2/18/2016

Treatment One Of The Most Challenging

t
Conditions To Diagnose & Treat
Planning Topics

Cracked Tooth
Syndrome

Many Teeth Exhibit Cracks Pulpal Involvement

t
Which Cracks Are Causing Symptoms? No Pulpal Involvement

Which Cracks Should Be Treated?

Through Root System

Pulpal Involvement
Cracked Tooth
No Pulpal Involvement Sign/Symptom Progression:

None

Difficult To
Detect
Radiographically
Through Root System

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Asymptomatic
Asymptomatic

Cracked Tooth Cracked Tooth

Sign/Symptom Progression: Sign/Symptom Progression:

None None
Occasional Pain With Chewing Occasional Pain With Chewing
Usually Needs To Bite In Specific Manner
May Be Difficult To Reproduce In Early Stages Consistent Pain With Chewing
Patient Has Difficulty Isolating Pain Patient Can Usually Isolate Pain
Pain Worse On Release Of Pressure Pain Worse On Release Of Pressure
Usually No Thermal Sensitivity Patient Avoids Area
Usually Pulp Tests Normal

Cracked Tooth Cracked Tooth

Sign/Symptom Progression: Sign/Symptom Progression:

None None
Occasional Pain With Chewing Occasional Pain With Chewing
Consistent Pain With Chewing Consistent Pain With Chewing
Cold, Hot, Sweet Sensitivity Cold, Hot, Sweet Sensitivity
Usually Concurrent With Above Symptom
Pulp Tests Abnormal Spontaneous Pain
Constant Pain/Fracture/Abscess

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Clinical Signs Of Cracked Tooth: Clinical Signs Of Cracked Tooth:

None None
Small Craze Lines Small Craze Lines
Differentiate Symptomatic/Asymptomatic
Definitive Crack (Radiographic/Clinical)

53 YO Female

Difficult To Visualize
On Unenhanced Radiograph

Referred For Crowns #3, 19, 30

Mother Of Treating Dental Student

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Clinical Signs Of Cracked Tooth:

None
Small Craze Lines
Definitive Crack (Radiographic/Clinical)
Periodontal Defect
Crack With Separation

Clinical Signs Of Cracked Tooth:

None
Small Craze Lines
Definitive Crack (Radiographic/Clinical)
Periodontal Defect
Crack With Separation
Mobile Segment
Missing Tooth Structure
Fistulous Tract

ULSD Clinical
Example

Not Pathognomonic
For Cracked Tooth

Possible Sign Of Cracked Tooth

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Knowledge Of Previous
Dental History Useful
With Differential Diagnosis
Cracked Roots Extremely
Difficult To Diagnose

Clinical Signs Of Cracked Tooth:

Diagnosis Of Cracked Tooth
None
Small Craze Lines
Patient Symptoms
Definitive Crack (Radiographic/Clinical)
Tooth Sleuth
Periodontal Defect
Crack With Separation
Mobile Segment
Missing Tooth Structure
Fistulous Tract
Provocation Test Results
Isolation Of Pain Source
Evaluation Of Pulpal Status

Diagnosis Of Cracked Tooth t

Patient Symptoms
Tooth Sleuth

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Diagnosis Of Cracked Tooth Diagnosis Of Cracked Tooth

Patient Symptoms Patient Symptoms

Tooth Sleuth Tooth Sleuth
Periodontal Evaluation Periodontal Evaluation
Dyes Dyes
Provocation Tests
Excavate Tooth
Pulpectomy To Determine
Extent Within Pulp Chamber

Diagnosis Of Cracked Tooth t Treatment:

Cracked Tooth

No Treatment
Direct Restoration
Extremely Important To Incorporate Crack
Involve Patient In The Cuspal Coverage

Diagnostic Process

t Treatment:
Cracked Tooth t Treatment:
Cracked Tooth

No Treatment No Treatment

Direct Restoration Direct Restoration
Indirect Restoration Indirect Restoration
Incorporate Crack
Cuspal Coverage
Endodontic Treatment
Crown Lengthening?
Biteguard
Preventative

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t Treatment:
Cracked Tooth

No Treatment
Direct Restoration
Indirect Restoration
Endodontic Treatment Signs Of Cracked Root Observed #19:
Crown Lengthening? Percussion Sensitivity
Biteguard Fistulous Tract
Extraction Radiographic Evidence
Abnormal Perio Pocket

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Addressing Cracked Teeth Addressing Cracked Teeth

Excavate & Evaluate If Indicated On UC TP

At ULSD

Addressing Cracked Teeth Addressing Cracked Teeth

Excavate & Evaluate If Indicated On UC TP Excavate & Evaluate If Indicated On UC TP

Provide Cuspal Coverage Provide Cuspal Coverage

Provisional Restoration
Direct Restoration
Indirect Restoration
(Phase II)
If Restorable, TP Endo Early If Indicated

QUESTIONS?