Hi thank you for your videos. I am just a patient but I have been dealing with chronic pain from grinding/clenching for a few years now. The pain has become really severe and I think a tooth is cracked but no one seems to be able to diagnose why I am in so much pain. It's really quite frustrating. Any advice?
Love this podcast Jaz super informative. Cracks are something I see alottt of. As a dentist in regional Australia, I see plenty of asymptomatic teeth restored with amalgams that have marginal ridge cracks. Almost all of these patients are bruxers and many of them come to me a few months or years down the road with cuspal fractures (possible confirmation bias). I find that almost all the marginal ridge cracks are going into dentine and even if they don't cause a microleakage problem, I find they lead to nasty oblique fractures that are hard to restore. I find myself thinking that it may be more conservative to just replace these amalgams with moderate-high risk profile patients than to wait for a problem to occur and try and salvage a subgingival fracture. What is your take on prophylactic restoration of marginal ridge cracks in restored teeth with moderate-high risk profiles?
If it’s 1/10 patients who end up with these cuspal fractures… tell your next patient that’s what their risk of fracture is. Their risk appetite is theirs alone, not yours
Great video again Jaz! Just wanted your thoughts on going straight to a ceramic restoration (CEREC) in a patient presenting with cracked tooth syndrome (fracture finder positive on certain cusps), large existing restoration but positive pulp vitality test and nil periapical pathology on the x-ray? Would you still prefer to start with a composite overlay, re-assess then "upgrade" to ceramic in 9-12 months time?
Hi Doc! I think access to cerec does change things here a bit - the ability to go indirect from the start is awesome. In such a case my threshold would probably go higher (ie more likely to go definitive in the scenario you mentioned) However, other factors I look at: How nasty the crack is (wider with plaque is reduced prognosis) Pocketing that indicates crack extension? The patient is more cautious time and maybe have never had RCT before Proximity of previous restoration to the pulp etc
Hello all. I’m happy to address any questions you may have about my “chat” with Jaz :)
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Hi thank you for your videos. I am just a patient but I have been dealing with chronic pain from grinding/clenching for a few years now. The pain has become really severe and I think a tooth is cracked but no one seems to be able to diagnose why I am in so much pain. It's really quite frustrating. Any advice?
Love this podcast Jaz super informative. Cracks are something I see alottt of. As a dentist in regional Australia, I see plenty of asymptomatic teeth restored with amalgams that have marginal ridge cracks. Almost all of these patients are bruxers and many of them come to me a few months or years down the road with cuspal fractures (possible confirmation bias). I find that almost all the marginal ridge cracks are going into dentine and even if they don't cause a microleakage problem, I find they lead to nasty oblique fractures that are hard to restore. I find myself thinking that it may be more conservative to just replace these amalgams with moderate-high risk profile patients than to wait for a problem to occur and try and salvage a subgingival fracture. What is your take on prophylactic restoration of marginal ridge cracks in restored teeth with moderate-high risk profiles?
If it’s 1/10 patients who end up with these cuspal fractures… tell your next patient that’s what their risk of fracture is. Their risk appetite is theirs alone, not yours
Tnx for your amazing content❤
Glad you enjoy them!
Great video again Jaz! Just wanted your thoughts on going straight to a ceramic restoration (CEREC) in a patient presenting with cracked tooth syndrome (fracture finder positive on certain cusps), large existing restoration but positive pulp vitality test and nil periapical pathology on the x-ray? Would you still prefer to start with a composite overlay, re-assess then "upgrade" to ceramic in 9-12 months time?
Hi Doc! I think access to cerec does change things here a bit - the ability to go indirect from the start is awesome.
In such a case my threshold would probably go higher (ie more likely to go definitive in the scenario you mentioned)
However, other factors I look at:
How nasty the crack is (wider with plaque is reduced prognosis)
Pocketing that indicates crack extension?
The patient is more cautious time and maybe have never had RCT before
Proximity of previous restoration to the pulp etc
Great podcast!