Cracked Teeth
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Includes Credits
CE Hours: 1.5
Description: Endodontic complications of varying severity can unfortunately occur during most stages of endodontic treatment. This lecture aims to enhance understanding of common endodontic complications and recommends current management and solutions with an evidence-based approach. Preoperative, intraoperative and postoperative issues will be discussed, including possible aetiologies and prevention during root canal therapy. We will address the impact of complications on both patients and practitioners, underscoring the importance of clear communication in preserving the clinician-patient relationship. Attendees will gain current advice and knowledge on how to tackle endodontic complications effectively, fostering excellence in clinical practice and improved patient care.
Learning Objectives:
- Recognize and identify common endodontic complications.
- Implement evidence based management strategies.
- Develop strategies for preventing endodontic complications.
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Includes Credits
CE Hours: 1.5
Description: “Cracked teeth” is one of the most widely debated, disputed and misunderstood topics in dentistry. The confusion and misunderstandings stem largely from early work on cracks and the lack of a good definition of a crack. Many dentists are confused about cracks and fractures, and they use these terms interchangeably even though they represent different problems. The confusion and misunderstanding also stem from traditional approaches to dealing with cracks in teeth which has largely been a mechanical approach. Whilst cracks are a weakness in the tooth structure, they are also a pathway for bacteria to enter the tooth and cause pulp disease. Symptoms associated with cracks in teeth come from the pulp and therefore it is essential to diagnose the pulp status and then manage the bacterial aspect of cracks rather than just dealing with them as a mechanical problem. This lecture will define cracks, explore the effects of cracks on teeth and provide guidelines for the diagnosis and management of teeth with cracks – especially teeth with reversible pulpitis, which can be managed conservatively.
Learning Objectives:
- Define cracks and fractures and differentiate between them.
- Explain that cracks are an etiology of various diseases, and not a disease or a syndrome.
- Outline the consequences of cracks in teeth.
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Includes Credits
CE Hours: 1.5
Description: Management of cracked teeth is a daily endeavor in endodontic practice. Understanding the multiple variables that impact cracked teeth longevity and employing specific modifications to treatments will maximize successful outcomes. New outcomes data is yielding increased optimism for saving more cracked teeth. This evidence-based presentation aims to answer the poignant questions: “which cracked teeth are treatable?” , “what is the success and prognosis of endodontically treated cracked teeth and those with radicular extension?”, “what is CBCT’s role with cracked teeth”, "How does crack-associated periodontal pocketing (CAIPP) impact these teeth?", and “how can I increase my success when managing cracked teeth generally, and those with radicular extension?”.
Learning Objectives:
- Describe specific, evidence-based treatment and post-treatment modifiers that increase the success of endodontically-treated cracked teeth.
- Describe the prognosis of endodontically-treated cracked teeth compared to non-cracked endodontically treated teeth, based on outcomes studies.
- Describe which variables are most impactful in cracked teeth treatment and management.
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Includes Credits
CE Hours: 1.25
Description: This session will present an interdisciplinary overview of detecting, diagnosing, treating and restoring teeth with fractures and cracks, both large and small. The presenters will review endodontics and restorative evaluation of fracture lines and cracks and discuss how the endodontist and restorative dentist communicate to make the best decisions to present to a patient for long term success of the endodontics/restorative procedures based on current endodontics and restorative EBD.
Learning Objectives:
- Determine the severity of fractures/cracks in teeth and work with their restorative colleagues on managing, restoring or making a decision to extract a tooth based on the patient's clinical presentation.
- Determine the long term prognosis of care rendered.
- Make an evidenced based decision for treatment options and selection of restorative materials and treatments for the best long term results.
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Includes Credits
CE Hours: 0.75
Description: CBCT has superior sensitivity in detecting periapical pathosis compared with conventional periapical radiographs. However, CBCT may not always be able to discern vertical root fractures and cracks due to the overlapping structures and fracture’s variability. Nevertheless, there are some pathological CBCT manifestations as secondary changes that aid us detecting these fractures/cracks. Several factors influence the diagnosis of cracks using CBCT such as those related to the device used, patient-related -and operator-related factors. The diagnostic accuracy detecting fractures / cracked teeth can be improved using certain strategies in clinical practice.
Learning Objectives:
- Discuss different types of cracked teeth.
- Discuss the secondary pathological changes using CBCT by correlating the clinical signs and symptoms with their CBCT manifestations.
- Discuss how to improve the diagnostic accuracy of CBCT in finding fractures / cracked teeth.
Homan Zandi, D.D.S, Ph.D
Dr Zandi graduated from University of Oslo with DDS and Endo specialty certificate. He also earned a PhD on Antibacterial and clinical outcome of retreatment of teeth with infection at University of Oslo, Dental school. He is part-time assistant professor at the same faculty and maintains a referral practice in endodontics in Oslo, Norway.
