Techniques for Diagnosing Cracks in Teeth

Three Visual–Diagnostic Methods for the Detection of Enamel Cracks: An In Vitro Study 
by Tim Hausdörfer, Lisa Harms, Philipp Kanzowand Michael Hülsmann

Excerpts from the paper:

Studies show that a cracked tooth is the third most common reason for tooth loss in developed countries. If detected early and accurately, patients can retain their teeth for a longer time. Unfortunately, most cracks remain undetected in the early phase due to nonspecific symptoms and a lack of adequate diagnostic tools. Within this study, only methods already routinely used in dental practice were evaluated.

To the best of our knowledge, this study assessed the validity of three examination methods readily available in dental practice for crack diagnosis under standardized conditions with two different examiners for the first time. With the limitations of an in vitro study, it can be concluded that FOTI and NIR are suitable for crack detection. Especially in the accessible tooth surfaces (vestibular and oral), we found good values for sensitivity and specificity. Unfortunately, no single method was able to estimate the exact crack depth.

Introduction to Cracked Teeth
Jeff Lineberry, DDS, FAGD, FICOI, AAACD

Discuss the different classifications of cracked teeth, the diagnostic methods for cracked teeth, and how to treat and manage them.

Diagnosis of cracked tooth: Clinical status and research progress
by Mingyue Yu, Jianing Li, Shuang Liu, Zunxuan Xie, Jinyao Liu, and Yuyan Liu

Excerpts from the paper:

Cracked tooth is a common dental hard tissue disease. The involvement of cracks directly affects the selection of treatment and restoration of the affected teeth. It is helpful to choose more appropriate treatment options and evaluate the prognosis of the affected tooth accurately to determine the actual involvement of the crack. However, it is often difficult to accurately and quantitatively assess the scope of cracks at present. So it is necessary to find a real method of early quantitative and non-destructive crack detection. This article reviews the current clinical detection methods and research progress of cracked teeth in order to provide a reference for finding a clinical detection method for cracked teeth.

Why Warm Your Composites?

Research has shown how it improves restorative outcomes for over 20 years!

There is research available that demonstrates why warming composite works, from better adaptation to color stability. The following are just a couple of examples.

Greater Degree of Conversion

The Effect of Temperature on composite Polymerization Stress and Degree of Conversion –Fernando C. Calheiros, Marcia Daronch, Frederick A. Rueggeberg, Roberto R.Braga

Clinical significance: Increasing composite temperature allows for reduced exposure duration and lower polymerization stress (both maximum and final) while maintaining or increasing the degree of conversion.

Reduced Shrinkage/ShrinkageStress

Pre-heating of high-viscosity bulk-fill resin composites: Effects on shrinkage force and monomer conversion.Journal of Dentistry – Taubock Tobias T,Tarle Zrinka, Marovic Danijela, Attin Thomas

Clinical significance: Composite pre-heatings significantly reduces shrinkage force formation of high viscosity bulk-fill and conventional resin composites, while maintaining or increasing the degree of monomer conversion, dependent upon the specific composite material used.

Less Micro-Leakage

Effect of pre-heating resin composite on restoration microleakage Warren C Wagner, Mert N Aksu, Ann-Marie L Neme, Jackson B Linger, Frank E Pink, Stephen Walker

Results: Preheating the composite resulted in significantly less microleakage at the cervical margins compared to the flowable liner and control.

Do preheated composites have less shrinkage?
This experiment was done by Professor Allan Grayson, DDS at NYU College of Dentistry.

Objective: To demonstrate the difference in shrinkage between room temperature and preheated composite.

Steps used in the experiment:

    1. Cut down anesthetic vials that were sandblasted inside. Bonding agent,(Scotch Bond) applied to the inner glass walls and cured.
    2. Glass vials maintained in a 940 F water bath.
    3. A composite, (3M, Filtek Supreme) was placed in the left vial using a Compex HD dispenser at approximately 1550 F (680 C).
    4. A composite, (3M, Filtek Supreme) was placed in the right vial at room temperature.
    5. Both specimens were approximately 3 mm thick and cured for 20 seconds with a Valo curing light @ 1,500 mw/cm2
    6. A Red-Cote disclosing dye was placed in both vials.


    1. Note that the red dye did not penetrate the inner circumference of the vial on the left which used a preheated composite.
    2. Note that the red dye penetrates the inner circumference of the room-temperature composite vial on the right.

Knit Lines and Voids in Dental Fillings by Dr. Richard Price

Dr. Price demonstrates how warmed composites have fewer knit lines and voids than room temperature composite.

