What is the treatment for minor tooth chips or cracks using tooth bonding?

Tooth Bonding for Minor Chips and Cracks

For minor tooth chips and cracks, composite resin bonding is the definitive treatment that restores both function and aesthetics while preventing bacterial contamination and further damage. 1, 2

Treatment Algorithm Based on Fracture Depth

Enamel-Only Fractures (Superficial Chips)

• Smoothing the sharp edges with a dental handpiece and polishing bur is sufficient if the fracture site is already smooth to touch. 1
• These fractures cause minimal to no sensitivity and don't require urgent dental referral unless sharp edges are causing soft tissue injury. 1, 2
• The tooth should be monitored for signs of pulpal necrosis (gray discoloration or gum abscess) until natural exfoliation in primary teeth or indefinitely in permanent teeth. 1
• Optional: A resin sealant can be placed over visible crack lines to prevent staining. 1

Enamel and Dentin Fractures (Moderate Chips Without Pulp Exposure)

• Restoration with tooth-colored composite resin material is the standard treatment. 1, 3
• If the original tooth fragment is available, it can be rebonded directly to the tooth using dental adhesive. 1
• Refer to a dentist within a few days—the more sensitivity present, the more urgent the referral. 1, 2
• Covering exposed dentin promptly reduces discomfort and prevents bacterial contamination of the pulp. 1
• The bonded restoration binds tooth segments together and prevents crack propagation. 3

Deep Fractures With Pulp Exposure (Complicated Fractures)

• These require immediate dental referral for pulp therapy (pulpotomy or pulpectomy) followed by restoration. 1, 2
• Timeliness is critical, especially in young permanent teeth where preserving pulp vitality allows continued root development. 1
• Extraction is indicated only if the patient cannot cooperate with treatment or if the fracture extends deep into the root. 1, 3

Immediate Pain Management Before Dental Treatment

• NSAIDs (ibuprofen) are first-line for acute dental pain, with acetaminophen as an alternative when NSAIDs are contraindicated. 2
• Apply cold compresses to reduce swelling and discomfort. 2
• Maintain a soft diet for 10 days after injury. 1, 2
• Avoid temperature extremes with food and beverages to prevent sensitivity. 2
• If a tooth fragment is available, store it in milk or saline (never water) for possible reattachment. 2

Critical Timing for Dental Referral

• Same-day referral: Crown fractures with pulp exposure, severe mobility, or significant pain. 2
• Within a few days: Enamel and dentin fractures causing sensitivity. 1, 2
• Within a week: Enamel-only fractures with minimal symptoms. 2

Common Pitfalls to Avoid

• Delaying referral for pulp-exposed fractures leads to pulpal necrosis and infection. 2
• Using water to store tooth fragments causes osmotic cell lysis—always use milk or saline. 2
• Underestimating pain from exposed dentin—prompt coverage prevents bacterial contamination and reduces discomfort. 1, 2
• Failing to monitor restored teeth for late complications like pulpal necrosis, which can develop months to years after trauma. 1

Long-Term Monitoring

• All fractured teeth require ongoing surveillance for pulpal necrosis, manifesting as gray discoloration, gingival abscess formation, or increased mobility. 1
• Primary teeth should be monitored until natural exfoliation; permanent teeth require indefinite follow-up. 1