Crack in the root of a tooth: symptoms, causes and what to do?

Causes of a crack in the root of a tooth

Not all patients understand why a root crack occurs in a living tooth. The reason lies in the uneven distribution of the load. Moreover, the load can be strong and sudden, or it can accumulate over years and lead to the appearance of a crack after some time.

Typically, the cause of a crack is caused by the following factors:

• domestic trauma
  - blow, fall, sudden load while chewing;
• improper treatment
  - strong pressure when cleaning canals or filling the root can injure the walls and in the future, with the slightest excessive load, cause a crack in the root;
• error during prosthetics
  - strong pressure when installing a pin or the manufacture of inappropriate dentures that unevenly distribute the load during chewing, leading to injury;
• Bruxism
  - unconscious clenching of the jaws, for example, during sleep, leads to a load that the patient does not notice and cannot control.

Causes of cracks

Why do cracks appear? The main reason is mechanical damage and daily stress on the teeth. Moreover, the general condition of the human body should also be taken into account. After all, one person may have such strong teeth that even daily crunching of nuts does not threaten to break the tooth, while for others, excessively hard food becomes their worst enemy. The reason for this is the characteristics of bone tissue.

Moreover, you should not think that you can avoid cracks by giving up solid food. After all, we must not forget that during the chewing process, the gums are massaged, which improves the condition of the oral cavity. It’s just important to observe moderation in everything if you want to have healthy teeth.

In addition to daily stress, the cause of crack formation can be:

• Bruises, falls, other jaw injuries.
• Opening bottles and cracking nuts with teeth.
• Bad habits of chewing pencils or other objects.
• Bruxism.
• Bite disorders.

It should be understood that smoking, lack of proper oral hygiene, and abuse of coloring foods and drinks are also potential threats.

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Types of tooth root crack

Pressure can be applied both vertically and perpendicularly to the crown. The following types of cracks are distinguished:

1. oblique crack of a tooth
   - a diagonal fracture, usually the healthy part is much larger, and the doctor can save the tooth by removing the affected part;
2. transverse crack of a tooth
   - part of the root is completely broken off and deprived of nutrition; the closer the crack is to the coronal part, the higher the risk of complications;
3. longitudinal crack in the root of a tooth
   - the fracture runs vertically, along the axis of the root, often accompanied by a fracture of the crown;
4. comminuted tooth crack
   - multiple root fractures intersecting with each other.

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• Elena
  spent a long time looking for a dentistry where doctors would not instill fear before starting treatment. And of course, the prices should be reasonable. Dentistry “14×14” suited me as a patient just perfectly. Good specialists, competent and courteous. I recommend.

• Vladimir
  I was worried about a crack in my tooth. The dentists at the 14×14 clinic provided advice and perfectly selected a method for restoring the unit. There were no complications. Everything went as comfortably and painlessly as possible. Thank you very much for your work!

Root crack diagnosis

Only a doctor can diagnose an injury. First, the specialist makes a preliminary diagnosis based on the patient’s symptoms and complaints. More detailed research is required to clarify.

1. Instrumental examination.
   By tapping the tooth, the doctor determines whether there are irregularities, fractures or bleeding in the root of the tooth.
2. X-ray.
   The image clearly shows the tooth root crack, its location and the severity of the injury.
3. Electrical exposure
   helps determine the condition of the pulp.

Dial-Dent specialists who took part in the treatment:

1. Orthopedic dentist A.S. Ivankov – installation of a pin tab, dental prosthetics with a ceramic crown.
2. Implant surgeon V.P. Alaverdov – removal of the broken part of the tooth, laser treatment of the gums.
3. Dentist-endodontist Yu.A. Borisova – inspection of a crack with a microscope, treatment of tooth canals with a microscope.
4. Dental technician D.V. Wolf – making a ceramic dental crown.
5. Neurologist E.V. Saxonova – diagnosis of neurological problems.
6. ENT doctor A.V. Arkhandeev – diagnostics of ENT problems.
7. Dental assistants – A. Antoshkina, M. Erkimbekova.
8. Center administrators – coordinating appointments with specialists, reminders about the visit.

See other examples of the work of Family Dental specialists here.

