Dentaltown March 2022 - 32

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NORTHBOUNDandDOWN
Member Since: 03/21/11
Post: 12 of 80
I treat these often with the following protocol:
First appointment:
* Adjust any opposing plunger cusp causing lateral tensile forces.
* Remove existing restorative to assess crack extent and make a restorative plan.
* If the crack can't be completely dissected or extends through the entire tooth, temp crown
and OBS.
* If the crack can be removed, a large DOL fi lling covering the DL tensile cusp works great
(especially once the opposing cusp is fl attened to create a fl atter occlusal scheme).
* Impression for NG if needed.
Second appointment:
Midoc
Member Since: 07/22/03
Post: 16 of 80
* Deliver NG, follow up on temp crown or fi lling to get a better idea on prognosis. ■
Does anyone else struggle with the word " proactive " ? That word basically means taking
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some action before the problem has even occurred. I'm not the word police and I don't care what
anyone else does; I just always thought this word came off awkwardly for years. When I used it,
I would fi nd that many patients would respond in a confused manner, like they were wondering
why I'd want to recommend treatment before there even was a problem.
When I talk about teeth like these in this thread, I do my best to identify to the patient
that there is already an existing problem. It's in a disease process and the disease process will
get worse at some point in time. Maybe only a little bit worse or maybe a lot worse; when and
how bad is unknowable. I recommend we treat the tooth earlier in the disease process when
treatment is more predictable.
I use the term " earlier intervention " to describe that approach instead of " proactive. " That
chrismet
Member Since: 10/14/03
Post: 17 of 80
probably sounds like unnecessary semantics to a lot of people, but it fi ts much better to me. ■
As we all know, we see cracks in teeth all the time. I get more concerned when I see fracture
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lines in teeth with small occlusal silver fi llings. In my experience, I see the most concerning
fractures in that situation. Kind of similar to splitting wood with a wood splitter. Most of the
time it is an asymptomatic situation, but if I see the fracture coming internally into the tooth, I
always recommend full coverage.
I use a lot of transillumination to try to fi nd concerning fractures that could result in future
crown fracture, RCT, crown lengthening or tooth loss. If you use your intraoral camera to show
patients the issues at hand, I rarely have patients refuse treatment. My determination for doing
the crown is: If the crack is only in enamel, I leave it alone, but if it is propagating internally into
the dentin, I recommend a crown ASAP. When we lose teeth because of fractures, I feel it only
makes us look bad as clinicians. We are there to prevent tooth loss. I do not wait for these teeth
to became symptomatic because in a lot of cases it is too late to prevent the signifi cant issues
mentioned previously.
For teeth without fi llings and evidence of distal marginal fracturing on lower second
molars, I go off symptoms and tooth-sleuth testing. I always explain to patients the symptoms
we are looking for when teeth are starting to fracture. I stress to them that these symptoms
can be very infrequent-once every few months-but it's important to communicate them
to me when I see them next. Your intraoral camera and communication are your best friends
in this situation. ■
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32 MARCH 2022 // dentaltown.com

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