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| DIAGNOSIS & TREATMENT OF CROWN FRACTURES DIAGNOSTICS Complete diagnosis of fractured teeth requires 3 distinct modalities: visual, tactile, and radio- graphic.1,6 UÊVisual: Most cases of direct pulp exposure are obvious, but it is important to evaluate all sides of the tooth for direct pulp exposure (Figure 5). Figure 5. Complicated crown fracture of the lingual surface of the mandibular left first molar (309) in a dog; this could have been missed on external examination. UÊTactile: Even the smallest amount of pulp exposure is sufficient to cause pulp necrosis. In fact, these small exposures are the ones that most commonly result in clinical abscesses (Figure 6). Therefore, it is best to use a dental explorer or small endodontic file to defini- tively rule out pulp exposure, and any soft spot should be suspect (Figure 7). UÊDental radiographs: Dental radiographs are a critical part of endodontic therapy. All frac- tured teeth are potentially nonvital and infect- ed; radiographs should be taken of all frac- tured teeth with dentin or pulp involvement.7 Radiographic evidence of endodontic disease is most commonly seen as periapical rarefac- tion (Figure 8) or a wider endodontic space (Figure 9).8 TREATMENT Figure 6. Uncomplicated crown fracture of the maxil- lary left fourth premolar (208) in a dog with a draining abscess. This tooth has been nonvital for years. Note how little tooth structure is missing, even though the tooth is severely infected. Uncomplicated Crown Fractures Confirmed uncomplicated crown fractures with no radiographic evidence of disease (Figure 10) should be treated with a bonded sealant (see Practice Step by Step: Bonded Sealant Application for Crown Fractures, page 44). This will resolve sensitivity, block infection, improve aesthetics, and smooth the tooth to decrease plaque accumulation, delaying periodontal disease. Complicated Crown Fractures Teeth with complicated crown fractures or radio- graphic evidence of nonvitality should be treated with root canal therapy or extraction.1,2,6 Large teeth, such as canines and carnassial teeth, are considered strategic teeth and should ideally be saved with root canal therapy. This gives an excellent long-term prognosis (up to 100%).9 Furthermore, when root canal therapy is provided for large stra- tegic teeth, the patient maintains jaw strength and tooth function and treatment is much less painful than surgical extraction. For minor teeth, such as incisors and premolars, extraction is a viable alternative; however, many clients are interested in maintaining all teeth. Figure 7. Complicated crown fracture of the maxillary right fourth premolar (108) in a dog. Note the mini- mal amount of tooth loss; however, careful probing revealed the fracture. 20 Today’s Veterinary Practice July/August 2011 FOLLOW-UP Follow-up dental radiographs are strongly recom- mended in 6 to 9 months to ensure continued vital- ity. (If the client declines this, radiographs should be performed during the next prophylaxis.) Q