Crack Tooth Syndrome

8/2/2019 Crack Tooth Syndrome

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CRACK TOOTH

SYNDROME

Group C


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GROUPS MEMBER


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Definition

Identifying Crack Tooth Syndrome

Management

OUTLINE


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a fracture plane of unknown depth and

direction passing through tooth structure

that, if not already involving, may

progress to communicate with the pulp

and/or periodontal ligament.

(Ellis SG, 2001)


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Dental History

Clinical Examination

Radiographic Examination

Special testo Bite Tests

o Restoration Removal

o Periodontal Probing

o

Periapical Testso Vitality Testing

o Staining

o Transillumination


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The patient will often complain of pain on

biting/eating (chewing tough, or crunchy foods)

The pain is brief, sharp in nature

There may be increase sensitivity to hot and cold,sweet depending extended to dentine

When the crack has extended deeply into the dentine

and the pulp chamber, symptoms of pulpal

inflammation and necrosis are manifested.

Dental History


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Dentine cracks in teeth are difficult to see with naked

eyes.

Moderately or heavily restored teeth may have visible

cracks in the enamel, at the marginal ridge, orextending from the external edge of the restoration.

Examination should focus on cracks in defective

restorations or unusual gaps between restorations and

the tooth structure.

Magnifying loupes and operating microscopes can be

helpful in the examination of cracks.

the tooth is not normally tender to percussion in an

axial direction

Clinical Examination


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Patient is instructed to bite hard on individual cusp by

various items such as a toothpick, cotton roll, wooden

stick

commercially available Tooth Slooth

Pain increases as the occlusal force increases, and

relief occurs once the pressure is withdrawn

Bite Tests


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Periodontal probing helps distinguish between a

cracked tooth and a split tooth when the fracture

line extends below the gingiva, thereby causing a

localized periodontal defect.However, isolated deep probing of ten indicates the

presence of split tooth

Periodontal Probing


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Vitality testing usually gives a positive

response

Bacteria contamination of pulp via crack

may lead to pulpitis and tooth

hypersensitivity.

in time, progressive degeneration

of pulp may give ve result as aresult of necrosis.

Vitality Test


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Dyes may used to stain the crack

Examples of stains include methylene blue,

iodine, or caries detection dyes

This method more time consuming as the

dyes need to sealed in the cavity for few

days to stain the crack.

Staining


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Transillumination by a fiberoptic light source

is an excellent method of fracture detection.

When a crack is suspected, it is crucial to

visualize the length and location of the crack.

The crack blocks or reflects the light, leaving

the nonilluminated fragment dark

Transillumination


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Removed of old restoration in a restored tooth

facilitates the visualization of crack and allows

exploration of cavity floor

(Aust. Dent, 1998) In the almost all cases, the crack if present will be

seen

It is not uncommon for vibration of handpiece, in

removing a restoration , to result in crack becominga complete fracture.

REMOVAL OF RESTORATION


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The application of the orthodontic (cooper) band is a

useful procedure to confirm the CTS

The cementation of band stabilizes the crack and

prevent further movement under occlusal forces. If symptoms on chewing are alleviated, this confirms

the diagnosis of CTS

If the symptoms continue, then it does not

necessarily exclude that tooth asband may be ineffective

ORTHODONTIC BAND


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The usefulness of radiography to detect a cracked

tooth is controversial

Generally, the crack is not visible on radiographs,

even if the crack is perpendicular to the film.

When a cracked tooth is suspected, periapical and

bitewing radiographs are essential to rule out caries

or faulty restorations

Radiographs are important to exclude other cause of

pain such caries, defective filling, periodontal

infection.

Radiography


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Crack Tooth Syndrome