root in children aged 10-14 years, it is recommended to perform a resection of the apex of the tooth root (i.e. remove the broken part) before fixation, and fill the canal.
If the fracture occurs in the area of the tooth neck, the root is usually preserved as a basis for a pin tooth.
As L. P. Siratska points out, the results of treatment of radicular cyst of traumatic origin obtained in her practice indicate the possibility of conservative therapy in children. For medicinal treatment of the root canal, it is advisable to use preparations of the metronidazole group (metrogil, trichomonocid). As a root filling - pastes containing calcium hydroxide with gutta-percha pins.
All children with acute dental trauma should be registered with a dental clinic. Follow-up examinations are carried out after 3 days, 1 week, 1, 3, 6, 12, 18 months after the end of treatment and include an objective examination, dynamic electro-odontodiagnostics, and after 1 and 1.5 years - radiography. The criteria for removing from the dental clinic register for teeth with unformed roots is the complete completion of their growth; for teeth with formed roots in the presence of periapical changes - restoration of bone tissue in the lesion.