Speaker Disclosure
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
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Includes Credits
CE Hours: 1.5
Description: Several technologies have been introduced to the endodontic specialty in the past few years. Among these technologies are CBCT, dental lasers, AI softwares and dynamic navigation. CBCT has become the scaffold for other technologies. Importing CBCT dicom files into e-VOLDx artificial intelligence (AI) software and dynamic navigation systems have added a new dimension to diagnosis and treatment. The incorporation of CBCT technology and a new imaging software e-VOLDX has provided clinicians with 300 times higher resolution and the ability to visualize dental structures clinicians were not able to visualize in the past. Structures as the dental pulp, nerve bundles and maxillary sinus membranes are few of these examples. Dynamic navigation software allows the clinician to visualize dental procedure on a monitor in real time while performing challenging non-surgical and surgical procedures. Another technology are dental lasers which are utilized in non-surgical (acoustic streaming disinfection of root canal systems) and surgical procedures (laser guided surgical incision, soft tissue management in invasive cervical resorption and photo-biomodulation to accelerate wound healing).
This presentation will focus on how the incorporation of these technologies can be utilized in non-surgical and surgical challenging endodontic procedures. Based on the information provided, changes in treatment protocols and armamentarium will be presented.
Learning Objectives:
- Import CBCT dicom images into e-VOLDX AI software in the following cases: Diagnosis of pain, cracked teeth, vertical root fracture and resorptive defects.
- Apply dental lasers in non-surgical (acoustic streaming disinfection of root canal systems) and surgical procedures (laser guided surgical incision, soft tissue management in invasive cervical resorption and photo-biomodulation to accelerate wound healing).
- Apply the dynamic navigation with Scopeye display in minimally invasive endodontic procedures as locating calcified canals and surgical cases in close proximity to vital structures.
Mohamed I. Fayad, DDS, MS, PhD
Dr. Fayad received his Doctor of Dental Surgery from the College of Dentistry, Cairo University in 1985. He received his Masters in Oral Sciences in 1994 and his PhD in 1996 from the University of Buffalo at New York. He had two years of Advanced Education in General Dentistry at Eastman Dental Center, University of Rochester at New York, and received his certificate of Specialty in Endodontics at the University of Illinois.
Currently he is the director of Endodontic research, and a clinical associate Professor in the Endodontic department at College of Dentistry at UIC, dividing his time between teaching, research, intra-and extra-mural continuing education and private practice. He currently serves on the Scientific Advisory and Manuscript Review Panels of the Journal of Endodontics, and Evidence Based Endodontics Journal. He served on the AAE Research and Scientific Affairs Committee and co-chaired AAE/AAOMR committee drafting the joint position statement on CBCT (2015). He has numerous publications and chapters in peer reviewed journals and textbooks (Pathways of the pulp) and (Contemporary surgical Endodontics). He is the co-editor of the CBCT text book (3-D Imaging in Endodontics: A new Era in diagnosis and treatment) by Springer (2016).
Speaker Disclosure
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
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Includes Credits
CE Hours: 1.0
Description: Crown fractures, and cusp fractures in particular, are relatively common findings in clinical practice. Treatment depends on the nature of the fracture location, severity, depth and whether the pulp is exposed. The majority of crown fractures do not require extraction, but do require clinical management. One particular challenge is a deep subgingival fracture involving maxillary teeth. Cuspidization is a technique that provides a conservative and non-invasive approach to manage deep cuspal fractures in the maxillary arch. This technique also presents an important biologic phenomenon (periodontal reattachment) that makes this approach possible. The result is a non-invasive, predictable treatment that meets our patient’s esthetic demands and can be implemented in everyday clinical practice.
Learning Objectives:
- Diagnose different types of crown fractures.
- Describe how to conservatively manage cusp fractures.
- Recognize periodontal soft tissue re-attachment.
Ryan M. Walsh, D.D.S., M.S.
Dr. Ryan M. Walsh attended the University of Iowa where he completed both his Biology and Dental (D.D.S.) degrees. Dr. Walsh relocated to Texas to continue his education at Texas A&M School of Dentistry (formerly Baylor College of Dentistry) where he received his specialty Certificate in Endodontics and Master of Science in Oral Biology (M.S.). Dr. Walsh is a board-certified endodontist and maintains a full-time private practice (limited to endodontics) in at Advanced Endodontics of Texas in Keller, Texas.
In addition to private practice, Dr. Walsh upholds a faculty appointment at Texas A&M School of Dentistry in Dallas, TX, where he teaches endodontic residents and dental students. Dr. Walsh is actively involved in translational and clinical research having published multiple peer-reviewed journal articles in these fields. His research interests focus on bioceramic materials, resorption processes and treatment, and tooth cracks/fractures. Dr. Walsh would like to thank the AAE for their continued support of endodontic education.
Disclosure(s): No financial relationships to disclose
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Includes Credits
CE Hours: 1.5
Description: I have been looking and collecting information about both cracked teeth and vertical root fractures for over 40 years of practice. I treated over 3,000 patients with cracked teeth and over 1,100 patients with vertical root fractures. I will be sharing what I have learned over the past 40+ years. There seems to be greater optimism than pessimism as we look at the literature! I will discuss definitions, diagnosis, radiographic features, treatment and prognosis/outcomes. Come keep me company on a Saturday afternoon!
Learning Objectives:
- Discuss the most recent definitions used for longitudinal fractures of teeth.