Techniques for Creating Marginal Ridge and Contact in Restorative Dentistry

Clinical considerations in restorative dentistry – A Narrative Review
by Shivakumar, Ashwini Tumkur; Kalgeri, Sowmya Halasabalu; Dhir,Sangeeta

Excerpts from the paper:

Restoring the proper anatomy of the tooth and maintaining the health of the soft tissue should be a prime consideration during the restorative procedure. This article reviews the clinical considerations that need to be adopted while restoring a natural tooth and or implant restoration.

Re-establishing the anatomy of the tooth Contact and contours

Establishing interproximal contact is the primary objective of restorative procedures. Ideal Proximal contact acts as a barrier against food impaction and thus contributes to underlying periodontal health. By providing food spillways and facilitating hygienic cleaning.

Improper restoration in the contact area will cause displacement of the teeth, lifting forces of the teeth, rotation of the teeth, deflecting occlusal contact, and food impaction.

How To: Marginal Ridge Heights in Class II Restorations | Tips from Dr. Lincoln Harris

In this video, Dr. Lincoln Harris shares tips and tricks for avoiding this common problem. He explains the factors contributing to high marginal ridges and demonstrates how to get the matrix height just right.

Click here to watch video

Creating Interproximal Contacts with Direct Restorations Presented by Javier Quirós, DDS

In this Tip of the Month video, Dr. Quirós shares a quick tip on creating great contacts in posterior restorations. Dr. Quirós uses matrices and composite to turn Class II restorations into easy Class I’s.

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Influence of composite resin consistency and placement technique on proximal contact tightness of Class II restorations
by Bas A C Loomans, Niek J M Opdam, Joost F M Roeters, Ewald M Bronkhorst, Alphons J M Plasschaert

Results:  The use of medium- or high-viscosity instead of a low-viscosity composite resin resulted in statistically significantly tighter proximal contacts (p < 0.01). The use of a separation ring resulted in a large, statistically significant increase (p < 0.001) in contact tightness. In contrast, the use of a hand instrument resulted in a small, statistically significant increase in contact tightness (p = 0.017). No statistically significant differences were found when a dead-soft matrix or a sectional matrix was used instead of a Tofflemire (p = 0.159, p = 0.261, resp.).

Conclusion: The use of a separation ring when restoring a Class II composite resin restoration has a greater influence on the obtained proximal

April is Oral Cancer Awareness Month

April is Oral Cancer Awareness Month

Dental associations urge regular oral cancer examinations – early detection saves lives!

Oral cancer screening is a quick process that takes only a few minutes, and dental professionals know that early detection of a problem can lead to faster and less invasive cancer treatment.

It’s important to discuss why oral cancer screenings are performed with your patients. If you come across suspicious areas, it’s crucial to recommend a follow-up appointment. If the suspicious area is still present at the follow-up,  encourage the patient to have the lesion examined for their peace of mind.

Dental professionals have expertise in the anatomy of the mouth, head, and neck, and by looking beyond the teeth and broadening our view, we can make a difference in the lives of our patients.

Your Healthy Family: April is oral cancer awareness month

Why you should do a screening and let your patients know what you are doing.

Click here to watch video

Surviving Oral Cancer: Melissa's Story

How her Dentist’s care saved her life and how much he means to her now.

Click here to watch video

Biofilm – what it is and why it matters

Biofilm – what it is and why it matters

Biofilm refers to communities of bacteria that form in various environments, including the human body. These bacterial clusters, if left unchecked, undergo maturation, leading to the development of pathogenic bacterial complexes that can result in oral health issues such as dental caries, gingivitis, and periodontitis. Identifying, disrupting, and managing these biofilms is crucial for the success of treatments and the overall well-being of patients. The significance of addressing biofilms lies in their connection to oral health, which is often considered a vital aspect of overall well-being. Poor dental health not only serves as the root cause of various oral problems and systemic diseases but can also have negative psychological effects, impacting self-esteem. Despite ongoing efforts to prevent biofilm formation on dental enamel, the challenge persists due to the universal phenomenon of adsorption and adhesion by sessile cells on dental tissue. Therefore, rapid diagnosis, vigilant surveillance, and regular interventions are essential to effectively combat the consequences of biofilm formation and promote optimal oral health.

Read: Biofilm Clinical Article

Dental biofilm: Risks, diagnostics, and management by Rina Rani Ray

Excerpts from the clinical article:

Biofilms are communities of bacteria that exist in both the human body and the environment. If left unattended, these biofilms undergo maturation, and the resulting pathogenic bacterial complex can lead to dental caries, gingivitis, and periodontitis. It is important to identify, disrupt, and manage these biofilms to ensure the success of your treatments and the well-being of your patients.


