DIAGNOSIS OF CRACKS & FRACTURES in endo.pptx

DIAGNOSIS OF CRACKS & FRACTURES.pptx

1. DIAGNOSIS OF CHRONIC CRACKS & FRACTURES DR ALEENA JOSE JR 2 DEPT. OF CONSERVATIVE DENTISTRY & ENDODONTICS GDC TRIVANDRUM

2. CONTENTS INTRODUCTION DEFINITIONS DIAGNOSTIC CHALLENGE CLASSIFICATION CLINICAL MANIFESTATIONS DIAGNOSIS CONCLUSION REFERENCES

3. INTRODUCTION

4. DEFINITION American Association of Endodontists (AAE) Glossary of Endodontic Terms, 2016

5. DIAGNOSTIC CHALLENGE

6. Pruden WH. Treatment of the cracked tooth. J N J Dent Assoc 1971;42: 22-23 CLASSIFICATIONS FOR CRACKED TEETH

7. Talim ST.,Gohil KS. Management of coronal fractures of permanent posterior teeth. J Prosthet Dent 1974;31:172-178.

8. Luebke RG. Vertical crown-root fractures in posterior teeth. Dent Clin North Am 1984;28:883-894 . Williams J. Incomplete vertical tooth fracture. J Mass Dent Soc 1988; 37:13-20 .

9. Clark DJ, Sheets CG, Paquette JM. Definitive diagnosis of early enamel and dentin cracks based on microscopic evaluation. J Esthet Restor Dent 2003;15:391-401

10. The cracked tooth conundrum: Terminology, classification, diagnosis, and management: American Journal of Dentistry, Vol. 21, No. 5, October, 2008 AAE CLASSIFICATION OF CRACKED TEETH

11. Craze line

12. Cracked and fractured cusps

13. Cracked cusp

14. CLINICAL MANIFESTATION

15. Cracked and split teeth

16. CRACKED TOOTH

17. Cracked teeth DIAGNOSIS

18. CLINICAL MANIFESTATION

19. LATE MANIFESTATION

20. SPLIT TOOTH

21. VERTICAL ROOT FRACTURE AAE Glossary of Endodontic Terms

22. DIAGNOSIS

23. CLINICAL MANIFESTATION

24. DIAGNOSIS

25. METHODS OF DIAGNOSING ENAMEL CRACK

26. Crack --- derange transmission of light Illumination without magnification – Disadvantages are Craze lines to give the impression of physical fractures Minor color shift is undetectable Use of magnification and fiber-optic transillumination

27. FIBEROPTIC TRANSILLUMUNATION One of the most ideal tools in the armamentarium for the diagnosis of fracture lines Uses the quartz halogen lamp and rheostat to give light of variable intensity Wilcox et al Most commonly used diagnostic tools for traditional crack diagnosis in clinics That it magnifies all faults causing even the most minute craze lines to be visualized as deep microcracks Operator sensitive technique

28. BITE TESTS Bite on individual cusps for fracture cusp isolation Presence of sudden pain on release confirms the diagnosis Ehrman et al

29. Not distinguish maxillary or mandibular origin May extend crack propagation FRACT FINDER TOOTH SLOOTH

30. QUANTITATIVE PERCUSSION DIAGNOSTICS Commonly used to detect peri-implant osteointegration Due to crack ,tooth tissue on both sides of the crack can be slightly moved under the action of QPD To detect hidden cracks and locate the presence of cracks that cannot be detected by light transmission, Interproximal or beneath the gingival/bone complex

31. RADIOGRAPHS Determine the overall tooth status Conventional periapical X-rays (PR ) When a root fracture is deviated Mesiodistal cracks can never be seen Buccolingual cracks will only appear if there is actual separation of the segments or the crack happens to be at exactly the same angle as the x‐ray beam. Only identifies at a later stage Radiographs at more than one angle & making bitewing radiographs – may help in early detection

32. Cone-beam computed tomography CBCT Zhou J et al - Enhance the accuracy of detection and determination of the depth of the crack Identify minor periapical bone loss during vertical root fractures Resolution --- 80 µm (Difficulty in diagnosis) Yuan et al – A contrast, meglumine diatrizoate can improve scanning with CBCT as compared to the usual approach because it can effectively highlight the hidden crack Yuan M, Gao AT, Wang TM, Liang JH, Aihemati GB, Cao Y, Xie X, Miao LY, Lin ZT. Using Meglumine Diatrizoate to improve the accuracy of diagnosis of cracked teeth on Cone-beam CT images. International Endodontic Journal, 53, 709–714, 2020

33. QUANTITATIVE EVALUATION OF CRACKED TOOTH MICRO-CT Chanchala HP, Godhi BS, Saha S. The Use of Fiber-optic Transillumination in the Diagnosis of Fracture Line in Teeth: A Method of Standardization in Fracture Strength Studies. Int J Clin Pediatr Dent 2022;15(4):475–477

34. SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY (SSOCT ) Cross-sectional diagnostic method Principle is identical to that of ultrasonic pulse-echo imaging Utilizes infrared waves which reflect the internal microstructure Highly sensitive than traditional OCT Construction of cross-sectional images of internal biologic structures

