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Fractures

An extremely difficult matter. Many uncomprehended complaints have as probable cause a fracture. The widespread use of the operating microscope has considerably simplified the tracing of fractures.

If old amalgam fillings are removed with the help of the operating microscope, it is striking how many (knob) fractures such teeth contain.

There is an impression that (old, possibly showing cracks) amalgam fillings cause expansion which finally make a tooth fracture. Maybe the edge crack is filled by corrosion products which causes expansion.

Of course there are many other causes which have been known for a longer period like:

• corrosion at root posts
• habits (bruxism, biting on hard things)
• trauma
• forces of spreaders with lateral condensation

How can the fractures be diagnosed:

• anamnesis (pain when biting on tough things)
• inspection (with operating microscope)
• multiple fistulas
• breaking of light (light source near tooth neck on element)
• colouring with methylene blue
• mobility of a tooth element
• small bubbles form while moving the element in question
• sound with percussion strongly deviates
• use of the Fracfinder
• solitary pocket (see also Endo/paro problem)

How to handle fractures:

Many fracture lines which occur superficially in the enamel, do not need any treatment. However, it is still very difficult to make such a distinction. Certainly when an old filling has been removed and there are fracture lines in the cavity, then treatment is called for.

If a (knob) fracture has not yet led to pain complaints or a non-vital pulp, then a knob covering (plastic) restoration may suffice.

Should it be a matter of irreversible pulpitis or a non-vital element, then a endodontic treatment is done according to the normal procedure. However, you should check carefully if the fracture does not yet cause such a crack that moisture from the parodontium can come in the canals. Should this be the case, then the element is lost.

Vertical fractures do not lead automatically to extraction of a dental element. This depends on the place of the fracture. For the time being, for a good treatment we refer to “Textbook and color atlas of traumatic injuries of the teeth”.

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From this page you can order in our web shop

• Operating microscoop
• Methylene blue
• Fracfinder

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to former chapter: Very large canals

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