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A root canal treated tooth is much more prone to fracture than an ordinary one and can render the entire root canal process futile. We lay out the reasons why this happens and what can be done to protect the tooth from fracturing.

There are not too many complications or side effects that can happen after getting root canal treatment for your tooth. One of the most common complaints, though, that patients have after getting root canal treatment is of a cracked tooth. Let us have a look at why this happens and how it can be prevented.

Why do root canal treated teeth fracture more easily than normal teeth?

The most common reason for needing root canal treatment is tooth decay [1]. A lot of the tooth has already been destroyed by the time the patient actually gets a root canal done. This in itself compromises the structural integrity of the tooth [2].

Furthermore, the very process of performing root canal treatment involves drilling inside the tooth and removing all the diseased structure so that the infection can be completely eradicated. What is left after the completion of the root canal treatment is like a shell of the tooth which can fracture very easily under pressure [3].

This is why almost all root canal treated teeth are advised to be covered with crowns for their protection.

Can a cap be avoided after root canal treatment?

There are a few exceptions to the rule when it comes to placing a crown on root canal treated teeth. The front teeth which are not under excessive biting pressure and those that have a healthy amount of tooth structure left after the treatment can be left without a crown [4].

The front teeth of the jaw also have a single root so only a small hole in the tooth needs to be made to gain access to the root. A simple filling to fill in the access hole created by the drilling is sufficient.

In some cases, if the root canal treated tooth does not have an opposing tooth then it can be left without a crown as well.

How quickly must a crown be placed on a root canal treated tooth?

It is nearly impossible to predict when a tooth will crack after root canal treatment and therefore it is recommended a crown be placed on a root canal treated tooth as soon as the tooth is symptom-free [5]. In general, dentists like to wait a week after the completion of root canal treatment to place a crown just to make sure that there is no post-operative pain or discomfort to the patient.

The reason that a tooth cracks after root canal treatment is because it is unable to bear the normal chewing forces in the mouth [6]. A back tooth whose primary function is to chew could fracture at any time and render the entire root canal process useless.

It may be difficult to predict when a root canal treated tooth is going to fracture but the possibility of it happening is almost certain.

Can a root canal treated tooth fracture even after having a crown on it?

Yes. It most certainly can and often does [7]. The chances of a fracture reduce immensely when the tooth is protected by a crown but just having a crown does not make the tooth invulnerable. There are a number of other factors at play [8]. If the tooth in question is supporting a bridge then its chances of fracturing increase. If the patient has a habit of grinding the teeth then the chances of tooth fracture increase [9].

Also, if there are many other missing teeth in the mouth which increase the load on the remaining teeth then the chance of a tooth fracture increases as well.

How to prevent a root canal treated tooth from fracturing?

There are several things that can be done to prevent root canal treated teeth from fracturing [10]. The first, as has been mentioned many times before, is to get a crown to protect the teeth. The second is to replace other missing teeth in the mouth if there are any.

Equal force distribution between all the teeth of the jaw is vital to the longevity of the teeth. A lot of the times patients are missing teeth on one side and can only eat from the side where the root canal treated tooth is.

Third, whether there is one single root canal treated tooth in the mouth or many, patients should be careful about trying to chew hard objects which require a lot of effort. Either break the hard object (like nuts) into small pieces outside or avoid them altogether.

The fourth and final thing which should be done is also the most basic advice given to all dental patients. Keep good oral hygiene. A root canal treated tooth can get decayed again whether it is under a crown or not. The patient may not have pain because of the previous treatment that was done but the tooth will continue to get weaker until it finally fractures.

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