Académique Documents
Professionnel Documents
Culture Documents
SYNDROME
DEFINITION
An incomplete fracture of a vital posterior tooth that involves the dentine and occasionally extends to the pulp or the periodontal ligament .
INCIDENCE
Age range is b/w 30 and 50 yrs Both sexes are equally affected Commonly affected teeth ----mand 2nd molars followed by lower 1st molars and max premolars Cracks are usually mesiodistally extended In mandibular molars buccolingual extension is seen( anatomical variation)
Pressure applied to CT separates tooth components along line of crack Movement of fluids in dental tubules Stretching n tearing of odontoblast processes---------pulp nociceptors are stimulated Dentine sensitivity starts Pulp stimulated if crack reaches the pulp Crack can even reach the furcation area
Sharp erratic pain on biting or withdrawal of biting pressure Sensitivity to hot and cold Identification of the tooth may be difficult History of bruxism History of repeated occlusal adjustments Prolonged pain which could not be diagnosed
may be intermittent Pain may be of short duration It has progressed to constant toothache
DIAGNOSTIC TOOLS
-
Magnifying loupes Surgical microscopes Transillumination light Staining.methylene blue Cotton rolls Tooth slooth radiographs
CLINICAL TESTS
Visual examination Examination of teeth with a sharp probe(Heavily restored teeth,cracked teeth, presence of facets on occlusal surfaces,caries, mesial & distal marginal ridges) Examine presence of periodontal pocket Transillumination
Staining of teeth
Hot or cold tests Biting Tests .Pain on application of a diagnostic tooth Slooth or cotton rolls Radiographs Removal of filling
Can have a very large or no filling at all Vitality test can be positive or negative May or may not be painful when percussed axially Pain elicited when a particular cusp is percussed as recently been filled e.g.. Inlay Has a large carious cavity
1. Restorative procedures
------Over-preparation of cavities
Inadequate
design features Insufficient cuspal protection in inlay/onlay design Deep cusp fossa relationship
2. Occlusal factors
Masticatory
3.
Developmental factors
Incomplete
4.
Miscellaneous
Foreign
TREATMENT OPTIONS
Assessment of tooth
Small peripheral cracks
Assessment of tooth
Asse ssme nt of Large central crack tooth No pulpal involvement detected
Immediate stabilization with orthodontic band, acrylic crown + occlusal adjustment if necessary Permanent stabilazation & cuspal protection
Bonded restoration Cast metal restoration
Assessment of tooth
Large central crack Pulpal involvement Immediate stabilization with an ortho band or acrylic crown + pulpal extirpation Monitor symtoms and thn complete endodontic treatment Permanent stabilization and cuspal protection
Bonded restoration
Assessment of tooth
Large central crack
Hopeless prognosis e.g - teeth with vertical crack, -Crack extending through pulpal floor, -poor crown root ratio, -crack extends below alveolar bone level
Extract
PREVENTION
Conservative prep of cavities Rounded internal angles Adequate cuspal protection Cast retorations should be fit in passively Pins should be placed in sound dentine Prophylactic removal of eccentric contacts should be removed in previous CTS cases
CASE PRESENTATION
Quranic Quote
Then, after them some of the successors who succeeded them lost prayer and pursued lustful desires, so they shall soon come across the out of turpitude (HELL). (Surah Maryam: Ayat 59)