Dentaltown March 2022 - 31

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 80
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Dentaltown March 2022

Table of Contents for the Digital Edition of Dentaltown March 2022

Dentaltown March 2022 - Intro
Dentaltown March 2022 - Cover1
Dentaltown March 2022 - Cover2
Dentaltown March 2022 - 1
Dentaltown March 2022 - 2
Dentaltown March 2022 - 3
Dentaltown March 2022 - 4
Dentaltown March 2022 - 5
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Dentaltown March 2022 - Cover3
Dentaltown March 2022 - Cover4
Dentaltown March 2022 - SI_1
Dentaltown March 2022 - SI_2
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