AAE Online CE
NS-20 Cracks and Fractures in Vital and Endodonticaly Treated Teeth
CE Credits: 1.5
Cracks and fractures that are found in vital and in endodonticaly treated teeth may present with a large variety of confusing signs and symptoms. The various clinical expressions of these two distinctive clinical conditions represent continuous processes that the operator happened to meet at a given time point. A vital tooth may present with a crack with no other symptoms than pain on chewing, then develop symptoms of pulpitis and eventually present with pulp necrosis and disappearence of pain on chewing, followed eventually by signs of apical periodontitis. An endodonticaly treated tooth may initially present with sensitivity and with a typical isolated narrow and tight periodontal pocket that is often inaccessible with a rigid metal probe and with no radiographic expression. Then, with advanced bone destruction of the cortical plate(s), it may be detectable on radiographs, as a radiolucency along the root or as a "halo." This occurs as soon as the extent of the cortical bone defect is larger than the silhouette of the root. This often represents a missed and delayed diagnosis.
At the conclusion, participants should be able to:
- List and describe the signs and symptoms of cracked and fractured vital teeth and explain their sequence of appearance.
- List and describe the signs and symptoms of a vertical root fracture in an endodonticaly treated tooth and explain their sequence of appearance.
- Explain the nature of the radiolucency that appears with long-standing vertical root fractures and explain why they often represent a missed or delayed diagnosis.
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Zvi Metzger, D.M.D.
Prof. Zvi Metzger graduated from the Hebrew University School of Dental Medicine in Jerusalem in 1970. Since 1973 he has been on the faculty at the Tel Aviv University School of Dental Medicine, where he served as Dean in the years 1987-1991. Prof. Metzger was Chairman of the National Board of Endodontics in Israel and Chairman of the Israeli Endodontic Society (2000-2002). He was an Associate Professor of Oral Biology and Professor of Endodontology at Tel Aviv University. Prof. Metzger was a visiting fellow at the National Institute of Dental Research, NIH, Maryland (1978-1981) and a visiting professor at the University of North Carolina at Chapel Hill (1995-1996). He served as Director of Research Laboratories (1981-2009) and recently (2008-2012) as Chairman of the Department of Endodontology at the School of Dental Medicine at Tel Aviv university, where serves now as Professor Emeritus. He retains a private endodontic practice in Tel Aviv.
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