Patient: This patient had a long history of both nocturnal and daytime bruxism. His medical history was unremarkable.
Description: He presented for his bi-annual cleaning and recall exam. He had no chief complaint. The craze lines on 8 and 9 were currently being monitored and the patient was due for annual bitewings and a periapical x-ray, if necessary. The dental hygienist noted that the craze line on #8 extended subgingivally, so she opted to include a periapical radiograph of 8 and 9 was well. She also took intraoral photographs of #8.
Below is the intraoral picture and radiograph:
The vertical fracture line on #8 and the smaller one on #9 was not expected. In my many years of practice I have yet to see another dental x-ray showing this type of fracture with this type of clarity.
With the patient still in the chair, I tested 8 and 9 for vitality with Endo-Ice. Both tested vital. In this case, the patient’s age and years of bruxing had contributed to calcification of the coronal pulp chambers. As a result, root canal treatment was not needed. With these findings and impressive pictures and radiographs, the patient immediately consented to crowns on 8 and 9 and a new nightguard.
8 and 9 were prepared and 3 weeks later all porcelain LAVA crowns were cemented and then impressions were made for an NTI appliance. The patient has been asymptomatic since then. I did not take pictures of the tooth preparations or final crowns. I wish I had. But the fractures are the most impressive part of this case!