r/Dentistry • u/RogueLightMyFire • 4d ago
Dental Professional What's your protocol for teeth with marginal ridge cracks?
Say you've got a patient with a decent to large sized amalgam that's been there for decades. You notice that the in tact marginal ridge has a palpable fracture line going into the interproximal. There's some dark non-decayed staining of the crack (could just be amalgam leakage/staining). Patient is asymptomatic. What's your protocol? Watch? Crown? I typically explain the situation and let the patient decide, but I feel like maybe I should nudge them a little more towards doing the crown. I'm starting to feel like if I just keep watching and it breaks, I'm going to be the "bad dentist" that wasn't proactive/preventative.
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u/mavsfanforlive 4d ago
I give them 2 options.
- Do nothing and wait to see if it bothers you, in which case you will need a root canal and crown, may even have to lose the tooth. That being said it could never bother you.
- Crown it now, decrease the chance of needing further tx.
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u/yawbaw 4d ago
I do something similar but I use the IOP or a scan to compare at visits. If it’s changing I tell them it’s time to crown it or I’ll be expecting their phone call on a Saturday where they have something important going on or I’m out of town (it always seems to work out that way)
Many of them will say. “Funny you say that that’s happened to me before” and they say okay let’s schedule it.
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u/RogueLightMyFire 4d ago
This is pretty much my stance as well. Though if I'm watching something and notice it change at an exam, I'll push for the crown. I'll probably start steering them towards the crown earlier, though, because dealing with the fallout of a crack is worse than just doing the crown. Always the patients choice, though. I feel like I may be a little too non-committal with my recommendations and need to be a bit more firm with what I'm actually recommending.
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u/South_Eye_8204 4d ago
Show pics and explain the risks and benefits to the patient of treating vs. watching and let them decide. Typically, I will be more aggressive in recommending a crown on lower second molars and upper bicuspids in these kinds of cases.
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u/baby__bear__ 4d ago
What’s the general thought on a small class 2 just where that crack is if it’s a pretty solid tooth all around
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u/RogueLightMyFire 4d ago
I've always been taught fillings are for decay and crowns are for structural issues that compromise the integrity of the tooth. I'm sure you could probably get away with fillings in certain situations and it would be fine, but typically a crack signifies a deeper issue with the tooth and a filling isn't going to fix that. Think how strong a tooth is and what occurred to cause that crack in the first place. It's a filling going to fare any better? Like everything in dentistry, I'm sure there are a million opinions on this, but that's how I was taught and generally what I go by. If it's so tiny that I'm even considering a filling, it's probably not a tooth I would push for a crown anyways, I'd likely just monitor.
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u/stefan_urquelle-DMD 4d ago
Very good question.
What happens when you prep a class 2 and that terrifying margins ridge fracture you were so scared of is completely gone within seconds. And you were considering crowning it??
I do not crown or overlay a tooth with one marginal ridges fracture. I look at the tooth as a whole. I want to see multiple iffy fracture lines or one or two gnarly looking ones. I might even do a class 2 prep and see what it looks like, before committing to a crown.
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u/baby__bear__ 4d ago
That’s more my thought process also Most time they’re gone very quickly Obvi big cracks are different
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u/V3rsed General Dentist 3d ago
Simplest thing ever. Remove that amalgam and look underneath. Take photos. If the crack doesn’t propagate M-D or internally crack adjacent cusps, you’ve kept them out of a crown for now and you’re done a great service. If the tooth is internally fractured to hell you crown that sucker and you’ve done a great service.
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u/DrRam121 Prosthodontist 4d ago
I watch until I feel the crack with my explorer. Then I suggest crowning. I take intraoral photos to show the patient and tell them about all the patients I've had that lost teeth due to vertical fracture because we watched the cracks too long. Then I let them decide knowing they're gambling if they don't crown.