CDS 421 - Longitudinal tooth fracture GA 2.pdf
Transcript
LONGITUDINAL TOOTH FRACTURE Dr. Ghaliah Alsawah BDS, DcSc Consultant in Endodontics TABLE OF CONTENTS 01 Introduction 04 Prevention Classification 02 Longitudinal tooth fracture types...
LONGITUDINAL TOOTH FRACTURE Dr. Ghaliah Alsawah BDS, DcSc Consultant in Endodontics TABLE OF CONTENTS 01 Introduction 04 Prevention Classification 02 Longitudinal tooth fracture types 05 Summary Mechanics 03 Definition, etiology, manifestation, diagnosis, management & prognosis 01 INTRODUCTION The presence of cracks or fractures can be difficult to diagnose and clinically manage. No symptoms / vague / specific. Symptoms alone are often insufficient for making a definitive diagnosis and the radiographic interpretation can be inconclusive. AAE - Glossary of Endodontic Terms Crack “a thin surface disruption of enamel and dentin, and possibly cementum, of unknown depth or extension.” Fracture “a split or break in bone, cartilage or tooth structure.” 02 CLASSIFICATION 01 02 03 Crown originating Split tooth Vertical Root Fracture fractures (VRF) Most cracks and fractures exhibit no radiographic manifestation in the early stages. Symptoms are slight and present for several months before an accurate diagnosis is made, which may be frustrating for both the patient and the dentist The final diagnosis is typically reached at a relatively late stage of these conditions, often after complications have already occurred. 03 MECHANICS Fracture Mechanics Craze line Crack Fracture Split tooth VRF Craze line Definition Merely cracks in the enamel that does not extend into dentin. Etiology Either occur naturally or develop post trauma. Mostly in posterior teeth. Craze line Diagnosis No symptoms. Light transillumination. Management No treatment necessary, unless they create a cosmetic issue. Cracked tooth Definition A crack between a cusp and the rest of the tooth structure that usually doesn’t involve pulp. Etiology Naturally, extensive occlusal restorations, or post trauma. Mostly in posterior teeth. Cracked tooth Manifestation Sharp pain when chewing. Pain lasting for long period. Cracked tooth Diagnosis “challenge” Patient history Biting test “Tooth slooth” Upon pressure or released Magnification Transillumination Removing restoration Cracked tooth Management Protecting the affected cusp by: Bonded composite restoration. Full coverage crown or onlay. Prognosis Depend on its extent. Fractured cusp Definition Propagation of a cracked tooth. Etiology Crack extending deep into Dentin, in mesial-distal direction. Fractured cusp Manifestation Visualization Diagnosis Patient history Magnification No pain to severe Fractured cusp Management Depending on the amount of tooth structure remaining: Small à conservative restoration of a bonded composite resin. Large à a full crown or onlay. Fractured cusp Prognosis Depends on the extent and orientation of the fracture, degree of symptoms, and treatment provided. Split Tooth Definition Continuation of a crack or fracture longitudinally leading to separating the tooth into two fragments. Etiology Masticatory forces, bruxism, and clenching. Split Tooth Manifestation Runs in buccal-lingual or mesio-distal direction passing through the central central fossa. Later stage can be wedged with a sharp explorer. Split Tooth Diagnosis Sharp pain on mastication. Patient history. Periodontal pocket or sinus tract, and can be radiographically evident in late stages. Anesthetizing the suspected tooth. Split Tooth Management Oblique split à small segment à remove it. Split extend below the osseous level à restorability checking. Split Tooth Prognosis Small à restorable, good prognosis Large à RCT or non-restorable à not favorable prognosis. Long-term success; avoid endodontic treatment in cases of definitive diagnosis of a split tooth or root. Vertical Root Fracture Definition A severe crack in the tooth that extends longitudinally down the long axis of the root. Often it extends through the pulp and to the periodontium. Vertical Root Fracture Etiology 1. Before endodontic treament: occlusal forces, pre-existing microcracks. 2. Secondary to RCT: decrease in hydration, excessive RC preparation and uneven thickness of remaining dentin, microcracks due to rotary instrumentation. DANGER ZONES Mesial roots of the mandibular molars, and anatomic groove on the palatal side of the buccal root of maxillary bifurcated premolars which exhibit a distal or mesial concavity. Uneven dentin thickness upon excessive instrumentation à application of internal strain à fracture. Vertical Root Fracture Etiology 3. After RCT: obturation method, type of spreader, post design, crown design. VRFs usually do not occur during the actual obturation of the root canal, but rather long after the procedure has been completed. Vertical Root Fracture Manifestation Sensitivity Swelling OR Sinus tract Hx of repeated clinical & radiographical examination Mostly in mand. PM , M root of mand. molar (initiated at any root level). Vertical Root Fracture Diagnosis Isolated deep perio-pocket. J-shaped lesion or halo RL on PA. CBCT Vertical Root Fracture Management Extraction Prognosis Poor 04 PREVENTION Diagnosis is often difficult. The awareness that many of these symptoms represent stages in an evolving process may make their interpretation easier for the clinician. Therefore, developing a diagnosis, prognosis assessment, and treatment plan for teeth with suspected cracks and fractures is essential, with an emphasis on early detection. In addition, endodontic and restorative procedures should focus on minimizing any offending and predisposing factors that may perpetuate cracks and fractures. 05 SUMMARY § Prevention is the key to managing VRFs. § There are many predisposing factors and iatrogenic causes of these fractures, all of which should be minimized as much as clinically possible. § Whereas VRFs may be present in teeth subjected to endodontic retreatment, they are rarely present in teeth that have never undergone endodontic treatment. Therefore, comprehensive clinical, radiographic, and periodontal examination is imperative when evaluating any tooth that is planned for endodontic treatment or retreatment. PATIENT MEDICAL HISTORY AGE: 48 years GENDER: Male ALLERGIES: None LOCATION: Saudi Arabia 2019 Oct, 2021 June, 2022 #47: RCT + tooth Pain in my lower Pain intensity colored restoration tooth increased REFERENCES AAE Cohen’s Pathway of the Pulp 12th Ed Endodontic Principles and Practice 6th Ed THANK YOU Any questions?
