Although enamel is extremely strong, it can suffer damage as a result of acute trauma. This can be from an external source such as a blow or knock to the mouth, or from biting injudiciously on something hard, or from an inadvertent levering action with a fork, for example, whilst eating.
Teeth are more vulnerable to fracture if undermined by decay or where previously filled. And of course, your front teeth are the most likely to suffer, should you get an accidental knock in the face.
This article will look at how chipped front teeth are treated, and you will see that the severity of damage is the main determinant of what repair option is best.
Click here for advice on a cracked tooth, eg one that is split – more common in the back of the mouth.
Degrees of severity of damage
A chipped front tooth can often be quite disfiguring. The severity can vary enormously – from a very tiny piece of superficial enamel being lost, through to a severe fracture. The latter results in a large part of the crown breaking off and perhaps even the pulp (“nerve”) being exposed (in which case their will be a lot of pain from the area).
With a more severe case, treatment is first directed at saving the tooth’s vitality (if at all possible) prior to considerations of restoring lost enamel and dentine. If the pulp tissue is severely damaged though, or likely to get infected or die off, then it may be necessary to instigate root-canal therapy. This involves removing the pulp, cleaning the inside of the pulp chamber and root canals, and then filling it with a bio-compatible material so that infection can’t get in.
This needs to be done first and could take a couple of visits before the tooth can be properly repaired. Read more on root canal here.
Treatment options for fixing a chipped tooth:
Here are the most common modern methods to fix a chipped tooth. Generally speaking, the are used in increasing order of severity of damage to the tooth:
- Reshaping and/or polishing
- Bonded composite filling repair
- Porcelain veneer
- Complete or full crown
Often a very small chip off the biting edge may involve only the superficial hard enamel layer and not penetrate far enough to involve the underlying dentine. In such cases the amount of chipping may be so slight that the tooth can be slightly ground or re-shaped with a high speed drill and polishing discs, to make it look normal again and no further treatment may be required.
White Fillings and Bonding
When damage causes dentine to be exposed then there is a need to restore the lost portion. This is to protect the dentine as well as to restore the normal appearance of a tooth. Dentine is, unlike enamel, a vital tissue and has minute tubules running through it to the pulp chamber at the center of the tooth. Thus there is the potential for bacteria to penetrate to the pulp unless the dentine is covered.
Modern technology has allowed far more choice when it comes to repairing a chipped tooth than used to be the case, with the advent of much better materials which can match the tooth color and give a satisfactory appearance, as well as repairing the physical damage.
It used to be the case that only gold would suffice to repair a tooth with one corner chipped off, and this would be made as a three-quarter or “basket” crown with a tooth-colored filling applied on the front face.
Nowadays however, we have porcelain or very strong composite fillings which can not only replace the missing part of a tooth, but match in appearance very convincingly too.
Even a reasonably large portion of lost tooth can be replaced with modern composites, which are a type of plastic material containing hard glass-like particles. The tooth-colored or “white” filling material comes in a choice of different viscosities and a range of color shades, to enable it to be used to simulate natural enamel and dentin very effectively.
This material is commonly used in what is termed an “acid etch technique” to chemically bond to the enamel to make a strong restoration. An acid gel is first spread over the enamel surrounding the broken portion and then rinsed off after about twenty seconds. This leaves the enamel very slightly roughened with microscopic tags, which can then successfully be used to bond with low viscosity acrylic resin which runs into them and is then set hard using a special light source. This layer forms the base of the restoration, sometimes with protection of the dentine as necessary, and subsequent layers of resin material of greater viscosity are then placed incrementally and light cured at each stage. Eventually the lost anatomy of the tooth is restored by careful additions and shaping of the resin composite, matching the color along the way.
A disadvantage of composite is that it is somewhat porous and may gradually discolor over time (although this is much less the case with modern materials than it was in the past), so porcelain is superior in this respect and may be preferred. Likewise with moderately chipped teeth, a white composite filling may be prone to debonding, and if it does a veneer will be the next option, as it stays in place better (usually).
In order to place a porcelain restoration, it is however, usually necessary to do some preparation of the tooth, which may involve reducing it to greater or lesser extent.
The most conservative method is to construct a porcelain veneer which is a thin sliver of porcelain that somewhat resembles a false fingernail, and to attach it to the front surface of the tooth. A porcelain veneer for a front tooth or porcelain inlay for a premolar/molar is generally custom made in a dental laboratory, from impressions taken in the mouth by the dentist.
Most often, a very thin layer of enamel is taken off the front surface of the tooth first, however, to allow for the thickness of the porcelain to be placed without it appearing too bulky. The porcelain is less than a millimetre in thickness, except in the region of the chipping, where it is thicker to restore that portion.
The porcelain veneer is bonded on to teeth surfaces using a low-viscosity acid-etch resin material, which makes for a very strong union between enamel and the porcelain. This restores the tooth to its proper shape and size.
Porcelain retains its smooth surface well and discourages plaque formation which is a good thing. It can also be used in cases where a tooth is non-vital and root-filled to satisfactorily restore appearance. Such dead teeth tend to darken markedly, but a veneer can hide the darkness and make the tooth a realistic life-like color once again. Sometimes a bleaching procedure may be needed beforehand.
Where a large portion of the tooth is missing, or where a veneer might not be strong enough, then the alternative is to construct a full crown or “cap”. This is made to fit completely over the tooth after it has been suitably reduced and shaped.
A full crown can be made from all-porcelain which gives the best appearance since it allows for some translucency like that of most natural teeth or from a combination of precious metal with porcelain fused to it. The latter is the stronger option and may be deemed necessary where a patient has a heavy bite.
You can find lots more information on crowns starting here.
A chipped tooth can usually be repaired by your dentist so that it can both look normal again, as well as continue to function without suffering further deterioration. The amount of treatment required (and cost involved) can depend, however, on how much damage to the tooth has occurred.
It is obviously prudent for anyone engaging in sports or activities where teeth might get damaged to wear a suitable protective sports guard, which is relatively easy and inexpensive to get, either off-the-shelf or custom made.
If the worst should happen however, and you break a tooth then you needn’t despair, because your dentist can generally fix it provided you get treatment straight away.