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Crack stopped shy of pulpal floor - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
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



boy, where have you been stranger.  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.

Both have their purpose. Use what works for you.   :-))) 
- 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.
- Danny O'Keefe
Protaper flaring

6 yr old Empress

Cvek pulpotomy

Middle mesial

Endo misdiagnosis

MTA retrofill

Resin core

BW importance

Bicuspid tooth

Necrotic #8 treatment

Finding MB2 / MB3

Deep in a canal

Broken file retrieval

Molar cases

Pushed over apex

MB2 and palatal canal

Long lower third

Veneer cases

CT Implant surgury

Weird Anatomy

Apical trifurcation

Canal and Ultrasonics

Cotton stuffed chamber

Pulp floor sandblasting

Silver point removal

Difficult acute curve

Marked swelling

5 canaled premolar

Sealer overextension

Complex anatomy

Secondary caries

Zygomatic arch

Confluent mesials

LL 1st molar (#19)

Shaping vs Cleaning

First bicuspid

In Vivo mesial view

Inaccesible canals

Premolar 45

Ortho and implant

Radioluscency

Lateral incisor

Obturation

Churning irrigant

Cold lateral

Tipped to lingual

Acute pulpitis images

Middle distal canal

Silver point

Crown preparation

Epiphany healing

Weird anatomy

Dual Xenon

Looking for MB2

Upper molar resorption

Acute apical abcess

Finding MB2

Gingival inflammation

Irreversible pulpitis

AG BU ortho band

TF Files

using TF files

Broken bur

Warm technique

Restorative prognosis

Tooth # 20 and #30

Apical third

3 canal premolar

Severe curvature

Interesting anatomy

Chamber floor

Zirconia crown

Dycal matrix

Cracked tooth

Tooth structure loss

Multiplanar curves