Expert: Zev Kaufman, D.D.S. - 12/25/2009

Question
if I feel that it looks like a split line running vertically from the bottom edge of an upper molar up into the gumline what does that mean?...is it possible to re-inforce the tooth somehow laterally at a 90 degree angle with pins or does the tooth have to come out? I ask because obviously if the tooth does crack down to the root completely I will no doubt know because of the pain but when or if that occurs is anyones guess. I'm looking for a possible prevention and yes I will go to my dentist to have it looked at but I'm trying to get an idea of procedures and possible cost just to inform myself.

Answer
Dear Peter:
You are correct in examining your options.  Without having X-rays and a clinical examination, I can only speculate.  However, if the fracture line has not advanced under the gumline and is evident, the only choice you have, aside of doing nothing, which is risky, is to cover the tooth with an appropriate restoration.  It can be a full crown, or an Onlay (which covers only the affected area).
The preparation and the choice of restoration are between you and your dentist.
In any case, the preparation of the tooth should include the fracture line and the design of the crown, or Onlay should be as such as to ferrule down on the tooth and direct the forces of occlusion (mastication, bite) to close the fracture and not split it.
The cost is rather difficult to estimate, since it varies greatly by the training and expertise of the dentist and location.  In New York (where I practice) the top end Prosthodontists (the specialists in restorative, cosmetic, and implant dentistry) charge upwards of $2000 for a crown.  The general/family/cosmetic dentists might charge as low as $800, depending on training and expertise.  I do not know what the price is in Canada.  I do know that the specialists charge somewhat less than in the US, but still on the $1500 side.  
The best thing to do is to go to your dentist an see what needs to be done based on clinical finding and X-rays.
Best of luck, Happy Holidays, and a Happy New Year,
Dr. Zev Kaufman