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In cases of cracks, dentists face difficulties when relying solely on clinical examination and peri-apical radiographs because these may not provide sufficient information for accurate tooth assessment. Often, cracks, fractures, etc can be correctly diagnosed only by removing the existing restoration to explore the extent of the crack lines. This report describes several cases of symptomatic patients keen to investigate fully the prognosis before deciding to either have their tooth treated with root canal treatment or plan for an extraction. Without early identification of the problems, these patients would have continued to experience symptoms after root canal treatment was completed.
CPD/Clinical Relevance:
The removal of restorations allows cracks and fracture lines to be discovered prior to the commencement of root canal treatment. This prevents unnecessary patient expense and disappointment.
Article
The location, direction, and extent of a crack in a tooth can affect the choice of dental treatments.1 It is important, therefore, that cracks be classified according to their anatomical location (e.g. in cusps, marginal ridges, development grooves, inclined planes, or incisal edges), the direction (e.g. single direction, vertical or oblique); and their extent (e.g. complete or incomplete). A diagnosis will be a combination of at least two of the above. Some examples would be complete vertical, complete oblique, incomplete vertical and incomplete oblique.2 Successful diagnosis and management not only require an awareness of the existence of a crack,3 but also an understanding of how the crack line relates to the pulp and periodontal ligament,4 and determination of the apical extent of an incomplete crack on the root.5 The lack of understanding regarding cracked tooth biomechanics among dentists6 may hinder their ability to manage cracked teeth properly. Comprehension of the characteristics and weakening factors of tooth cracks and available strengthening mechanisms is fundamental to designing better treatment.7
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