- Describe the radiographic features of both cracked teeth and vertical root fractures.
- Discuss prognosis for cracked teeth requiring root canal treatment using the Iowa Staging Index.
Keith V. Krell, D.D.S., M.S., M.A.
Dr. Krell received his D.D.S. and M.S. degrees from the University of Iowa in 1981 and 1983, respectively. He earned his M.A. degree in sociology-anthropology in 1975, from the United States International University in San Diego, Calif.
Dr. Krell has been an endodontist for over 43 years. He was a full-time educator for 8 years at the University of Iowa and was in private practice in West Des Moines, Iowa for 29 years until he retired December 31, 2017. He is still an adjunct clinical Professor in the Department of Endodontics at the University of Iowa College of Dentistry. He has lectured nationally and internationally about his research on cracked teeth based on his data base of over 3,000 private practice cases. His complete data base is over 50,000 cases.
Dr. Krell is a Diplomate of the American Board of Endodontics, as well as a past president and past director of the ABE. He is a past president of AAEF (now the Foundation for Endodontics) and finally is past president of the American Association of Endodontists.
Dr. Krell has been married for over 52 years to Diane and they have five grandchildren. He still has research interests in cracked teeth and vertical root fractures.
Disclosure:
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
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Includes Credits
CE Hours: 1.0
Description: This will be an update on diagnosis, treatment, prognosis and restoration for cracked teeth.
Learning Objectives:
- Diagnose cracked teeth with available technology
- Treat cracked teeth with the latest techniques
- Explain outcomes to patients based on the Iowa Staging Index
If you have any questions for Dr. Krell, you can email him at keithvk@aol.com with the subject line "AAE Webinar"
Keith V. Krell, D.D.S., M.S., M.A.
Dr. Krell received his D.D.S. and M.S. degrees from the University of Iowa in 1981 and 1983, respectively. He earned his M.A. degree in sociology-anthropology in 1975, from the United States International University in San Diego, Calif.
Dr. Krell has been an endodontist for over 43 years. He was a full-time educator for 8 years at the University of Iowa and was in private practice in West Des Moines, Iowa for 29 years until he retired December 31, 2017. He is still an adjunct clinical Professor in the Department of Endodontics at the University of Iowa College of Dentistry. He has lectured nationally and internationally about his research on cracked teeth based on his data base of over 3,000 private practice cases. His complete data base is over 50,000 cases.
Dr. Krell is a Diplomate of the American Board of Endodontics, as well as a past president and past director of the ABE. He is a past president of AAEF (now the Foundation for Endodontics) and finally is past president of the American Association of Endodontists.
Dr. Krell has been married for over 52 years to Diane and they have five grandchildren. He still has research interests in cracked teeth and vertical root fractures.
Disclosure:
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
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Includes Credits
CE Hours: 0.75
Description: Cracked teeth received a variety of definitions and descriptions over the years. A lack of agreement still prevails among clinicians on this topic when it comes to diagnosis and treatment planning. Accurate clinical evaluation, including 3D imaging, should be the foundation of our assessment of cracked teeth, mainly to avoid over diagnosis of such a condition. A current understanding of differential diagnosis plays a major role in ruling out any other pathosis that may mimic a cracked tooth. This presentation will include a review of clinical cases that initially presented as cracked teeth and ended up being saved. The clinical cases will be accompanied by the most recent evidence-based literature regarding classification, diagnostic terms and prognosis of cracked teeth.
Learning Objectives:
- List the challenges in the diagnosis of cracked/fractured teeth
- List the possible differential diagnosis for a cracked tooth
- Discuss possible treatment options for cracked/fractured teeth based on the relevant prognostic factors
Elinor Alon, D.M.D.
Dr. Elinor Alon received her D.M.D. from the Hebrew University School of Dental Medicine in Jerusalem, Israel in 2008 and then continued her training as a general dentist in their Advanced General Practice Program. In 2014, Dr. Alon completed her Certificate in Endodontics at the Hebrew University School of Dental Medicine. She has been a full time educator at Tufts University School of Dental Medicine since 2016. In June 2019 Dr. Alon became a diplomate of the American Board of Endodontics. Dr. Alon was the Post Graduate Program Director and Interim Chair in the Department of Endodontics at Tufts University School of Dental Medicine between the years 2019-2023. In August 2023, Dr. Alon moved to Connecticut due to her husband's new position at Yale University and she is currently practicing Endodontics in the area. She is a member of the American Association of Endodontics, American Dental Association, and the Connecticut Dental Association.
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.
Rachel Monteiro, M.Sc., Ph.D.
Dental School - State university of Campinas - Brazil - 2007 Residency in Endodontics - Sao Leopoldo Mandic- Brazil- 2009 Master in Endodontics - State University of Campinas - 2011 PhD in Endodontics - State University of Campinas - 2015 Assistant Professor at Tufts University School of Dental Medicine - 2019- present
I declare that I have no proprietary, financial, or other personal interest of any nature or kind in any product, service, course, and/or company, or in any firm beneficially associated therewith, that will be discussed or considered during the proposed presentation.