Can someone who begins a voluntary fast break it?
It is preferable for someone who begins an act of worship not to break it.
Allah the Exalted has said {what means}: "and let not your [good] deeds come to nought!" [Muhammad/33].
However, if a person starts a voluntary fast (nafl) and needs to break it, they are going against what is preferable, but there is no sin upon them.
What is the Islamic ruling on one who was unable to fast and then regained the ability?
He is not required to make up the fast (Qada) even if he becomes capable of it; whether he regained the ability to fast after paying the fidya (feeding a needy person for each day of missed fasting) or before it, because he was liable for paying it in the first place, so it remains binding upon him. However, if he delayed paying it beyond the first year, nothing is required of him due to the delay. If he is unable to pay it, it does not remain as a debt upon him. And Allah the Exalted knows best.
Does tooth extraction during the day in Ramadan break the fast?
Simply extracting a tooth during the day in Ramadan does not break the fast. However, if water or blood enters the body cavity, the fast becomes invalid.
Whoever's fast is invalidated in this way must refrain from eating and drinking for the rest of the day out of respect for the sacred month and make up for that day later.
It is preferable to postpone the extraction until nighttime or after Ramadan if possible.
Is an elderly or chronically ill person required to pay additional fidyah if they delay it beyond the first year?
An elderly person or someone permanently unable to fast must pay fidyah by feeding one needy person for each missed day.
However, if they delay paying fidyah beyond the first year, no additional fidyah is required.
This differs from someone who delays making up missed Ramadan fasts (qada) without a valid excuse until the next Ramadan begins—such a person is required to pay an additional fidyah for the delay.