Monday, November 21, 2016

Partners In Patient Care: Assisting in Treatment Planning - Cracked Teeth

The endodontists at Superstition Springs Endodontics are partners in your patient care.  One of the many ways we assist with the quality treatment of your patients in addition to endodontic diagnostics is in evaluation of restorability.  With the benefit of the dental operating microscope, we are able to excavate decay and evaluate cracks in your patient's tooth.  Every crack is unique and the extent, depth, discoloration, pulpal status, patient occlusion and parafunctional habits should all be considered in the treatment planning a tooth with a crack.

Cracks that go below the cemento-enamel junction and are not able to be completely removed when the buildup is placed or completely covered by the new crown will likely affect the long term prognosis of the tooth.  These types of cracks are best evaluated under the magnification of the microscope.  Additional tools such at staining and transilluination are also frequently used tools in the endodontist's evaluation of a crack.

Patients should be given the options and prognosis and helped to make the treatment decision that is in their best interests and meets their desires.

The following case demonstrates this process and usefulness of the microscope.

Pt is referred for endodontic evaluation/treatment.  Tooth is diagnosed with irreversible pulpitis, normal periapex and gross distal decay.  RCT recommended.

Distal decay is removed, mesial amalgam removed.  Crack identified on the mesial wall of the pulp chamber.

Further excavation reveals the extent of the mesial crack - going below the CEJ and starting to enter the root.  Patient is informed of the extent of the decay and the options: 1. Complete RCT, buildup and crown with guarded long term prognosis 2. Extraction and replacement with implant or bridge  Pt elects extraction in this case.