Fracture
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Includes Credits
CE Hours: 1.0
Description: This study evaluated the treatment outcomes and prognostic factors of root canal–treated posterior cracked teeth using the Modified Iowa Index, as published in the Journal of Endodontics. The index enables structured prognostic stratification by integrating crack morphology, periodontal status, radicular crack depth, periapical conditions, occlusal risk, and definitive restoration type. Understanding survival trends and independent risk factors supports evidence-based clinical decision-making and improves long-term tooth preservation in compromised posterior cracked teeth following root canal treatment.
At the conclusion of this article, the reader will be able to:
- Explain the value of the Modified Iowa Index for assessing prognosis and predicting tooth survival in posterior cracked teeth after root canal treatment.
- Identify independent risk factors associated with endodontic failure, including Age, Probing depth ≥ 5 mm along the crack, Radicular extension ≥3 mm, Presence of periapical lesion, Multiple crack lines, Absence of occlusal splint in patients with parafunctional habits, Restoration with onlay or resin composite.
- Interpret outcome and survival patterns to guide post-endodontic treatment planning, including selection of definitive restoration and occlusal stress control to optimize long-term success.
Norachai Wongkornchaowalit, DDS, MSc
Dr. Norachai Wongkornchaowalit graduated from the Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand, in 2008. He subsequently completed a Master of Science in Endodontics in 2011 and a Higher Graduate Diploma in Endodontics in 2012, both from Chulalongkorn University. In the same year, he also received the Thai Board Certificate in Endodontics.
From 2011 to 2015, Dr. Wongkornchaowalit served as a full-time lecturer at Chulalongkorn University and has continued as a part-time lecturer since 2015. He currently serves on the board examination committee and is the secretary of both the Thai Endodontic Association and the Thai Board of Endodontics.
He has delivered numerous lectures and hands-on courses on root canal treatment nationwide, co-authored two endodontic textbooks, and contributed to academic publications.
His clinical interests include microscope-assisted root canal therapy, management of cracked teeth, non-surgical and surgical retreatment, and post-endodontic restoration.
Taratorn Soontornkiat, DDS, MSc
Dr. Taratorn Soontornkiat is a diplomate of the Thai board of Endodontics (2000) and the American Board of endodontics (2004). She currently works in private practice and serves as a part-time faculty member in the department of Conservative Dentistry and Prosthodontics, Faculty of dentistry Srinakharinwirot University and Department of Operative Dentistry and Endodontics, faculty of Dentistry, Mahidol University, Thailand.
Dr. Soontornkiat received her Graduate Diploma in Clinical Science (Endodontics) from Mahidol University (1992). She completed her Specialty Certificate in Endodontics (1997) and MSc. (1998) from University of Minnesota School of Dentistry. She was a past president of Thai Endodontic Society of Thailand (2010-2011).
Tadkamol Krongbaramee, DDS, PhD
Dr. Tadkamol Krongbaramee is a Diplomate of the American Board of Endodontics (2024). She currently serves as a full-time faculty member in the Department of Endodontics, Faculty of Dentistry, Chiang Mai University, Thailand, and is also the owner of a private dental practice in Chiang Mai, where she provides specialty care focused on root canal treatment. Dr. Krongbaramee earned her PhD in Oral Science (2021) and Specialty Certificate in Endodontics (2023) from the University of Iowa College of Dentistry, receiving advanced training in evidence-based endodontic therapy and translational oral science research.
Attawood Lertpimonchai, DDS, MSc, PhD
Dr. Attawood Lertpimonchai is an Associate Professor in the Department of Periodontology at the Faculty of Dentistry, Chulalongkorn University in Bangkok, Thailand. He attended Chulalongkorn University where he received his D.D.S. in 2007 and his M.Sc. in Periodontics in 2011. He furthered his education at Mahidol University, earning a Ph.D. in Clinical Epidemiology and Biostatistics in 2017. Dr. Lertpimonchai has authored numerous publications in the field of periodontics and dental research, with recent work appearing in the Journal of Endodontics, Journal of Clinical Periodontology, and BMC Oral Health. His primary research interests include periodontal disease, periodontal medicine, epidemiology, and statistics.
Keith V. Krell, D.D.S., M.S., M.A.
Dr. Krell has been an endodontist for 44 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. In 1993, he retired from the United States Army National Guard as a lieutenant colonel after 22 years of service. He was also an adjunct clinical Professor in the department of Endodontics at the University of Iowa, College of Dentistry until July 1, 2025 completing a 50 year career with the University of Iowa. He received the University of Iowa, Distinguished Service Alumni Award Sept 26, 2025. He is a past president of the American Association of Endodontist, and also a past president of both, the American Board of Endodontics and the Foundation for Endodontics. He is a Diplomate of the American Board of Endodontics and is a both a Fellow in the American College of Dentists and in the International College of Dentists.
