Clinical Tips 7: Cracked Tooth

Cracked teeth are one of the hardest things we treat! Here we have a symptomatic tooth, it is sensitive to cold and to biting. We know cracked teeth can be a tough battle, needing more invasive treatment such as root canals or extractions and implants.

We hope we can do an onlay and save as much tooth as possible for possible for future crown(s). We start by isolating with a rubber dam.

We reveal the fracture, or crack, on the mesial of the tooth (or side facing the midline).

We begin to open this up, by removing the old silver filling. Its so important this is done under a rubber damn with proper protection to keep the mercury and other heavy metals from being inhaled, or swallowed by dental staff or patients.

Here, we see how much damage was done by the fracture. The metaphor I use is that a fracture is like a break in a coconut shell – it lets the fluid come in and out of the protected inner soft portion of the tooth.

Here we do immediate dentin sealing, a technique often abbreviated IDS, which involves bonding the innermost portion of the tooth with flowable composite and bond right after prepping, still under a rubber dam, to enhance bond strength and reduce sensitivity.

Our overlay prep here, shows how much of the remaining tooth is not touched by our burs and survives after this treatment. This does leave a ‘finish line’ where you can see the ceramic to tooth margin, which makes this treatment better for posterior teeth then anterior.

Fillings weaken teeth, crowns and onlays or overlays can strengthen them if done correctly! Glad how this overlay turned out, since the patient reports that the sensitivity is GONE! Clinical success!