Make an appointment for a consultation by phone +7-499-110-18-04 or through the form on the website. You can ask questions about dental prosthetics to the chief doctor of the clinic, Sergei Vladimirovich Tsukor, at

Crack in the root of a tooth: what to do

After diagnosis, patients are concerned with the question of whether it is possible to cure a crack in the root of a tooth. It all depends on the severity of the injury, the type of fracture and location. But there is no therapeutic treatment - tablets, ointments and injections; in any case, surgical intervention is necessary.

Ⅰ.

In case of a transverse fracture, the tooth can be saved, but the pulp is removed without exception. The doctor cleans and fills the root canals, and fastens the crack with a pin. Now the tooth needs rest and a minimum of chewing load - to reduce mobility, the teeth are splinted, that is, fixed in the correct position with a special splint-onlay.

Ⅱ.

Splintered, vertical and oblique cracks in most cases are only the initial stage of destruction of the root system, and over time the fault will grow. Therefore, depending on the severity of the injury, the doctor removes either part of the root with a crown or the entire tooth. A partially lost tooth can be restored using an inlay on a pin, or a complete tooth can be restored by installing a prosthesis or implant.

Treatment of a crack in the root of a tooth requires following the following recommendations:

• limit the chewing load - it is better to eat soups, cereals and other soft foods, avoid hard foods;
• monitor the temperature - all foods and drinks should be slightly warm, ice cream or hot tea have an undesirable effect on the injured root;
• eliminate pressure - do not open your mouth wide, do not close your jaw too tightly, brush your teeth carefully, avoid blows.

Types of dental cracks

Damage can occur on any area of ​​the enamel; the most dangerous is a split of the tooth root. According to the clinical picture and type of damage, the dentist selects a therapeutic regimen. Types of cracks and their degree of danger:

• Vertical cracks in teeth
  are usually shallow, small in size, and affect exclusively the enamel. Usually they do not bother a person and rarely require serious treatment, but they must be closely monitored, since against the background of constant loads, the fracture may increase in size.
• Diagonal cracks,
  regardless of depth
  ,
  quickly become the main cause of tissue destruction and the appearance of chips and chips on the tooth. Moreover, the destruction affects both the enamel layer, dentin and the pulp chamber.
• Horizontal cracks in teeth
  pose a similar risk to diagonal fractures and require immediate treatment. It doesn’t matter whether the enamel on the front incisor is cracked or the molar is split across, such damage quickly grows, damaging deep dental tissues. They are the cause of large chips, splitting of the tooth to the top of the root.

If a crack has formed on the surface of the tooth, you should immediately go to the doctor. The lower the degree of damage, the less invasive and costly the intervention will be. Today, dentistry offers a lot of techniques that allow you to “patch” a crack before it causes serious damage, including the loss of a dental unit. But if a microcrack can be eliminated with regular grinding, then if there are chips or a deep split in the tooth, the help of an orthopedist will be required.

Complications and consequences of a root crack

In this situation, timely treatment is important: seeing a doctor at the initial stage will help avoid consequences. If this is not done, you may encounter the following complications:

1. abscess.
   A crack without treatment can provoke an inflammatory process, which in the future will turn into suppuration of soft tissues and lead to the formation of an abscess. Treatment of a purulent cavity is much longer, more expensive and unpleasant than treatment of a fissure;
2. phlegmon.
   Suppuration, which, unlike an abscess, does not have clear boundaries and does not flow into the formation of a cavity. Cellulitis is a decay of cells that can spread to any tissue in the cavity;
3. periodontitis.
   Inflammation of the periodontium, that is, the tissues surrounding the tooth, leads to their death and the inability to hold the tooth in the gum. The result is the complete loss of one or more teeth; pulpitis. The death of the pulp - the neurovascular bundle of tissues in the tooth through which it receives nutrition. Pulpitis is quite painful and can affect neighboring tissues;
4. tissue injury.
   A root fragment can injure soft tissue. In this case, the doctor will have to extract a piece of the root and remove the infected tissue.

How to treat cracked teeth?

Any treatment begins with a visit to the dentist, who will examine the oral cavity. After this, you may be referred for an x-ray. After all, it is possible to quickly detect a defect only if it is located on the front tooth. If the patient has typical complaints, it will be possible to notice the crack only with the help of an image. In addition, professional teeth cleaning may be required, which will make it possible to fully assess the condition of the oral cavity and detect the slightest defects in the tooth enamel.