Dr. Krell has been married for 54 years to Diane and they have two grown children, and five grandchildren. He still has research interests in cracked teeth and vertical root fractures and has provided continuing education nationally and internationally for the past 40 years. He has played guitar for more than 50 years and has collected guitars for the past 30 years.
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 study aimed to diagnose vertical root fracture (VRF) of endodontically treated teeth using clinical features and bone loss information from cone beam computed tomography with machine learning models.
At the conclusion of this article, the reader will be able to:
- Explain why machine learning models for the diagnosis of VRF using age, sex, tooth type,the quality of root canal filling and bone loss position, height, width, and depth are valuable for clinical decision making after root canal treatment
- Describe how to diagnose vertical root fracture (VRF) of endodontically treated teeth using clinical features and bone loss information from cone beam computed tomography
- Explain the relationship between VRF and machine learning models
Shujun Ran, PhD
Qiang Wang, MEng
Jia Wang, PhD
Jing Huang, MD
Wei Zhou, MD
Pengfei Zhang, MS
Keyong Yuan, PhD
Yushan Cheng, MD
Shensheng Gu, PhD
Jingjing Zhu, MS
Zhengwei Huang, PhD
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Includes Credits
CE Hours: 1.0
Description: This study aimed to assess the effect of cavity designs on instrumentation, obturation and fracture resistance for mandibular first premolars with Vertucci V canal.
At the conclusion of this article, the reader will be able to:
- Discuss which cavity design is appropriate for mandibular first premolars with Vertucci V canal.
- Compare the effectiveness of different cavity designs in instrumentation, obturation and preservation of dentin and fracture resistance.
- Describe the steps of preparing an access cavity for premolars with Vertucci V canal.
Yuxuan Liu, DDS
Yaxu Feng, DDS
Xianhua Gao, DDS
Wei Fan, DDS, PhD
Bing Fan, DDS, MSc, PhD
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Includes Credits
CE Hours: 0.75
Description: Calcium hydroxide has a long history of applications in endodontics and dental traumatology. The material has strong disinfectant and osseo-inductive properties. With regard to dental traumatology, the use of calcium hydroxide has applications in vital pulp therapy of complicated crown fractures, pulp necrosis following trauma, avulsions with extended dry time, apexification, MTA barrier techniques and regenerative endodontics. However, the use of calcium hydroxide in apexification has become controversial. Cvek identified a high incidence of transverse root fractures for immature teeth treated with long-term calcium hydroxide dressings. In vitro studies have reported calcium hydroxide has decreased the fracture strength of root dentine over time. However, this finding is also controversial with inconsistent and conflicting observations reported. Calcium hydroxide has been used for 50 years and now some authors and organizations advocate for the use of MTA barrier techniques rather than calcium hydroxide. The purpose of this presentation is to discuss the science around calcium hydroxide, its use of and concerns with calcium hydroxide in dental traumatology.
Learning Objectives:
- Critically appraise the calcium hydroxide literature.
- Follow fracture mechanics principles of root fracture mechanics.
- Appraise the different approaches to treat immature permanent teeth with pulp necrosis and infection.
Bill Kahler, DClinDent., Ph.D.
Bill is a full-time Endodontist and an honorary Clinical Professor at the University of Sydney. He has a DClinDent in Endodontics from the University of Adelaide and a PhD from the University of Sydney. He is a Board member and Treasurer of the International Association of Dental Traumatology. Bill has published 80 papers in international dental, material science and engineering journals. Bill is a contributing author for 6 book chapters on renarrative endodontics, endodontic outcomes, vital pulp therapy, and dental trauma, including the iconic North American and European texts, “Pathways of the Pulp” and the “Textbook and Color Atlas of Traumatic Injuries to the Teeth”.
Disclosure(s): No financial relationships to disclose
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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.
Paul V. Abbott, B.D.Sc., M.D.S., FRACDS(Endo)
Paul Abbott is Emeritus Professor of Dentistry at The University of Western Australia. He is a Specialist Endodontist with over 45 years of clinical practice experience. Prior to taking a full-time University position in 2002, he spent 17 years in private specialist endodontic practice and he also held part-time academic positions at The University of Western Australia and The University of Melbourne. He was Dean and Head of the School of Dentistry at The University of Western Australia and Director of the Oral Health Centre of Western Australia from 2003-2009. He has presented over 1000 lectures and courses in 52 countries. He has over 420 publications with 259 articles in refereed journals, 25 textbook chapters and 51 Newsletter articles. From 2015-2022, he was the Editor-in-Chief of the international journal Dental Traumatology. Prof. Abbott’s main research and clinical interests revolve around dental traumatology, tooth resorption, and the diagnosis and management of pulp, root canal and peri-radicular conditions, with particular emphasis on pain control and disinfection of the root canal system. He has received numerous awards for his teaching and service to the dental profession, including Honorary Life Memberships of several professional societies and associations. In 2015, he was appointed by the Governor-General of Australia as an Officer of the Order of Australia, and in 2024, he received the Jens O. Andreasen Lifetime Achievement Award in Dental Traumatology from the International Association for Dental Traumatology. At this year's Annual Session, he will receive the Louis I. Grossman Award from the AAE in recognition of his cumulative publications of significant research studies that have made an extraordinary contribution to endodontology.
