bgles These can end up being the worst kinds of teeth. They become symptomatic and then eat up a few grand in dental insurance and patient money before failing because of fracture past the crownable/coverable distal aspect of the tooth. I explain cracked tooth syndrome and the risks and let them make the call. If I can feel that crack extending down the back of the tooth, I'll show them a couple that didn't work out so well for the patient and implore them to get it covered before " feeling " it. ■ Member Since: 05/29/03 Post: 6 of 80 1/24/2022 Midoc I would recommend a full-coverage crown any day of the week on these teeth. In my decision-making matrix, an indication is not the same thing as an absolute need. I'm saying that because I don't want anyone to think that I'm specifi cally saying that every time treatment is indicated then it must be done. #18 doesn't look quite as bad as #31, so I'll focus on that. #18 itself has three separate indications for a full-coverage restoration: 1. Distal crack on lower second molar. 2. Occlusal attrition into the dentin. (See the circle.) 3. Existing occlusal restoration greater than 2/3 of the B-L dimension of the occlusal table. (See the measurement lines.) Member Since: 07/22/03 Post: 7 of 80 I treat these teeth very often with crowns and I very rarely have an issue with insurance. The trick is to fi nd out what the patient's policy actually says about when and why crowns are a covered benefi t. Then you write your narrative to fi t that situation without a bunch of added BS and appeals to their humanity. Cracked teeth have decay inside the crack a very large percentage of the time. Find the decay and document it. Include that in the narrative. Include occlusal attritional loss of tooth structure in your estimate of total missing tooth structure. If you restore this tooth, then consider what your interocclusal distance looks like and take that into account both while prepping and when deciding if and how to adjust the opposing. ■ 1/24/2022 In my experience, I really only crown these cracked seconds if they are symptomatic. I think if you look closely enough, the majority of second molars we see on adults will have wear and cracks. Patients don't love the idea of having to buy a crown for a tooth that doesn't hurt. I just tell them that eventually the crack will most likely grow and one of these days it will start hurting. Let me know when it hurts often enough to bother you and we can fi x it with a full-coverage restoration. ■ 1/24/2022 dentaltown.com \\ MARCH 2022 31 CrosstownDDS Member Since: 08/16/17 Post: 10 of 80http://www.dentaltown.com