3, (B) with the occlusal amalgam removed, (C, D) endodontic treatment complete showing multiple cracks extending well into the MB2, DB, and P canals, and (E) orifice barriers placed. (D) 4.8-year post-operative periapical radiograph showing complete bony healing.įigure 5. (A) Cracked tooth No. (C) Facial-lingual crack that extended 3 mm subgingivally on the lingual. 14 with sinus tract and a diagnosis of pulpal necrosis with chronic apical abscess. (From Davis and Shariff 2019, Success and survival of endodontically treated cracked teeth with radicular extensions: a 2- to 4-year prospective cohort, Journal of Endodontics, 2019 (45), pages 848-855.)įigure 3. Iowa Staging Index with associated success rates (From Krell and Kaplan, 12-month success of cracked teeth treated with orthograde root canal treatment, Journal of Endodontics, 2018 (44), pages 543-548.)įigure 4. (A, B) Cracked tooth No. The patient’s symptoms along with the crack’s orientation, depth, and pulpal and periodontal involvement dictate the appropriate restorative approach.įigure 2. (A) Microscopic view internally of a deep radicular crack extending 3 mm beyond the level of the canal orifice (arrow) and (B) deep orifice resin-modified glass ionomer placed 2 to 3 mm apical to the extent of the crack. Not only do patients with cracked teeth present with varying symptoms and clinical presentations, but survey studies also indicate a lack of consensus within the dental community regarding cracked tooth treatment protocols (Alkhalifah, Alkandari et al 2017).Īn accurate endodontic evaluation is the first critical step in proper management of cracked teeth. Management of cracked teeth can be challenging. This makes early diagnosis the key to managing treatment. Regardless, studies have shown that with the earlier the diagnosis of cracked teeth, the less likely there will be progression to pulpal pathosis requiring endodontic treatment (Krell and Rivera 2007 Abbott and Leow 2009 Opdam, Roeters et al 2008). Presumptively, the mental and emotional stress of the pandemic and adhering to strict state or local guidelines to mitigate the spread of COVID-19 has led to a higher incidence of bruxism and grinding, though no studies have examined incidence during “stressful” periods of time. The mechanism for crack development is concentrated repetitive stress with subsequent fatigue of enamel and then dentin. In this era of COVID-19, dentists are reporting increased numbers of patients presenting with cracked teeth (Shannon 2020).
0 kommentar(er)
