How Does A Dentist Fix A Fractured Cusp

In the first ii parts of this iii-function serial on tooth cracks and fractures, I take discussed and reviewed the nature of diagnosing cracked or fractured teeth and the five types of molar fractures that accept been defined and described by the American Association of Endodontists (AAE).^1,two In this final article of the series, I will discuss the handling options and rationale for the v different cracks when found in teeth.

When it comes to managing and repairing fractured teeth, there are a lot of thoughts/ideas/beliefs in doing and so, peculiarly for the ones that are slightly cracked or have non-restorable fractures.

We will first with the easier types of croaky teeth to manage and and so we will delve into the teeth with cracks that require dissimilar treatment modalities.

From craze lines to fractures

The nearly common, yet to the lowest degree concerning, "scissure" institute in teeth is a craze line, which only involves the enamel. They are commonly found in anterior and posterior teeth, are nowadays on the enamel surface, and require no restorative treatment and just monitoring when properly diagnosed. No handling is indicated for these types of "cracks"; you simply need to monitor them for any changes in the tooth and craze-line area (Craze lines are more of a concern when near or adjacent to restorations).

On the other end of the spectrum of cracked or fractured teeth are vertical root fractures and split tooth fractures. In one case a tooth has been diagnosed with a vertical root fracture, sometimes the root involved is removed or, near of the time, the entire tooth is condemned and removed.

Vertical root fractures tin can mimic other conditions such every bit periodontal disease or, in previously treated root canal teeth, a failing endodontic treatment, so we may sometimes need to have a periodontist or endodontist involved to help dominion out these other possible concerns prior to final treatment of the tooth involved.

A split tooth starts in the coronal portion of the tooth and extends downward into the root surface. If the tooth is not split also far apically, then the tooth may exist salvageable. Only if the scissure goes too far apically downwards the root surface, the tooth volition often have to be extracted. Of form, you have to assess the pulpal condition, equally the pulp often is or has been involved in the deeper cracks and will crave treatment.

Planning handling for fractured cusp vs. cracked tooth

The last two types of croaky teeth, fractured cusp and cracked molar, get a lot more than interesting. We as clinicians take to manage each patient and tooth individually, since every state of affairs tin can have a different set of variables. It can vary from a completely asymptomatic fracture noted upon removal of an old restoration to a tooth that has abiding hurting upon biting and thermal sensitivity to one that has a fractured cusp present with no sensitivity. Do you treat each of these the same? No. If not, how do yous manage them? Here are some insight and guidelines on how to manage that cracked tooth or fractured cusp:

As outlined in Function I of this serial, once you take gathered data and developed a working diagnosis on the molar in question, you have to determine the extent of the crevice and whether the lurid is involved and/or healthy. If the pulp is salubrious and stable, and so is it a fractured cusp we are managing or croaky molar? If information technology is a fractured cusp, then nosotros accept to look at removing the fractured cusp and assess the remaining molar construction. If enough tooth remains, it may be possible to do a direct restoration to manage the state of affairs. If not, then the tooth may crave either an inlay, an onlay or a build-up and crown.

Which one? It depends on many things: the corporeality of tooth and enamel left, power to isolate, material option, whether you are bonding or cementing, whether it is in an esthetic area where margin placement is of concern, how it plays into the long-term treatment programme (is it next to an area missing teeth, will the patient need other restorations, bite changes, orthodontics, etc.).

Considerations for croaky molar treatment

If information technology is a cracked molar rather than a fractured cusp, the fracture/scissure tends to be more centered in the molar and, if not managed properly and/or with no treatment, volition lead to a split tooth and eventual tooth loss. In these situations, it is recommended that the patient be informed of the guarded long-term prognosis of the pulp and/or tooth earlier pursuing treatment. Even with our all-time efforts, a croaky molar can somewhen get worse and atomic number 82 to pulpal necrosis and/or a separate tooth and tooth loss.

With a cracked tooth in which the pulp is involved and irreversibly inflamed and/or necrotic, the tooth will need root canal treatment forth with assessing how deep the fissure goes. Is information technology simply into the lurid chamber or is it deep into the pulpal floor and down into the root itself? The deeper the fissure, the more concerned we have to exist about the long-term prognosis and whether the tooth will go a split tooth and eventually be lost.

If the pulp is salubrious and intact, then the goal is keep the crack from getting worse. Covering the crack in its entirety will also go on bacteria from invading deeper into the molar and leading to pulpal necrosis and/or future tooth loss. We also want to alleviate any symptoms prior to completing the terminal restoration.

Efficacy of final restoration methods

Ideally, the restoration should cover the entire crack along with giving cuspal coverage and support. Often times this is best managed with a crown and/or a build-up, as information technology accomplishes both criteria.

I report^three shows that if a croaky tooth with reversible pulpitis is managed with a crown and/or build-upward, over fourscore percent of these are still vital in 6 years, with the remaining twenty percent of them eventually leading to irreversible pulpitis. Today, with all the new and improved materials and bonding techniques, many clinicians endeavour to be "bourgeois" by leaving more of the molar backside and managing these types of cracks with bonded direct or indirect restorations. The research is all the same out on just how constructive these types of restorations are, but it looks promising^4,5.

It is in the author's opinion that one part of success for these types of bonded restorations is that they are more than technique-sensitive than crowns, and require the incorporation of sound restorative and bonding principles and have to be completed at a very high level using first-class isolation and magnification of the tooth in question. The other part that was mentioned in and discussed in one literature review^{half dozen} is simply the power of the clinician to develop a consensus of when to care for, what type of restoration to consummate, and when to intervene with handling.

With this in mind, ultimately, if the cracked tooth cracks further and somewhen involves the pulp and/or develops into a split tooth and is lost, and so we have to ask ourselves, did we actually assistance our patient long-term? Hopefully nosotros volition accept more clinical studies in the future that tin assistance guide us to doing the best and most conservative handling and help our patients keep their teeth for a lifetime.

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Jeff Lineberry, D.D.S., F.A.G.D., Spear Visiting Faculty and Contributing Writer - http://www.jefflineberrydds.com

References

one. American Association of Endodontists. Cracking the croaky tooth lawmaking. Endodontics: Colleagues for Excellence. 1997 Fall-Winter;: i-13.

2. American Association of Endodontists. Great the Cracked Tooth Code: Detection and treatment of Diverse Longitudinal Molar Fractures. 2008. Summertime; 1-seven.

three. Krell KV, Rivera EM. A six yr evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. J Endod. 2007;33: 1405-1427.

4. Signore A et al. A 4- to 6-year retrospective clinical written report of cracked teeth restored with bonded indirect resin blended onlays. Int J Prosthodont 2007; 20: 609-6160.

5. Opdam NJM et al. 7-year clinical evaluation of painful cracked teeth restored with direct composite restoration. (JOE 2008; 34: 808-811).

vi. Lubisich, EB, Hilton, TJ, Ferrance, J. Cracked Teeth: A Review of Literature. J Esthet Restor Paring. 2010; Jun22:(3)

(Click this link for more than dentistry manufactures past Dr. Jeff Lineberry.)

Jeff Lineberry, D.D.Due south., F.A.Thousand.D., Spear Visiting Faculty and Contributing Writer - http://www.jefflineberrydds.com