I HATE Cracked Teeth with Dr Kreena Patel

I love Dentistry...but I I HATE Cracked Teeth.
I am joined by Endo Queen, Dr Kreena Patel @kreenaspecialistendodontics to discuss all things cracked teeth to make our decision making process clearer in General Practice!
CRACKS = DIFFICULT CONVERSATIONS with our patients.
We discuss:
0:00 Introduction
5:40 Impact of CBCT in Endodontics
8:41 Can you spot a crack on a CBCT?
11:29 Managing situations where pain is difficult to localise and you're in a diagnostic dilemma?
15:08 Cotton wool roll as an alternative to a tooth slooth
19:17 What if you just CANNOT find out which tooth it is? What should you say to the patient?
20:33 Different types of diagnosis with cracked tooth
30:09 Success rate given to the patient based on clinical findings
33:00 Upon opening up a molar and trace a crack - how far into the orifice is deemed not worth saving?
33:36 Evidence for RCT in patients with cracks
39:22 Consent conversations with patients regarding cracks
42:02 SHOULD YOU CHASE A CRACK???
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[@mattdavis8224]

Very nicely done Jaz and Kreena!

Thank you, Kreena, for mentioning the study - there is a nine-year follow up to that study that I will publish soon. Still gathering data, but survival of these deeply cracked teeth, even those with pockets seems to be very high.
Regarding the approach to cracked teeth: I agree that patient communication is paramount. Outlining expectations and ensuring that if the patient is on board that they are invested in the outcome. Their behaviors are critical to the success of these teeth: getting in with their general dentist asap for the crown, not chewing on the affected tooth side until then, and coming back for follow-up visits to check occlusion, etc. These variables are likely as critical to success/survival as the treatments we render.
One point I make in my lectures is that the overall body of evidence (admittedly limited) in outcome studies of endodontically treated cracked teeth (my study, Krell and Caplan, Kang, Sim, Tan, etc.) indicate that success and survival rates are similar to endodontically treated non-cracked teeth (systemic reviews by Ng 2007 and Burns 2022). So, I think that at some point we need to relinquish our paradigm of seeing cracked teeth as "questionable" or "50/50" since what evidence that we do have refutes this. When approaching the challenge of treating a patient’s cracked tooth, we should stick to answering our ethical question: "what would I do if this were my tooth?" This is meaningful to patients. Painting a grim picture to a patient on a tooth that I would unquestionably treat if it were mine doesn't make sense ethically.
On a personal matter, my upper left molar has a 6-7mm pocket that is asymptomatic and does not change. I will certainly NOT consider extracting my tooth in favor of an implant. Implant outcomes studies are indicating success rates that are much lower than we thought, as well as increasing issues surrounding them long-term. Just some food for thought...
Anyway, I’m so glad to see these podcasts that delve into challenging aspects of dentistry. We need more open dialogue like this! Cheers, and best to both of you!

[@protrusive]

amazing to read this response this is brilliant! Thank you Doc!!

[@ebzzzz1]

Thank you Jaz..your content is a blessing !!

[@bitradedeepya6985]

Hi Dr jaz...i have been watching your information videos one after the other.... today I came across this ona.... I have a doubt if a patient is having deep cervical caries with pulp involved and also mild attrition of tooth after pulpectomy is full coverage crown advised? The tooth are lower first molar,both premolars.

[@protrusive]

yes after RCT and weakened tooth - some sort of cuspal coverage is USUALLY indicated (no such thing as always and never e.g. if tooth is unopposed then it wouldn't need cuspal coverage ;) ) - as always tooth preservation is key to longevity and in deep caries cases I bias towards vertical preparation crowns (BOPT / shoulderless)

[@bitradedeepya6985]

@@protrusive Thank you Dr.

[@davidzhang218]

In regards to crack width in which a tooth needs TE, how large of a width does the crack need to be to be considered for TE vs tx?

[@protrusive]

sorry doc but what's TE? It's a stupid question I'm sure