35. ADVANTAGES

36. LIMITATIONS

37. NEAR INFRARED IMAGING Recent diagnostic modality for enamel cracks Long wavelengths of 1300–1700 nm of near-infrared ----- greatest contrast between enamel and dentine DEPTH OF CRACKS DIFFERENTIATE BETWEEN THE DIFFERENT TYPES OF CRACKS Developed to overcome the limitation of insufficient scanning range of the SS-OCT

38. MAGNETIC RESONANCE IMAGING Ultrashort echo capture time technology Sweep Image With Fourier Transformation (SWIFT)

39. Presence of water in the crack produces positive contrast enhancement 2 mechanisms

40. Schuurmans et al MRI and CBCT's detection results of root cracks in excised teeth after root filling Result : MRI is better than CBCT in identifying partial hidden cracks Root filling or crown filling has little effect on MRI imaging Djat Idiyatullin et al Gradient recalled echo (GRE) and SWIFT MRI to detect two tooth cracks in vitro Results : SWIFT MRI could detect the cracks as small as 20 µm MRI examination takes a long time -- prone to artifacts SWIFT MRI for cracked tooth can be controlled at about 10 min (Djaudat et al)

41. CONTRAST MEDIUM-ASSISTED IMAGING After the contrast medium is introduced into the crack, the crack is easier to identify when the transmission density under X-ray is higher than that of tooth hard tissue Loversol ( Zhou et al ) Only mark the length of crack in the direction of the long axis of the tooth Cracks are usually irregular – reduces accuracy Meglumine diatrizoate(MD)( Yuan et al ) Not suitable for the detection of subgingival cracked teeth Saliva environment

42. ULTRASONIC TESTING TECHNOLOGY Nondestructive testing method, which has the characteristics of wave length, high resolution and no danger Has the ability to penetrate the hard structure Very effective in detecting physical discontinuities Couplant mediated contact

43. LASER ULTRASONIC (LU) TECHNOLOGY

44. OPTICAL POLARIZATION IMAGING SYSTEM Based on the optical birefringence characteristics of the tooth surface Optical polarization imaging system -- Tien YH et al Preliminarily detect the cracks Detection results are not completely consistent with the actual depth on the tissue section.

45. VIBROTHERMOGRAPHY ( VibroIR) Principle Defect generates heat by friction under ultrasonic vibration. And the defect is detected by the temperature change Matsushita TM et al.------ tried to detect artificially created cracks extending to the root with different parameters of VibroIR. depth of dentin crack can be detected by using VibroIR

46. Craze line

47. Cracked or fractured cusp

48. Split tooth In the case of a problematic tooth with no apparent reason for the pulpitis or necrosis, like a tooth with minimal or no caries, restoration, or trauma, a crack or fracture must be considered

49. Vertical root fracture

50. Banerji, S.; Mehta, S.B.; Millar, B.J. Cracked Tooth Syndrome. Part 1: Aetiology and Diagnosis. Br. Dent. J. 2010, 208, 459–463 .

51. REFERENCES Cohen’s Pathways of the Pulp TWELFTH EDITION Zidane, B. Recent Advances in the Diagnosis of Enamel Cracks: A Narrative Review. Diagnostics 2022, 12, 2027 PradeepKumar AR, Subbiya A. Cracks and Fractures in Teeth. J Oper Dent Endod 2017;2(1):25-30 Chanchala HP, Godhi BS, Saha S. The Use of Fiber-optic Transillumination in the Diagnosis of Fracture Line in Teeth: A Method of Standardization in Fracture Strength Studies. Int J Clin Pediatr Dent 2022;15(4):475–477 Mingyue Yu, Jianing Li, Shuang Liu, Zunxuan Xie , Jinyao Liu, Yuyan Liu , Diagnosis of cracked tooth: Clinical status and research progress: Japanese Dental Science Review 58 (2022) 357–364 American association of endodontists. The obvious and the obscure: steps for crack detection and confirmation, Endodontics: Colleagues for Excellence , 2008. American association of endodontists. Transillumination: the “light detector , Endodontics: Colleagues for Excellence , 2008.

52. Mathew S, Thangavel B, Mathew CA, Kailasam S, Kumaravadivel K, Das A. Diagnosis of cracked tooth syndrome. J Pharm Bioall Sci 2012;4:242-4. Kukreja et al: VertIcal root fracture”- a dilemma revisited; Dental Journal of Advance Studies Vol. 3 Issue I, 2015 Kim et al. Detection of cracked teeth using a mechanoluminescence phosphor with a stretchable photodetector array ; NPG Asia Materials (2022) 14:26 William Kahler; The cracked tooth conundrum: Terminology, classification, diagnosis, and management : American Journal of Dentistry, Vol. 21, No. 5, October, 2008 Yuan M, Gao AT, Wang TM, Liang JH, Aihemati GB, Cao Y, Xie X, Miao LY, Lin ZT. Using Meglumine Diatrizoate to improve the accuracy of diagnosis of cracked teeth on Cone-beam CT images. International Endodontic Journal, 53, 709–714, 2020 Banerji, S.; Mehta, S.B.; Millar, B.J. Cracked Tooth Syndrome. Part 1: Aetiology and Diagnosis. Br. Dent. J. 2010, 208, 459–463.