You need to understand that you won’t be able to remove cracks on your own. And delaying a visit to the doctor can only worsen the pathology. Therefore, it is better to immediately contact a specialist who will select the appropriate type of treatment:

• Remineralization.
  Using a dental gel with calcium, phosphorus and fluorine, the enamel is restored. Next, the crack is filled with a composite, which hardens under the influence of a special lamp. Next, the tooth is treated with dental varnish, which acts as additional protection.
• Veneers.
  Thin plates are installed on the tooth, which protect it from destruction and mechanical damage. Veneers are individually made for each patient, which ensures maximum adherence to the tooth. You can use the veneer installation service in our clinic.
• Crown.
  If a partial tooth extraction is performed due to a crack, your dentist may suggest a crown to save the remaining portion of the tooth. In this case, the nerve will be removed and root canals will be performed. After this, the dental crown will be placed.
• Delete.
  If the tooth cannot be restored, it will need to be removed. An implant can be placed in place of the extracted tooth.

Prevention of root injuries

The best treatment is disease prevention. To prevent cracks at the root, try to follow a few recommendations:

• be careful and attentive, because half of the cases of root cracks are household injuries, which can be avoided if you take care of yourself and your health;
• carefully choose a clinic and a doctor - before visiting a dentist, check the reviews and ratings of the clinic, certificates and specialist diplomas, do not go to questionable dentists;
• strengthen your teeth - eat healthy foods, do not forget about the importance of calcium and fluoride in strengthening your teeth, choose suitable dental hygiene products.

If symptoms of a root crack occur, do not self-medicate and do not wait for the pain to go away on its own. See your doctor. If the pain is caused by a temporary phenomenon, you will be calm, and if a crack is discovered at the root, treatment at the initial stage will help maintain the health and beauty of your smile, avoid complications and unnecessary expenses.

Multidisciplinary approach to the treatment of root fracture: a clinical case

Traumatic injuries to the anterior teeth can be a very tragic experience in the lives of patients and require careful treatment planning and sufficient experience and skill from the doctor.

Innovations in both endodontic and implantology techniques have allowed us to preserve more of our patients' own teeth, and if a patient expresses a desire to preserve their tooth, this should be done even at the slightest opportunity.

In this clinical study, the use of a membrane and bone material with simultaneous placement of an implant, as well as endodontics under a microscope, helped to obtain the high result that the patient desired.

Introduction

A dental injury often requires the intervention of several doctors: a general dentist and one or more specialized specialists. Since trauma is not common in general practice, treating traumatized teeth is quite difficult, and there is usually a strong emotional component to the damage.

A horizontal root fracture can be classified according to the location of the fracture line (apical third, middle third, or cervical portion). Factors of tooth damage, such as the location of the fracture line, the mobility of the coronal fragment, the degree of displacement of the coronal fragment and the distance between the fragments (pulp rupture at the fracture site), the stage of root development (mature or immature root), the age of the patient (growth of the alveolar process) have a huge influence on the treatment process.

In a horizontally fractured tooth, pulp necrosis often occurs in the coronal portion, while the pulp in the apical fragment remains vital. This creates a certain basis for further treatment of horizontal tooth fracture.

In permanent teeth with a horizontal fracture in the apical or middle third, coronal root treatment with gutta-percha alone (coated with calcium hydroxide) has been found to be successful, whereas endodontic treatment of both fragments with gutta-percha has failed.

The purpose of this therapy is to form a calcium barrier in the apical part of the coronal fragment, according to the principle of treating a non-vital immature tooth (by apexification). MTA was developed in the 1990s as an apical root filling material.

Since then, this material has been widely used in many aspects of endodontic treatment. This is due to its good apical healing performance when used as an apexification material in immature teeth with an open apex, as it actively stimulates hard tissue formation, is biocompatible, provides a good seal (prevents microleakage) and is non-resorbable. Thus, MTA is the material of choice instead of gutta-percha for the coronal segment of a tooth with a horizontal fracture.

This case report involves three teeth that suffered trauma and were treated with a multidisciplinary approach. After careful evaluation, the only option is sometimes removal and replacement with an implant. Bone regeneration in general is a necessary step in cases of trauma and subsequent implant placement due to the trauma process itself or post-traumatic infection. The authors have used only allo- or synthetic materials over the past ten years, without the use of autogenous components (blocks, chips, particles). Delayed immediate placement has become the standard protocol, where the tooth or root is carefully removed without damaging the remaining bone, then left to heal for three weeks.

