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Hidden Split in a Mandibular Central Incisor

Terry Pannkuk, DDS, MScDDiagnostic Puzzles, Clinical Endodontic Technique Instruction, Diagnosis, Complications: Advanced Management, Fractured Roots, All by Date


Lightly pushing on the labial half of the crown caused it to shear off at the gingival level

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hidden split in a tooth

Patient: 61year-old female with a history of colitis and hypothyroidism

Chief Complaint: biting and cold sensitivity

Dental History: The patient reported no recent dental procedures and started experiencing discomfort 5 days prior to the endodontic examination

Significant Findings: Severe localized percussion sensitivity was associated with the mandibular left central incisor (tooth #24). Sharp transient sensitivity was also noted with tooth #24 with the adjacent teeth responding within normal limits. Periodontal findings as well as all other clinical tests and findings were within normal limits. Fiberoptic transillumination of the tooth demonstrated a break of the beam through the incisal edge with the labial half of the crown remaining dark.

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Hi Terry, nice work, if you were to restore this yourself how much tooth tissue would you remove lingually ? I used to do these myself and when cementing the post I would utilise the buccal composite excess as the core, which I assume you have done likewise. I would prep for a crown immediately and fit a crown either as a temporary or permanent within 4 days. I would remove as little tooth tissue as I could lingually to maximise strength and use a metal backing to keep the bucco-lingual thickness as sensible as possible, I found the more I removed the weaker the end result. Jan Skrybant

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