Monday, November 1, 2010

Managing a Cracked Tooth

Dealing with cracked teeth can be very challenging. In the first place, there is a lot of confusion about what we are calling a cracked tooth. Craze lines, fractured cusps, split teeth and vertical root fractures are all often called "cracked" teeth. However, treatment and prognosis are different for all of these different situations.

Cracks in teeth are findings, not a diagnosis. Proper pulpal and periapical diagnosis as well as the location and extent of a crack are needed to determine a proper treatment plan. The problem with cracks in the tooth are the possibility for future bacterial penetration, which leads to inflammation and disease.

With these considerations, many teeth with cracks can be saved. Keys to saving teeth with cracks are:
1. Early detection and treatment
2. Proper endodontic diagnosis
3. Proper determination of the location and extent of a crack

The following case of a cracked tooth was recently treated at Superstition Springs Endodontics.

This patient presented with mesial decay on #14 causing discomfort. The tooth was normal to percussion, probing and no response to thermal test. DX: Necrotic pulp w/ normal periapex. A crack was noted on the distal marginal ridge. RCT recommended.

Removal of decay and access revealed the crack extending down the distal wall.

Closer examination finds that the crack ends near the level of the CEJ. Pt is informed of the crack and the prognosis is good, since the new crown will be able to cover the crack. The crack should be removed at the time of the build-up.

A main key to saving teeth with cracks is to identify the location and extent of a crack.

An upcoming Inner Space Seminar, entitled "Breakdance" will help clinicians know how to identify and classify cracks in teeth, as well as treatment plan restorative options for teeth with cracks.

3 comments:

Nathan Saydyk said...

Thank you for the great CE course. Cracked teeth are always a pain.

I also looked for the Browning 10mm Ballistic Flashlight and found that they are discontinued. However, the new light from browning is: Browning 2120 MicroBlast Penlight with Bore Light Adapter, and retails for about $15.

I only mention this because I have spent the last 30 min looking for the one you mentioned and had to call Browning to find the replacement.

Thanks again!

Jason J. Hales D.D.S., M.S. said...

Thanks Nathan for that research.

We discussed transillumination as a tool for identifying cracks in teeth. This penlight with Bore Light Adapter is an inexpensive light for transillumination.

You can find it at:
http://www.browning.com/products/catalog/flashlights/detail.asp?value=033H&cat_id=371&type_id=2120&content=microblast-pen-light-with-bore-adapter-model-2120-flashlights

tiffany bonfiglio said...

Thanks for the info

Tiffany Bonfiglio
www.pro2pronetwork.com