This standard protocol, used in more than 1800 cases over 10 years, ensures soft tissue closure and bone preservation until the modeling phase. Preserving the edge, compared to new profile construction and modeling, saves time and is less traumatic for the patient. Bone healing is further improved by avoiding the use of traditional (collagen) membranes, which reduce periosteal blood flow to the graft site, which accounts for 85% (or more) of the blood supply to that area. Stability and restoration of soft tissue is also important for bone regeneration and is provided by the CaSO4 element in the replacement material.

Clinical case

A 25-year-old man presented to the clinic after being involved in an accident that resulted in trauma to the right upper central incisor, right lateral incisor, and right canine. There was a horizontal fracture in the middle and apical portion of the upper right lateral incisor and upper right canine (Figure 1). The teeth were splinted at the local hospital and then treated by a general dentist.

Photo 1: Trauma 13, 12 and 11

The patient contacted the study authors three months after the injury with swelling and pain in the lateral incisor area. Clinical examination revealed the third degree of mobility of the specified tooth, the central incisor and canine remained motionless. The canine did not respond to sensitivity tests (EDI and cold). A targeted x-ray (Figure 2) showed a horizontal fracture of the lateral incisor and canine roots in the middle and apical third.

Photos 2a and 2b: X-ray three months after injury

The lateral incisor was filled, the coronal fragment was displaced at intervals of 2 mm, and a lateral zone of lucency was noted. The canine was not filled, the gap between the fragments was up to 1 mm and no clearing zone was observed. The central incisor was treated, but not perfectly obturated; however, no bone loss was noted at the root.

The patient expressed a wish to preserve both teeth. Since 13 was immobile, the gap between the fragments was less than 1 mm, no pathological pockets were noted, the prognosis for treatment of such a tooth was accepted as good.

The fact that the lateral incisor turned out to have 3 degrees of mobility, the only treatment option was its removal. The patient was satisfied with this proposal and voluntary consent was obtained. The initial goal of treatment was to preserve the canine through endodontic treatment.

Endodontic treatment of the canine

It was decided to treat only the coronal fragment of the upper canine root, since the apical fragment was considered vital. The rubber dam is fixed near the tooth using a Q9 clamp (Dentsply Ash, UK). Access was created using a long conical diamond bur. The pulp chamber is cleaned using the BUC-1 ultrasonic handpiece under copious amounts of water spray. The canal was identified under a microscope (Global G3 DP Medical Systems, UK) using a DG16 probe (Dentsply Ash).

The working length of the root canal of the coronal fragment is determined by an apex locator (Raypex 5; VDW). An X-ray was also taken to monitor data from the apex locator. The canal is processed to working length using manual K-Flexofiles (Dentsply Maillefer) to size ISO 70 using the balanced force technique.

The canine root canal is filled to the level of the fracture with a minimum layer of 4 mm MTA (Angelus) using a gun (Miltex) to inject the material (Photo 3). An ultrasonic tip is also used for packing and inserting the MTA. The remaining canal space was filled with gutta-percha, and the cavity was restored with a composite material (Filtek Supreme XT Universal Composite, 3M Dental Products). After filling, an x-ray was taken (Photo 4). There is a noticeable slight extension of MTA beyond the fracture line, but since MTA is biocompatible, the prognosis for treatment remains good.

Photo 3: Introduction of MTA

Photo 4: Connected root canal

Placement of the implant in place of the lateral incisor

The surgical phase of treatment began with removal of the fractured lateral incisor. A removable partial denture was fabricated as a temporary structure; a composite bridge was rejected due to cost and the patient's desire to avoid affecting adjacent teeth.

The root apex is extracted using a periotome (Photos 5a and 5b) to avoid damaging the buccal plate of the bone. Probing of the socket revealed a significant vestibular defect (Photo 6) and a thin gingival biotype. The partial denture is tried on (Photo 7) and the site is left to fully heal for three weeks.

Photos 5a and 5b: Using a periotome to remove a root fragment

Photo 6: Defect shown by probe

Photo 7: Partial removable denture

After soft tissue healing, good tissue coverage was observed (Figures 8 and 9), but the bony defect persisted. The flap was detached while preserving the papillae of the adjacent teeth.

Photo 8: 3 weeks later: soft tissue healing

Photo 9: Bone defect visible

The concept of using membranes in bone material allows you to create a smaller flap, reducing trauma and preserving the blood supply from the periosteum.

