Discussion revolves around how cracks in teeth can lead to infections, with emphasis on removing cracks rather than covering them. Mention of Australian endodontists' study showing superior results after crack removal. Evolution of dentistry practices towards more precise crack identification and treatment for better clinical outcomes.
24:26
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Quick takeaways
Identifying and removing cracks in dentin alleviates symptoms and yields better results than traditional full-coverage crowns.
Preserving tooth structures like sub-oclusal oblique transverse ridges is crucial for enhancing tooth fracture resistance.
Deep dives
Revolutionizing Dentistry: The Birth of Minimally Invasive Dentistry
The podcast delves into the transformative shift in dentistry in 1999 through encounters with pioneers like Tim Rainey and Graham Milachitch. Focus is placed on the concept of minimally invasive dentistry, covering discussions on aerobrasion and the manifestation of stress in teeth, leading to a groundbreaking paper on stress distribution in 2000.
Challenging Traditional Dental Practices and Concepts
The episode challenges traditional concepts like extension for prevention by GV Black, emphasizing the importance of preserving tooth structures like sub-oclusal oblique transverse ridges. It highlights the detrimental effects of conventional filling preparations on tooth fracture resistance, with a significant emphasis on the role of cracks in tooth pathology.
Biometric Dentistry and Global Knowledge Exchange
The shift towards biometric dentistry is explored, emphasizing the mimicry of natural tooth structures to enhance treatment outcomes. The episode details the global exchange of knowledge among dental experts like Inakoshi, Graham Milachitch, and the speaker, focusing on the importance of adapting new techniques for improved patient care and long-term success in dentistry.
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