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• It is an incomplete fracture of a vital posterior tooth that involves the dentine and occasionally extends into the pulp. • The term was introduced by Cameron in 1964. • Patients aged between 30 and 50 years are commonly affected.
• Mandibular second molars. • Two classic patterns of crack formation exist. • **The second is where the crack is more peripherally directed and may results in cuspal fracture. followed by mandibular first molars and maxillary premolars. are the most commonly affected teeth. . *The first occurs when the crack is centrally located and following the dentinal tubules may extends to the pulp.
The etiology of CTS. • CTS has been reported in pristine teeth (unrestored) or teeth with minor restorations. who claimed that the teeth involved were usually quite heavily restored. .(incomplete fusion of areas of calcification) • This contrasts with the findings of Cameron. • This may be due to developmental weakness of the tooth.
Parfunctional habits . • Nowadays common causes include Masticatory accidents such as biting on a hard.• Thermal cycling and parafunctional habits have also been implicated in the development of enamel cracks in such unrestored teeth. Excessive removal of tooth structure during cavity prepration.Bruxism. rigid object with unusually high force. .
expantion of certain poor quality amalgam alloy when contaminated with moisture.placement of retentive pins predispose to fracture formation.• Excessive condensation pressure. • Other iatrogenic causes of CTS include excessive hydraulic pressure in luting agent when cementing crown and bridge retainers. .
. Processes in the dentinal tubules→ stimulate pulpal nociceptors→ pain. Pain on biting that ceases after the pressure has been withdrawn is a classical sign. • Incidence usually occurs while eating or where objects such as pencil or a pipe are placed between the teeth. • Reason.Symptoms and diagnosis • History.Pressure applied to the crown of a crack tooth → separation of the tooth component along the line of the crack → movement of fluid in the dentinal tubules →stimulating odontoblasts in the pulp and stretching and rupturing odo.
.• Ingress of saliva along the crack→ increase the sensitivity of dentine. – usually positive • Normally not tender to percussion in an axial direction. periodontal or periapical causes of pain. • Vitality test. • Diagnosis should exclude pulpal. • Direct stimulation of pulpal tissues occurs if the crack extends into the pulp.
but in CTS pain increases as the teeth close further together due to increase occlusal forces. . – pain occurs on closing the teeth together but decreases as full contact is made.• Galvanic pain associated with recent placement of amalgam should be ruled out. transillumination and staining with methelene blue. • Medical history – Oro – facial pain or psychiatric disorders should also be excluded. • Visual inspection. – With the aid of magnifying loupes.
Toothpick. cottonroll orangewoodstick or the commercially available tooth slooth. At the apex of the pyramid is a small concavity which accomadate the cusps of the tooth . • Tooth slooth – small plastic bite block attached to the handle.BITE TEST • Bite on various items. Pyramidal in shape.
• Periodontal probing. .lingual cracks will only appear if the segments are separated or the same angle as the x-ray beam. – Narrow pocket formation along the crack can be differentiated from the broad-base pocket in periodontal diseases. Usually inconclusive as cracks tend to run in a mesio – distal direction rather than bucco – lingual direction.• Radiographs. • Bucco .
• If patient presents early and the condition is diagnosed – application of a stainless steel band will frequently cease the problem.Treatment of CTS • The key successful treament of the CTS lies in early diagnosis. If no pain diagnosis confirmed. • Review after 2-4 weeks. .
Extraction is the treatment. • If cusp flies off during removal of the fillingreplace the lost tooth substance. • Pain on biting with pain on temperature changes – sedative dressing (IRM) placed to sedate the pulp.• The ideal permanent restoration for such tooth is a full coverage crown. gold and porcelain onla • Vertical crack or the crack extends through the pulpal floor or below the level of the alveolar bone – prognosis hopeless. .overlay.
.• If sensitivity to temperature changes has not ceased or the crack extends into pulp. – endodontic therapy is necessary.
• Round internal line angles preferred to sharp line angle to avoid stress concentration.Prevention • Awareness of the existance and etiology of CTS is important. • Pin placement in sound dentine at appropriate distance from enamel. . • Cavity preparation – conservatively.
vol.References • Australian Dental Journal.43:4 . no.8 • Australian Dental Journal 1998. 68. 1990. September 2002.35(2):10512 • Journal of the canadian Dental Association The cracked tooth syndrome.