Case Details

Conservative Dentistry Endodontics

Indian Dental Network posted a case

10 days ago

Diagnosing what it's cracked up to be: A lesson in endodontics

Courtesy: Dental News

There’s no one-size-fits-all approach for diagnosis/treatment of cracked or fractured teeth. Dr. Stacey Gividen presents two clinical cases to help you sort things out.

Is the tooth cracked or fractured? Does it need a root canal? You’ll want to keep the decision matrix in this article as a reference tool for your endo cases.

Resource for your patients >>> Cracked tooth: Types, causes, and treatments

Patient: “My tooth hurts, especially when I bite down.”

You: “Does the pain linger? Is it sensitive to hot and/or cold? How long has the pain been going on?”

Meanwhile … tests begin and clues to the puzzle begin to come together.

Diagnosis: Cracked tooth? Fractured tooth? Split tooth? Extent—unknown (or … you may have an idea, but it is subjective). So how do you decide which one it is?

Now what? Root canal? Crown? What is the prognosis for treatment versus alternative replacement options? These are all questions that run through my mind when a patient presents with a cracked or fractured tooth. Sure, the test results will dictate a subsequent recommended treatment plan; however, what I’ve learned is that there is not a one-size-fits-all diagnosis and treatment for teeth such as these. Why is that?

Additionally, one must consider patients who present with completely asymptomatic craze and crack lines all over their teeth. You cringe just looking at these teeth and know that there’s likely going to be a problem at some point down the road. What is the dialogue that you have with these patients? “Watch” these teeth? Recommend crowns (and often get accused of trying to bamboozle money from the patient for expensive dental work because a second opinion from another dentist suddenly renders you incompetent)? The conundrum is real.

Treatment and outcome for a cracked or fractured tooth is dependent on location, direction, type, and size of the crack. Being able distinguish the difference can aid in a diagnosis that will ultimately lead to proper care and treatment.

The American Association of Endodontists has classified five types of cracks in teeth:
1. Craze lines
2. Fractured cusp
3. Cracked tooth
4. Split tooth
5. Vertical fracture

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