Oral health is considered to be wealth, as poor dental health is not only the root cause of various oral problems and various systemic diseases but also imparts negative psychological effects by damaging self-esteem. Despite many promising strategies for the prevention of biofilm formation on dental enamel, the pervasive phenomenon of adsorption and adhesion by the sessile cells on dental tissue is becoming a universal phenomenon. Rapid diagnosis with strong surveillance and regular use of…

Watch: Does Dental Affect Your Heart

Does Dental Health Affect Your Heart? – Cleveland Clinic

To learn more about oral health and the risk for cardiovascular disease.

Read: Biofilm Clinical Article

Dental plaque as a biofilm and a microbial community – implications for health and disease – Philip D. Marsh

Excerpt from the clinical article:

Dental plaque is the community of microorganisms found on a tooth surface as a biofilm, embedded in a matrix of polymers of host and bacterial origin. Of clinical relevance is the fact that biofilms are less susceptible to antimicrobial agents, while microbial communities can display enhanced pathogenicity(pathogenic synergism). The structure of the plaque biofilm might restrict the penetration of antimicrobial agents, while bacteria growing on a surface grows slowly and display a novel phenotype, one consequence of which is a reduced sensitivity to inhibitors.


The key to a more complete understanding of the role of microorganisms in dental diseases such as caries may depend on a paradigm shift away from concepts that have evolved from studies of classical medical infections with a simple and specific (e.g. single species) etiology to an appreciation of ecological principles. The development of plaque-mediated disease at a site may be viewed as a breakdown of the homeostatic mechanisms that normally maintain a beneficial relationship between the resident oral microflora and the host. … This way, the clinician does not just treat the end result of the caries process but also attempts to identify and interfere with the factors that, if left unaltered, will inevitably lead to more disease.

Unlocking the Power of Bioactive Materials in Restorative Dentistry

Unlocking the Power of Bioactive Materials in Restorative Dentistry

In the realm of modern dentistry, the quest for materials that not only restore but actively promote oral health has led to a revolutionary breakthrough: bioactive materials. These innovative substances represent a paradigm shift, transforming traditional restorative procedures into opportunities for proactive dental care. As we delve into the realm of bioactive materials used in restorations, we uncover a world where dental treatments not only repair but also rejuvenate, offering patients a path to lasting oral health and vitality.

Join us on a journey to explore the science, benefits, and clinical applications of bioactive materials, as we unlock their transformative potential in restorative dentistry.

WATCH: Bioactive Dental Materials

In a one-hour video, Dr. Robert Lowe explores the transformative potential of bioactive dental materials in restorative dentistry. He discusses how these materials contribute calcium and phosphate ions, aiding in the natural processes of rebuilding healthy apatite. This represents a new paradigm in restorative dentistry, offering exciting possibilities for enhancing dental treatments.

READ: Clinical Study on Natural Layering Concept

A new shading concept based on natural tooth color applied to direct composite restorations by Didier Dietschi, DMD, PhD, Stefano Ardu, DMD, Ivo Krejci, DMD

Excerpts from the clinical study:

Influence of the natural layering concept on shade recording:
The quality of the final restoration, of course, depends on a correct shade recording. According to the natural layering concept, only 3 steps are involved: (1) selection of dentin chroma in the cervical area, where enamel is the thinnest, using samples of the composite material, (2)selection of enamel tint and translucency, by simple visual observation, and (3) preparation of a simplified chromatic map(visually or through an intraoral photograph) to decide whether the application of effect materials is needed.


The natural layering concept has enabled this objective to be achieved in a predictable way by incorporating newly acquired knowledge about natural tissue optical properties into contemporary composite systems. This advance can be regarded as a milestone in operative dentistry, as it will give direct composite application a tremendous advantage, enabling a larger number of patients to receive more conservative and esthetic restorations.

READ: Article on the Promise of Bioactive Restorative Dental Materials

Bioactive Restorative Dental Materials Hold Great Promise in Terms of Function, Use by John Fluke, DDS

Excerpt from the article:

Bioactive materials have been a part of dentistry for several years, but what makes these materials markedly different from traditional dental materials? With bioactive materials, direct dental restorations can interact with the oral environment and encourage activity that can be beneficial to both the lifespan of the restoration, but also to the health of the restored tooth and surrounding dentition. Understanding what bioactive dental materials are, how they work, and where and when they are best used is an important part of deciding on the best restorative material for a case.

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