Dentaltown November 2020 - 49

Fig. 1

Fig. 3

Fig. 2

Fig. 4

"Cracked tooth syndrome" refers to an
incomplete fracture of a vital posterior tooth.
It incorporates the dentin and sometimes
continues into the pulp. The designation
of cracked tooth syndrome was presented
early on by Cameron in 1964.1 Previously,
references existed of pulpal discomfort
initiating from a partial tooth fracture.2
The diagnosis, treatment and prognosis
depend on the extent of the fracture, the
intervention time and the restoration type.
These are crucial parameters in determining
the treatment outcome. A tooth stress or
fracture plane may be completely supragingival and may or may not intersect the pulp
chamber.3 A partial fracture (Figs. 1 and 3)
is potentially noncatastrophic. Such teeth
can be restored with a direct restoration,
a crown (Figs. 2 and 4), or an endodontic
procedure with post/core and crown.
A fracture can be catastrophic when it
involves the periodontal attachment. That
would be nonrestorable. To avoid irreversible
damage, it is imperative that a cracked tooth
be treated as soon as possible.4 Immediate
immobilization using an extracoronal or
intracoronal splint should be employed.
Traditionally, crowns are used as preventive
treatment for fractured teeth; however,
full crowns can increase the risk of tooth
fracture, particularly with endodontic treated
teeth. Full crowns are described as the least
desirable option5 and should be avoided
unless it involves re-treatment of a previously
crowned tooth.

Studies demonstrate that posterior
composites have an acceptable long-term
clinical performance when clinicians follow
certain clinical parameters.6 If clinicians are
adequately skilled and familiar with most
adhesive dentistry secrets, they will perform
beyond the indications of direct restorations
into a more destroyed tooth.7 Composite
restorations have become routine because
of patients' increasing aesthetic demand
and the high survival rates of restorations
placed in large cavities.8
This article describes two different
direct composite restoration techniques to
treat cracked tooth syndrome:
* One technique involves two layers
of bulk-fill composite (SonicFill
from Kerr), with high-strength
polyethylenefibers (Ribbond)
encrusted between them.
* The other uses three layers
of composite, with pieces of
high-strength polyethylene
fibers between each.
Fibers increase the damage tolerance
of a tooth, and can also be used to provide
additional support to weakened cusps and
to small cracks.9

dentaltown.com \\ NOVEMBER 2020

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Dentaltown November 2020

Table of Contents for the Digital Edition of Dentaltown November 2020

Dentaltown November 2020 - Intro
Dentaltown November 2020 - Cover1
Dentaltown November 2020 - Cover2
Dentaltown November 2020 - 1
Dentaltown November 2020 - 2
Dentaltown November 2020 - 3
Dentaltown November 2020 - 4
Dentaltown November 2020 - 5
Dentaltown November 2020 - 6
Dentaltown November 2020 - 7
Dentaltown November 2020 - 8
Dentaltown November 2020 - 9
Dentaltown November 2020 - 10
Dentaltown November 2020 - 11
Dentaltown November 2020 - 12
Dentaltown November 2020 - 13
Dentaltown November 2020 - 14
Dentaltown November 2020 - 15
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Dentaltown November 2020 - 17
Dentaltown November 2020 - 18
Dentaltown November 2020 - 19
Dentaltown November 2020 - 20
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Dentaltown November 2020 - Cover3
Dentaltown November 2020 - Cover4
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