FRACTURES OF TEETH

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ROLE OF CBCT IN MICROFRACTURES
CBCT has greatly helped with the question of the elusive microfracture’s presence as well as its extent, both of which are significant factors related to treatment planning. The case below illustrates this challenging question related to a patient that presents with the classic “cracked tooth syndrome
The patient had intermittent hyperemic sensitivity as well as pain upon release from occlusion. With a 3-D evaluation made possible by CBCT, the clinician can better evaluate the presence and extent of microfractures. In this case, close evaluation of axial slices enabled the clinician to verify that a microfracture was present). Additional slices suggested that the microfracture was limited to the coronal tooth structure, as there were no signs of osseous changes in the periradicular attachment. After treatment was initiated, the extent of the microfracture was further verified under the microscopeThe successful outcome to eliminate the patient’s symptoms and to retain the tooth with full coverage was confirmed at the one-year follow-up appointment (

VERTICAL ROOT FRACTURES
The following 2 cases illustrate the ability of CBCT to help close the gap in determining the presence of vertical root fractures (VRF).

Vertical Root Fractures: Case 1
When the patient presented for evaluation of generalized discomfort in the lower right, a 2-D image was taken (Clinical findings were suggestive of a VRF. However, it was because of the benefit of CBCT that the patient and clinician felt more at ease in proceeding with the extraction of this tooth. CBCT was able to verify and illustrate for the patient the classic 3-D presentation of the changes in surrounding tissue in association with a VRF (Upon removal of this hopeless tooth, granulomatous tissue could be seen along the mesiobuccal root (Figure 4d). The VRF was confirmed when the root was scaled for direct assessment
Vertical Root Fractures: Case 2
The second VRF case illustrates the ease of CBCT to show a straight buccal VRF. This is an obvious limitation of 2-D radiographs. A digital periapical radiograph was taken when the patient presented with a minor localized swelling near the buccal of tooth No. 28 ( Clinically, the probing and presentation of the periodontal tissues suggested that a VRF was present. However, the patient desired more definitive information before extracting the tooth and losing the long spanning bridge. Initial disassembly was undertaken to both eliminate the post’s impact on scatter in CBCT and for initial microscopic evaluation. Upon the post removal, the internal extent of a straight buccal VRF was documented through the microscope (. With the use of CBCT, the classic vertical bone loose adjacent to the straight buccal VRF was accurately demonstrated in this frontal slice (. This additional verification appeased the patient’s desire to be more certain that the tooth’s condition was currently untreatable