Breaking the mould

30 May 2024

Nimisha Nariapara explains how oral scanning can be a helpful tool to diagnose and treat enamel cracks.

Diagnosing a cracked tooth can be difficult, as symptoms can differ according to the location and extension of the incomplete fracture. Early detection is critical because restorative treatment can prevent fracture propagation, microleakage, pulpal or periodontal tissue involvement, and catastrophic cusp failure.

Cracked dental enamel occurs when the outer layer of the tooth is compromised, while incomplete tooth fractures involve damage to both the enamel and underlying layers of the tooth. These conditions can arise due to several causes, including trauma from accidents or injuries, biting down on hard substances like ice or nuts, bruxism and tooth decay.

One of the primary symptoms of cracked dental enamel and incomplete tooth fractures is tooth sensitivity, especially to hot or cold temperatures. Patients may also experience pain or discomfort when biting or chewing, as the damaged tooth structure can put additional pressure on the nerve endings. The prevalence of cracked teeth is around 80 per cent in patients over 40 years of age, and these fractures are more common in restored teeth.

Micro enamel cracks and incomplete tooth fractures are conditions that often go unnoticed in 2D dental imaging techniques. Indeed, traditional methods of dental crack detection are not sensitive or specific. They include clinical examination, visual inspection, exploratory excavation, and percussion testing. The dye test used blue or gentian violet stains to highlight fracture lines.

Early detection

3D scans, however, can give a more precise examination of the damage caused to the tooth’s structure, allowing for early detection of cracks and fractures and, therefore, an enhanced prognosis. In fact, cone-beam computed tomography (CBCT) has been shown to be more efficacious than traditional clinical dental imaging techniques in detecting longitudinal tooth cracks.One of the main advantages of 3D oral scanning technology is its ability to capture highly detailed and accurate images of the teeth and surrounding structures. Unlike traditional imaging techniques like X-rays, CBCT scanning creates a three-dimensional model of the entire oral cavity. This allows an examination of the teeth from all angles and can detect even the smallest cracks or fractures that may be present.

CBCT scanning technology allows for precise measurements to be taken. This is particularly useful in diagnosing micro cracks and incomplete fractures, as it can help determine the extent and severity of the condition. Dental professionals can then accurately measure the depth and width of the crack or fracture, providing them with valuable information to develop the appropriate treatment plan.

CBCT scanning then facilitates the creation of custom-made dental restorations for patients with a crack or fracture diagnosis. The scan data can be sent to a dental laboratory, where technicians can use computer-aided design and manufacturing technology to fabricate precise and natural-looking dental crowns or fillings (if necessary). This ensures a better fit and durability compared to traditional communication methods, improving the long-term prognosis for patients with these dental conditions.

AI assistance

Artificial intelligence (AI)-powered systems have significantly improved the diagnostic capabilities of 3D oral scanning. By analysing the captured data, AI algorithms can detect abnormalities, identify potential cavities, and even assist in early-stage oral cancer detection. This can help dental professionals make more accurate and timely diagnoses, enabling earlier intervention and better treatment outcomes. This data-driven approach allows for more personalised treatment planning too, as dental clinicians can consider individual patient characteristics and history when making informed decisions.

The CS 9600 CBCT system from Carestream Dental features AI-powered positioning which records each patient’s parameters, making follow-up imaging repeatable with a single touch. Featuring never before achieved 2D and 3D imaging quality, the unit is scalable and designed to grow with a practice. It offers a multi-function system blending 2D panoramic and cephalometric imaging, CBCT imaging, 3D facial scanning and 3D model scanning. With its Scan Ceph module, the system is even smarter and more versatile than ever. Boasting a 10-year warranty for greater peace of mind, it is perfect for dental professionals looking for a new level of precision.

CBCT scanning technology is a valuable tool for dental professionals in the diagnosis and treatment of micro enamel cracks and incomplete tooth fractures. Its ability to provide highly detailed and accurate images, precise measurements, and aid in treatment planning makes it an invaluable asset in modern dentistry. By incorporating CBCT scanning into their practice, dental professionals can enhance their ability to detect and treat these dental conditions, resulting in improved patient outcomes and overall oral health.

References available on request.