Disclosure(s): OzDent Pty Ltd: Consultant/Scientific Advisor (Ongoing), Honorarium (Ongoing), Other Research Support (includes receipt of drugs, supplies, equipment or other in-kind support) (Ongoing), Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Ongoing)
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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.
Matthew C. Davis, D.D.S.
Dr. Matthew Davis is a board-certified endodontist in private practice in the Chicago suburbs of Winnetka and Glenview, Illinois. He attended the University of Iowa College of Dentistry where he received his DDS in 1999 and his specialty certificate in endodontics in 2001. He has been a full-time practicing endodontist for over twenty years. He became a diplomate of the American Board of Endodontics in 2010. He has authored several publications and has been a member of the Scientific Advisory Board for the Journal of Endodontics from 2013 to the 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.
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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: 1.0
Description: Tooth autotransplantation, intentional replantation and surgical extrusion are different treatment options with a similar principle; the preservation of the periodontal ligament (PDL) in order for the tooth to heal and be newly articulated with the bone. Tooth autotransplantation is defined as the surgical movement of a tooth from one alveolar socket to another, either after extraction or by surgically preparing the recipient site in the same patient, it is a viable option to replace lost teeth or poor prognosis teeth. Thus, both function and preservation of the alveolar bone crest is maintained. Its success is associated with healing of the PDL and pulp tissue, absence of root resorption, soft tissue healing, and radicular formation. Intentional replantation is the atraumatic extraction of a tooth enabling the clinician to do a procedure (mostly endodontic microsurgery, or cervical resorption treatment) in less than 15 minutes (extra-alveolar time) in teeth in which, otherwise, access would not be possible. Surgical extrusion consists of atraumatic luxation and coronal repositioning of a tooth with in its same socket, this with the purpose of exposing root resorption, root fractures or decay and treat it, leaving sound tooth structure subgingival.Over the last 15 years these techniques have had a great evolution due to the introduction of cone beam computed tomography (CBCT), intraoral scanning, 3D planning software, 3D printers and computer aided dynamic navigation devices. All this technology enables a more predictable, faster and safer procedure with lower extra-alveolar times. In this lecture several clinical cases, with a proper follow up period, show the rapid progress of the technique always based in the best scientific evidence available and trying to inspire Endodontists to have this type of treatments as valid options to help their patients.
Learning Objectives:
- Evaluate if a patient is a potential candidate for Tooth Autotransplantation, Surgical Extrusion or Intentional Replantation.
- List the digital work flow necessary to perform computer guided Tooth Autotransplantation.
- Introduce these type of treatments as possible options for clinical cases that otherwise would be hopeless.
Felipe Restrepo, D.D.S. M.Dent
Dr. Felipe Restrepo, was born and raised in Medellín - Colombia. Graduated from the University of Antioquia with a degree in Dentistry 2003, after one year as general practicioner he entered a two year Endodontic program and graduated from University CES in 2007. Associate Professor at the University of Antioquia teaching their postgraduate level students in endodontics and also Director of the Dental Emergencies Diploma. Dr. Restrepo has authored several scientific articles in peer-reviewed journals. Ex-president of the Antioquian Association of Endodontists. Private practice limited to Endodontics, Endodontic Microsurgery and Tooth Autotransplantation in Medellín since 2007, international speaker.
Disclosure(s): No financial relationships to disclose
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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: 1.0
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 has been an endodontist for 44 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. In 1993, he retired from the United States Army National Guard as a lieutenant colonel after 22 years of service. He was also an adjunct clinical Professor in the department of Endodontics at the University of Iowa, College of Dentistry until July 1, 2025 completing a 50 year career with the University of Iowa. He received the University of Iowa, Distinguished Service Alumni Award Sept 26, 2025. He is a past president of the American Association of Endodontist, and also a past president of both, the American Board of Endodontics and the Foundation for Endodontics. He is a Diplomate of the American Board of Endodontics and is a both a Fellow in the American College of Dentists and in the International College of Dentists.
Dr. Krell has been married for 54 years to Diane and they have two grown children, and five grandchildren. He still has research interests in cracked teeth and vertical root fractures and has provided continuing education nationally and internationally for the past 40 years. He has played guitar for more than 50 years and has collected guitars for the past 30 years.
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.