Why can fully detached teeth be re-attached, and yet if you break / crack your Maxillary-first-premolar the only option is extraction and disposal?

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Why can completely detached ( de-attached ) teeth be so easily re-attached by dentists, and yet if you break / crack your Maxillary-first-premolar right up / down the middle ( so that one half moves freely sideways ) the only option is extraction and disposal ?
 
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MattKW

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A fracture above the gumline might be able to be fixed, like denting a panel in your car.
With a 1st premolar fracture, it's like shearing your car in two down the middle. Maxillary 1st premolars can do this because:
  • They are 2-rooted, which makes them more likelt to split between roots rather than a single rooted tooth;
  • There is a groove on the mesial root surface that leads into the area between the roots.
  • Sometimes people have PM1s with very prominent cusps, adding to the splitting force when chewing.
I had a patient who had a spontaneous fracture in a perfectly good 1st PM due to these fractures. I suggested we move to crown the tooth on the opposite side, but she fractured that within 2 weeks.
 

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why can't I tie a string around the broken Maxillary-first-premolar, hopefully fitting the fracture together properly, so that natural remineralization will may occur.

  • Maybe the Maxillary-first-premolar starts out like two separate teeth and then natural mineralization occurs and they join to become one tooth, I obviously don't know.
  • Two or three years ago I insisted to a dentist that they greatly reduce the very prominent inner cusp on this exact Maxillary-first-premolar ( PM1 ), because I was very afraid that this exact thing would occur, from noticing how sometimes it would accidently knock very dangerously against lower teeth, but the dentist refused saying that taking away valuable tooth material is wrong.
  • I have noticed that when i keep the broken inner cusp ( free moving cusp ) of this Maxillary-first-premolar against the intact cusp, instead of sometimes wiggling it, that that seems to greatly reduce the episodes of gum inflammation ( lots of septic tasting fluid ) and more recently bleeding, the septic fluid and blood have lessened very very noticeably. What if that septic fluid and blood are part of the body's mechanism of natural remineralization ( even though that sounds very unlikely that they would coincidentally also help with natural remineralization ) .
  • I just cannot find any webpages of people ( DIY ) tying a string around their broken Maxillary-first-premolar, hopefully fitting the fracture together properly, so that natural remineralization will may occur, obviously I would not be the first to think of this.
 

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MattKW

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Teeth do not reform like a bone fracture; there are no living bone cells within the enamel or dentine that would allow this. All you are doing is to allow further ingress of bacteria down the fracture line, and infection is inevitable. Get it extracted ASAP.
 

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Other types of tooth fractures can and do actually heal, via natural remineralization, some toothpastes are designed to help do that.

I have observed that keeping the broken cusp in it's proper position, in other words never moving it, seems to stop infection and bleeding ( as I described in a reply above ).

So there is a chance that the string ( or something ) idea I typed above could have some sort of percentage chance of being successful.

I think that probably the reason dentists insist on extracting it is to not run any risk at all of patients health being affected by infection, regardless of it being an idea that could have some sort of percentage chance of being successful.

Since I can find nothing on the internet of people doing this string ( or something ) idea DIY, I will have to have it extracted.
 
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MattKW

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Do show us the evidence that tooth fractures can heal.
Remieralising toothpaste reharden softened teeth (early decay), not fractures.
 

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