From: Mark Dreyer
To: ROOTS
Sent: Monday, August 07, 2006 11:59 PM
Subject: [roots] Crack

First case of the day.  Crack stopped shy of the pulpal floor, so we went for it. - Mark 


Hi Mark, This is a cracked tooth I have been treating for almost 6 months now.  After listening to Carr, Schwartz
and other pretty smart guys, I am taking a more cautious approach to these cases.   I think given the predictability
of dental implants, especially in the posterior mandible, we need to leave no stone unturned in these cracked tooth
cases. 


The pics show the fracture, which is a bit of an odd one, running down the lingual surface of the tooth to the ML canal.
I have been staring at this thing every month since February (preop) and nothing has changed.  There was never a probing
defect in this tooth.  He has been symptom free for over five months.  While this is no guarantee of success, we did due
diligence and then some.  Pic4 is 1 month, pic5 is 4 months with evidence of healing, and pic6 is the final from today.

We finished the case today without anesthetic at the patients request.  You can grumble about the mesials being short,
but they are actually about .25mm long.  He could feel them just a little bit when I was fitting cones.  There were three
distals, with two of them merging.  I thought there was an MM initially, but after troughing (pic3)--nothing.  The tooth
was restored with a bonded amalgam, and remains out of occlusion.  We recommended a crown ASAP, and my recommendation
would be for full coverage gold. - John A Khademy

Are you still using that intraoral camera thing for your photos? if so, which one are you using?
Those are great shots, and i need something for my 2nd office. - Gary

Hi Gary, I am using both the intraoral camera, and a Sony DCR-PC100 (DV camera) with a memory stick on the scope.
The images are low resolution compared to Carlos' and others', but in print form you can't tell.

The intraoral camera is cheap and really easy to use and give that "fisheyed" view of the whole chamber as opposed
to the "confusing to some" mirror shots required by a scope mounted cam.  The above pics are intraoral camera pics.
- John A Khademy

What beautiful dentistry !!!!!!!   I am sure you used a bonded temporary, adjusted the tooth out of occlusion,
and told the patient not to bite on it. The patient could be offered a gold crown or temporary Plastic crown from the
beginning.  - Dr. Danny O'Keefe