Endodontics
Course Review
Enoch Ng, DDS 2014
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Cracked Tooth
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Incomplete fracture
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May or may not involve pulp
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Extends from occlusal to apical
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Mesiodistal direction
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Excursive interference precursor for fracture
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Restored teeth 29x more likely to fracture than unrestored teeth
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Dental History
Repeated occlusal adjustments with minimal/transient decrease in symptoms
Vague/elusive symptoms
Extensive restorative history
Parafunctional habits
History of cracked teeth, history of trauma
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Subjective Exam
Episodic discomfort on biting
Patient remembering precipitating incident
Patient may not localize or ID tooth accurately
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Clinical Exam
Visual – restoration integrity, marginal discoloration
Tactile exam with explorer
Perio probings – isolated defect
Percussion – might have sensitivity
Bite test – sensitive on bite or release
transillumination
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Radiographics
Variable detection
Fractures not usually visible
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Restoration removal
Allows access
Aids in placement of stain to determine extent of crack
Methylene blue = caries indicator helps visualize location, direction, extent of crack
Necessary to determine mobility of segments
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Treatment
Cuspal coverage restorations may impede propagation of racks
Orthodontic bands
Occlusion reduction
Reduce height of non-functional cusps
Eliminate occlusal contacts on non-functional cusp
Re-contour outer incline of non-functional cusp
NSRCT when indicated by diagnosis – sensitivity testing shows pulpal damage is irreversible
Tooth prognosis decreases as crack propagation continues
21% of teeth with reversible pulpitis from cracks will require NSRCT in 6 months
Cuspal coverage = almost 0% failure
No cuspal coverage, composite restorations instead = 6% annual failure
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