The periosteum at the site of injury also plays the role of an inducer of stromal cell factors, which leads to an increase in the number of mesenchymal cells necessary for the normal healing process. Thus, the authors believe that the use of traditional collagen-type membranes may be more of a hindrance than a help in tissue healing.

The intervention site is carefully curetted to remove all granulation tissue. The bacteriostatic nature of CaSO4 allows the use of chlorhexidine to be avoided, although its effect on fibroblasts remains controversial.

A 3.8 x 12 mm Dio implant (Dio Implant Corporation) is placed in the socket with a slight palatal slope (Photo 10-11) to the desired torque of 25Nm. The author always places an implant during grafting, even in cases of severe bone resorption, since the titanium implant has regenerative properties and also provides stabilization of the bone material.

Photos 10a and 10b: Implant (Dio 3.8 mm x 12 mm) placed palatally, preserving the papilla

Figure 11: Adjacent bone tissue requires grafting

In such a situation, the implant comes first, as it promotes bone regeneration and is also necessary for fixing the abutment and crown in the future.

The correct seating of the pin was carried out in advance, type 49 ISQ 38 (Photo 12). Bone material (Vital, Biocomposites) was prepared according to the manufacturer's instructions and inserted into the surgical site and pressed down with gauze to avoid bleeding during the first three minutes (Photo 13). The ability to cure, and thereby become more stable, leads to greater material survival and bone regeneration. The intervention site is carefully closed and sutured with 5.0 Vicryl sutures (Photo 14).

Photo 12: Ostell smart peg (type 47) inserted into Dio implant

Photos 13a and 13b: Graft in place, bleeding control

Photo 14: Suturing with Vicryl 5.0

The CaSO4 element of the material will provide an occlusive barrier to soft tissue for the first three weeks (depending on the patient), while vascular porosity will allow angiogenesis.

Vascular porosity is increased as CaSO4 is bioabsorbable, which provides the necessary elements for the regeneration process in the BTcP (99% pure beta tri-calcium phosphate) structure.

It has also been noted that some grafting materials (for example Vital) have a negative isoelectric charge in an aqueous solution, which attracts substances such as osteoponin and osteocalcin in large quantities. These substances then attract the patient's negatively charged mesenchymal cells (osteoblasts), which also positively affects the healing process. This is why the authors have not used any autogenous bone for the past nine years, as they believe that the introduction of dead bone slows down the healing process due to the initial osteoclast phase.

Avoiding the use of autogenous bone leads to a shorter rehabilitation period and better passage through surgical procedures.

Twelve weeks later, the flap was elevated to evaluate the formed bone and remaining bone material (Figure 15). A ball-shaped bur (Meisinger) is used to create access to the head of the implant (Photo 16), which is important for seating the pin and taking a correct impression.

Figure 15: Flap elevation after three months to assess newly formed bone and remaining bone material (less than 15%).

Photo 16: Using a ball-shaped bur, excess bone is removed

The bioabsorbability of the material is extremely important for the maturation of new and high-quality bone. Multiple studies have shown that within 10 weeks, 85% of the material is completely absorbed and improves bone regeneration as well as overall healing (Photo 17).

Figure 17: A preparation showing a small amount of bone material remains, hematoxylin-eosin stain (Dr Mangham).

The flap is also used to move the attached, keratinized gingival margin more buccally after fixation of the healing cap (SANH 4224) and reattachment of the prosthesis for another week (Figure 18).

Photo 18: Fixation of the healing cap and prosthesis

The next improvement is noticeable in photo 19.

Photo 19: Soft tissue healing after a week

The correct abutment (SACN 4835T) was selected to place the crown margin 1 mm below the gingival margin, despite the deeper seating of the implant (Figure 20). This was done to optimize this abutment system and improve the soft tissue seal around the implant.

Photo 20: Abutment fixation - note the new bone level

An E-max crown is fabricated (Simply Crown and Bridge in Surrey) which is then cemented with Premier cement (Swallow Dental Supplies). Excess is removed in the gel phase so as not to leave cement fragments under the gum.

The patient was happy with the results and came for regular check-ups every 6 months to ensure long-lasting results.

Observation

At the first visit, there was an improvement in the vestibular profile and complete healing of the gums (Photo 21), with no bleeding on probing despite excess cement from the newly cemented veneer on the central incisor.

Photo 21: Six months after loading

Radiographically, bone density improved in the neck area (Figure 22), possibly as a result of functional modeling and final adaptation of the bone material, which may occur over a period of 9 months, depending on the patient's physiology.

