Cracks, the new threat or just old sores ?
Bio-mechanical considerations of crack prevention and restoration of posterior teeth.
The “molar lifecycle” or the “Circle of Death” whereby a small filling can eventually lead to loss of vitality or even extraction of a tooth is well known. Nevertheless, a clear strategy and guidelines on how to prevent this dramatic scenario to develop has not been proposed. Thorough understanding of the bio-mechanical behavior of teeth, both sound and restored, on a macro- and micro-level will allow us to come forward with effective measures to save teeth and be less aggressive in our treatment proposals. A pro-active approach will be proposed, both for vital and non-vital teeth. The importance of early diagnosis, healthy strategy , effective isolation and skillful execution will be evident in this presentation.
Both the direct and indirect approach to cuspal coverage will be dealt with. Numerous issues will be adressed : Immediate dentin sealing, deep marginal elevation, cavity design, luting. How to cummunicate with patients when dealing with cracks is the juicy cherry on the cake.
- Understand crack initiation and act with preventive measures to prevent crack progression.
- Material choice guidelines.
- Cuspal coverage or not ? Clear protocol and guidelines.
- Early diagnosis of different types of cracks.
- General cavity design guidelines.
- Communicate openly with the patiënt.