CLINICAL EVALUATION

● Probing the crack may elicit pain or even reveal moving segments on either side of crack line, indicating a split tooth

● Apply some pressure to the cusps that are adjacent to any visible crack

● On some occasion, pressure to the cusp or actual probing of the crack will reveal a split tooth that would not have otherwise been found

CRACK PROBING

● Selective sensitivity when the tooth is percussed in a particular direction

● Use the blunt end of a dental mirror handle

SELECTIVE SENSITIVITY

● Tooth with recurrent endodontic pathosis - coronal leakage

● Tooth that is an abutment to a cantilever bridge

RESTORATIVE TREATMENT

● Indication of a vertical root fracture (VRF) is the presence of multiple sinus tracts adjacent to the tooth in question

● Fracture may be present on at least two surfaces of the tooth, and the infected area may drain to multiple sites,creating multiple sinus tracts

MULTIPLE SINUS TRACT

● Seen after RCT

● Cement extruded through and out of the fracture site, after which it becomes visible radiographically

● It can be confused with the obturation passing through accessory canals

CEMENT TRAIL

● Halo-like bone loss

● The bone loss has a tendency to give a "halo-like” appearance, traversing circumferentially around the root

● The radiolucent area may also travel almost completely up one side of the root, with this pattern of bone loss often termed a “J-shaped / J-type” apex to cervical 3rd of the root.

● Extensive bone loss that is isolated by just one tooth in the absence of advanced periodontal diseases________ (Isolated bone loss??)

● This could be suggestive of vertical root fracture or split root.

RADIOGRAPHIC EVALUATION

● If left undetected, it creates a dehiscence in the bone and a V-type pattern of bone extends apically.

● When the periodontal probe is inserted into this type of periodontal pocket, it is tight within the pocket, and the periodontal probe’s movement from side to side is restricted.

PERIODONTAL EVALUATION

● When root perforations occur, communication between the root canal system and periradicular tissues or the oral cavity must be reduced.

● Success depends on immediate sealing and infection control

● MTA, EBA, IRM, GIC, Composites

PERFORATIONS

● Perception of pain in one part of the body that is distant from the actual source of pain

● Pain of non-odontogenic origin can refer pain to the teeth

● Anterior teeth seldom refer pain to other teeth of the opposite arches, whereas posterior teeth may refer pain to the opposite arch or to the periauricular area nor seldom___

● MANDIBULAR POSTERIOR TEETH tend to transmit referred pain to the periauricular area MORE OFTEN than maxillary posterior teeth.

REFERRED PAIN