Photo 22: Six months later – bone continues to recover

Complete bioabsorption of the material is important for bone maturation and health without the presence of foreign hydroxyapatite (HA), which can interfere with the natural functioning of the osteoblast-osteoclast cycle. After loading, changes in the profile along the gum line are noticeable, which indicates the importance of functional load for strengthening the bone.

Twelve months after treatment of the upper canine, the bone loss zone had disappeared (Figure 23). Sometimes it can take up to 4 years for the defect to recover completely. The patient did not note any pathogenic symptoms, the canine remained motionless, periodontal pockets did not exceed 3 mm, and there were no swellings. Overall, the prognosis for the upper right canine is favorable.

Photo 23: X-ray a year later – restoration of the bone even around the canine

Discussion

One year after loading, the patient experienced further bone regeneration in the lateral incisor area due to functional modeling (Figure 23).

The author believes that it is necessary to use certain bone material to replace defects - not only to support regeneration, but also to regulate the patient's own response, which was evident in a recent study of 38,000 genes.

The patient's hygiene was not ideal due to reluctance to use floss, however, gum bleeding was not observed and no side effects of treatment were noted. The gingival papilla remained healthy (Figure 24), but emphasis was still placed on oral hygiene.

Photo 24a and b: One year after exercise – oral hygiene needs correction

The prognosis of a tooth root fracture depends on the length of the fracture line, pulp involvement, mobility of the fragment and dislocation of the fragments. The most unfavorable outcome occurs when fractures are localized in the gingival third of the root.

The canine fracture occurred at the level of the middle and apical third of the root. It was immobile and the coronal fragment was not displaced, so the prognosis for this situation was favorable.

The International Association of Dental Traumatology recommends endodontic treatment only in cases of pulp necrosis and not as a preventative measure. Cases of trauma should be carefully monitored clinically, radiographically and using sensitivity tests (thermal tests, EDI). Each case must be treated with an individual approach, since such clinical situations are rarely the same.

In case of pulp necrosis, endodontic treatment of the coronal fragment is indicated, since with such a root fracture the apical part often remains vital.

In the Cvek 2004 study, gutta-percha was used to fill the canal canal, and the authors proved that removing the material into the space between the fragments does not lead to healing. In this case, healing occurred, possibly due to the use of MTA instead of gutta-percha.

Detection of a fracture radiographically often comes down to a variety of targeted images and occlusal views, however, do not forget about CT (the patient refused), which provides a more complete assessment of the condition and prognosis.

Conclusion

The result exceeded the patient's expectations. With the use of new materials and technologies, the treatment process can be made faster and less traumatic.

The synthetic bone material used does not require testing and selection, as is necessary when using donor materials.

Modern materials and techniques in endodontics also provide high-quality treatment for root fractures.

The patient's desire for an economical, painless and aesthetic restoration was fulfilled.

Authors: Peter Fairbairn , BDS, Private Practice, West London, UK, Visiting Professor, Department of Periodontology and Implant Dentistry, University of Detroit Mercy, School of Dentistry, Michigan, USA

Sharon Stern , BDS, Private Practice, West London, UK, Lecturer, Postgraduate clinical program in Endodontology (Parttime), Kings College, London, UK

Diagnostics

If a tooth is fractured, you must consult a dentist. Of course, if the problem does not cause discomfort, which occurs in rare cases, there is no need to rush. But delay can cause even more serious damage, resulting in the tooth having to be removed. Fracture of the anterior elements of the dentition has an extremely negative effect on the beauty of the smile.

A specialist can easily diagnose a tooth fracture. You just need to establish the extent of the fracture and understand whether the remains of the tooth can be saved. To do this, an x-ray is taken, with which the doctor checks for displacement, damage to the root, adjacent tissues and the direction of the fracture. The specialist examines the injured area, analyzes the presence of external damage, swelling, and changes in the color of the enamel. The latter may be a sign of soft tissue necrosis or damage to the neurovascular bundle and filling of the dentinal tubules with blood.

If during percussion a person experiences painful sensations in the damaged tooth and nearby elements of the dentition, this may be a sign of injury to the periodontal and periapical tissues or tooth dislocation. Electroodontometric diagnostics may also be necessary, with which the doctor checks the viability of the pulp in the event of a serious fracture, so that in some cases it can be preserved.