In 2000, Graem Milicich and Tim Rainey published an article outlining how traditionally treated teeth were at greater risk to infections from cracks due to the increased stresses on the tooth. This includes peripheral rim fractures, which occur when restored teeth are not connected side to side like with amalgam or poorly bonded composite. These small cracks around the edge of the restoration lead to occlusal effect caries and increased risk of larger cracks in the tooth.
When Dr. Alleman began learning more about structural compromise, he purchased a microscope for his office and was then able to visualize cracks in dentin. He saw how these cracks were symptomatic, but the dental school recommendation of a full-coverage crown wasn’t enough to stabilize them. Dr. Alleman began removing the cracks and seeing symptoms resolve. This was confirmed by a paper he discovered later by Abbott and Leow, two Australian endodontists who studied symptoms after crack removal and found superior results to previous recommendations of full coverage crowns or attempting to bond over the cracks. When the cracks were removed the symptoms went away.
Articles referenced in this episode:
- Milicich G, Rainey J T. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodont Aesthet Dent. 2000;12(7):695-700.
- Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent. 1981(6)2-5.
- Walker et al. Enamel cracks the role of enamel lamella in caries initiation. Australian Dent J. 1998;43(2) 110-116.
- Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Australian Dent J. 2009; 54:306-315.
- Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10)-453-457
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Six Lessons Approach Podcast by Dr. David Alleman