Badly Broken Down Tooth: Can It Still Be Saved?
This page is for anyone asking whether a badly broken down tooth can be saved. That depends largely on how much sound tooth remains, including a collar of sound tooth above the gum called a ferrule. Where enough remains, it may be rebuilt; where too little remains, extraction may be necessary. NHS guidance says to see a dentist, not a GP, if you have chipped, cracked or broken a tooth.
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Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
This page was reviewed by Dr Ibraheem Ijaz, principal dentist at Deepcar Dental Care and a General Dental Practitioner, GDC 301711.
What does "restorable" mean for a broken down tooth?
A broken down (structurally compromised) tooth is restorable when enough sound tooth and healthy support remain to rebuild it with a predictable outcome (prognosis).
The British Endodontic Society (BES) guide says restorability should be considered before root canal treatment, which often follows major loss of tooth to decay or injury.
The guide says X-rays of the tooth should be clear enough to show whether it can be restored. It adds that varied presentations can make a tooth's remaining structure difficult to assess in a standardised way.
What is the ferrule, and why does it matter?
The ferrule is a collar of sound remaining dentine above the gum, all the way round, that the edges of a crown sit on.
The BES guide calls the ferrule effect a well established principle for predictably keeping a crown in place, while noting considerable variability in how research assesses it, which makes specific guidance on protocols for restoring root-filled teeth difficult. It advises dentists to make every effort to provide an optimum ferrule when planning crowns and other restorations made outside the mouth.
Before root canal treatment on a broken down tooth, the guide says, predictable results need at least 2mm of tooth structure all round above the gum and not less than 30% of the tooth's original crown remaining.
When can a broken down tooth be saved?
Whether a broken down tooth can be saved depends largely on how much sound tooth remains, the BES guide indicates.
NHS guidance advises seeing a dentist, not a GP, about a chipped, cracked or broken tooth. Treatments it lists may include gluing the fragment of tooth back on, a filling or a dental crown (a cap that completely covers the broken tooth), or root canal treatment for a badly broken tooth where the nerves are exposed.
The BES guide compares a tooth to a garden shed: losing a whole wall significantly weakens it. It says each case should be considered individually, that in most cases a root-filled back tooth missing a wall next to a neighbouring tooth needs a restoration covering its biting points, or cusps, and that with two or more walls missing, cusp coverage should be used.
How is a badly broken down tooth rebuilt?
In general, a badly broken down tooth may be rebuilt in stages, from the inside out.
Where root canal treatment is needed, NHS guidance says the tooth is then sealed with a filling or crown to stop it becoming infected again. Our guide to treating an infected tooth explains how root canal treatment can save it.
Where the remaining tooth cannot hold a core on its own, a post in the root canal can hold one for the crown to cover, as our page on rebuilding a tooth with a post and core explains.
Treatments at Deepcar Dental Care include broken and chipped tooth repair, white fillings, composite and ceramic inlays and onlays, crowns, post crowns with fibre posts or cast metal posts, and root canal treatment. No overseas laboratory work is used.
Questions about this treatment? Book online or call the practice.
When can a broken down tooth not be saved?
Some broken down teeth are beyond saving because they cannot be rebuilt with predictable results, and extraction may then be necessary.
For root-filled teeth, the BES guide says extraction may be necessary where survival is poor because of gross loss of tooth tissue, periodontal (gum) disease, lengthways fractures that cannot be restored, or extensive resorption.
A tooth snapped off or crumbling to the gum line, or below it (a subgingival margin), may leave too little tooth for a ferrule. NHS advice is to see a dentist, not a GP, about a broken tooth. A 2012 review of the ferrule effect concluded that, for root-filled teeth with no natural crown left, orthodontic extrusion (gently moving the tooth further out) should be considered rather than surgical crown lengthening (reshaping the gum and sometimes bone) to create a ferrule. Where neither can be performed, it said available evidence suggests a poor clinical outcome is very likely.
When should you see a dentist about a broken tooth?
NHS guidance gives non-urgent advice to see a dentist, not a GP, if you have chipped, cracked or broken a tooth.
For urgent dental treatment, call a dentist; if they are closed, their answerphone may say what to do. If you do not have a dentist or cannot get an emergency appointment, call 111, who can advise you what to do, or find a dentist near you and ask for an emergency appointment. You may have to pay for your appointment.
If a tooth has just broken badly, NHS guidance says to call your dental practice or get advice from 111 online or by calling 111, and that a badly broken adult tooth will need to be treated as soon as possible (within 30 minutes to 1 hour, if possible). First steps after an injury are on our page about what to do about a broken tooth.
What happens if a broken down tooth needs to come out?
If a broken down tooth has to be removed, NHS guidance describes bridges, partial dentures and dental implants as ways to replace missing teeth.
Extractions at Deepcar Dental Care include simple, surgical and same-day extractions. Replacement options include bridges, dentures and dental implants, and our implant section covers replacing teeth with implants. Our comparison page explains deciding whether to save or remove a tooth.
Frequently asked questions
Does a post make a root-filled tooth stronger?
No, a post holds the core in place rather than strengthening the tooth. The BES guide says a post is not there to strengthen the root or to make up for a missing ferrule, and that post material has no effect on the tooth's survival.
How long will a rebuilt tooth last?
It depends mainly on how much sound tooth is left and the restoration chosen, the BES guide says of root-filled teeth. Restorative problems linked to structural failure are the most common reason such teeth are extracted, it adds. NHS guidance notes that crowns may need to be replaced in the future.
Are crowns and extractions available on the NHS?
Usually, NHS guidance says. Among NHS dental charges in England, Band 2 (£76.60) may include extractions, fillings and root canal treatment, and Band 3 (£332.10) may include crowns, inlays and onlays, bridges and dentures. If you need treatments from different bands, you pay the highest band's charge. Some people can get free NHS dental treatment.
Is a root-filled tooth more likely to break?
It can be, for two reasons, the BES guide says. Without its pulp, the tooth senses chewing forces less well, and the tooth lost to the original problem and to treatment weakens what remains. Teeth touching only one neighbouring tooth or none, and the last standing molar, are particularly vulnerable, it adds.
Book a consultation.
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Deepcar Dental Care is at 334 Manchester Road, Deepcar, Sheffield, S36 2RH, and is open 8am to 8pm, Monday to Sunday.
For restorative dentistry, our cost page explains what it costs, and patient feedback is on the practice's reviews page.
Other signs that a tooth may need restoring are among the options in this section. Our page on repairing and rebuilding damaged teeth explains how restorative dentistry aims to keep natural teeth rather than replace them with implants.
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