Here is another one from yesterday slated for a crown.

Patient broke ML cusp of on old amalgam.

Showed patient crack on buccal which was asymptomatic.

Once amalgam removed (with anesthetic) then noted crack went right through to prep from buccal.

Advised patient on weakness of tooth and advised on crown…….showed him cracks…..( it was a cracked tooth kind of day)……..

Tooth not bothering him but he is booked for crown…..photos sold the crown prep which he obviously needs.

Glenn

You Know Lee this is an interesting question……..

I havent heard back from the fellow with the dual cracks but they werent very deep at all.

I find cracks that run Mesial to distal ( the endo tooth) are bad ones and often involve endo……

In general if the patient has significant cold and hot sensitivity AND Chewing sensitivity I tell them that they are probably looking at endo + crown.

IF they have just chewing sesitivity then I tell them they MAY need endo but there is a good chance that only a crown ( or a restoration if the crack is small) will be needed.

One good thing with the scope is the ability to document these cases……..its wonderful to show the patient the crack..helps medicolegally.

I have found that some patients live with the chewing discomfort and chew on the other side while others just cant handle it.

I have tons and tons of these cases documented and Dr. David Clark has written an article for the Journal of Esthetic and Restorative Dentistry magazine that attempted to classify these cracks BEFORE they become endstage and symptomatic…….

The scope is awesome for endo , decay detection, cracks, placement of margins , crown inserts, laser dentistry (seeing how far the tip is away from the tooth, troughing on crowns effectively) just to name a few things off the top of my head.

Cracks are tough to treat at the best of times but I would strongly suggest adjust the occlusion once, remove the restoration put a temp in if you wish but patients want results and they want the pain to go away. Being able to show them the cracks and head in the right direction …….(crown +/- endo) is at least heaing them there.

Let us know how your case ends up……..hopefully it is a simple solution but unfortunately it isnt always.

One last thing……its amazing to see how many teeth crack after the bur enters into the occlusal pits…..not always polymerization shrinkage………I have seen this with my own eyes with crosscut fissure burs on occlusals.

Like a lightning storm……………

Good luck with your patient……

Glenn

Andy, Andrew,
All my Nd:YAG cases are now done using the 360micron contact fiber from MDT, Before this year I used 320 micron fibers. These new fibers seem more durable.
The reference to biologic width come from my Dental Town Case presentations and a case published in the DTown magazine in February, one anti-laser heckler could not get off me on biologic width. Glenn and others now include pictures w/ a perio probe on laser cases to keep the subject from starting again.

Glenn,
I use Karl Schumacher spoon excavators (#045) or a small round burr to remove the final debris and insure hard surface to bond to. These spoon excavators are so small, on a penny the excavator head only covers one number on the date. I’ll post a photo later.
I use no bases or liners (not since 1995), just a dentin bonding agent, in this case I-Bond.
Jeff