Lee Ann Brady, DMD's Dental Blog

  • Home
  • About Dr. Lee Ann Brady
  • Dental Practice
  • Categories
    • Dental Materials
    • Esthetic Dentistry
    • Occlusion/TMD
    • Practice of Dentistry
    • Preventive Dentistry
    • Restorative Dentistry
    • Restorative Techniques
    • Treatment Planning
    • Videos
    • A-Z Topic List
  • Speaker’s Packet Request
  • Contact
You are here: Home / Restorative Dentistry / Treating Cracked Tooth Syndrome: The Diagnostic Provisional

Treating Cracked Tooth Syndrome: The Diagnostic Provisional

By Lee Ann Brady on 06.28.12Category: Restorative Dentistry

It is a standard protocol to recommend a full coverage indirect restoration for patients who present with the symptoms we call “cracked tooth syndrome”. I have personally suffered from multiple cracked teeth, and the pain associated with biting down on these teeth is intense. Despite it’s very short duration, it is also exhausting as you struggle to avoid hitting that tooth while eating, and just when you think you have it figured out, “ZING!”. If you have never experienced the symptoms I am describing you are fortunate, and can’t appreciate how much patients look forward to the resolution and being able to eat normally again. Given this anticipation it is truly frustrating when the pain continues after the cementation of your new crown. We have all experienced how frustrating this is for us as providers as well.

Many of these teeth will require endodontic therapy in addition to an indirect restoration, and as we know many of them continue to have symptoms no matter what we do. Given the uncertainty how can we minimize the unmet expectations. The first protocol for me is not to rush into a final solution. These teeth are the prefect opportunity to use a provisional restoration as a diagnostic tool. Prepare the tooth for an indirect restoration, and fabricate a provisional out of a rigid bisacryl like Venus Temp 2 from Heraeus. I cement the provisional with Fynal and then we monitor the tooth for symptoms. The majority of these teeth will be symptom free in the provisional phase. When this happens send the impression to the lab and cement the final crown with confidence. For the group that don’t get better, you can now refer the patient to the endodontist without the stress that they will be cutting a hole in a brand new restoration.

With this approach there are two things to remember. Be clear with the patient that sometimes the crown does the trick and for other patients eliminating their symptoms may require further treatment. Second, charge for the provisional separately from the final crown, as this approach requires extra chair time on your part.

Related

Share

Comments

  1. Phil says

    June 29, 2012 at 8:26 PM

    Hi Lee! How long will you wait and watch to see if symptoms persist or subside before you either send the patient to the endodontist or cement the final crown?

    Reply
    • Lee Ann Brady says

      June 30, 2012 at 6:40 AM

      If the symptoms are truly coming from the fluid movement int he detinal tubules because of a crack and separation the provisional should work fast, almost as soon as the anesthetic wears off. I normally appoint the patient a month out, just to make sure they are really able to eat don;t find it in an excursion etc. If at a month they still have symptoms of the cracked tooth, it means the theory of containment to prevent movement of the cracked segments isn’t effective, the crack may extend beyond the margins and on to the root. Placing the permanent restoration may make marginal improvement as it is a more rigid material and we can opt to bond it in. At this point alleviating symptoms may require endo, which only prevents the perception of the fluid movement int he dentinal tubules and pain. During the endo access, using high power microscopy we want to ascertain if we can visualize a crack down the pulp chambers or not.

      Reply

Leave a Comment Cancel

Search

Recent Posts

  • Retraction Paste Technique Sensitivity
  • The Next Generation of Glass Ionomer Cements
  • A Fantastic New Temporary Cement
  • Tissue Blanching When Seating An Implant Restoration
  • Is It Time To Get An Intra-oral Impression Scanner?
  • Does Your Team Order The Dental Materials You Want?

Recent Comments

  • Shavon on Allergic Reaction To A Dental Cleaning?
  • Joe on Stick Bite: Why and How
  • Joan Johnson on Post & Core’s Coming Loose?
  • Rosemary on Ugh, The Margins Are Open!
  • Sakshi on Removing An e.max Restoration
  • Jeremy Montrose on Ugh, The Margins Are Open!

Policies

Terms of Use

Privacy Policy

Cancellations and Refunds

Security Seal

© 2020 Lee Ann Brady LLC, All Rights Reserved Site by CSL