But after a while, and in the right light, the differences do make themselves clear. In Ray-Tracing mode, the world seems deeper, warmer, and softer - I am not going to get technical because Tom from Digital Foundry has done that. Shadows are darker and fill the cracks and corners and edges of the world; colours are richer and bolder; foliage is soft, almost like down, when you see it swaying in the wind before you.
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Tooth cracks may not show up on radiographs,[1,10,12,13,14,15] since X-ray photons passing through a radiolucent fracture plane also pass through extensive amounts of radiopaque healthy tooth structure. A tooth may be cracked if it shows, on a radiograph, a large peri-apical radiolucency that is contiguous with a furcation, or an entire root surrounded by a radiolucency.[10,16,17]
Cracked teeth are often asymptomatic. The pain symptoms that cracked teeth can show are not uniquely associated with cracked teeth but can occur with other causes of tooth pain, such as caries, pulpal pathology, or periodontal disease. Percussion sensitivity, if present, could indicate that the tooth has an irreversible pulpitis or an abscess, which may be associated with a crack. A cracked tooth may not exhibit temperature sensitivity if the crack has caused pulpal necrosis or exhibit sharp pain if a patient occludes on a rubber wheel placed on a suspected cracked cusp.[18] The only consistent sign of a cracked tooth is the existence of a fracture plane within the tooth.
Cuspal fractures can be caused by forces put on existing restorations during masticatory cycles; these forces stress the stress planes located apical to the cusps that retain the restorations.[32,40] With an amalgam, the preparation axial walls converge toward the occlusal, so occlusally directed forces on the restoration stress the cuspal stress planes. The walls of an inlay preparation diverge toward the occlusal, so apically directed forces stress the cuspal stress planes. If the dentist removes the restoration and observes the dried preparation surface, the dentist may observe a crack line located at what was previously the apical-lateral aspect of the restoration [Figure 7].
Cuspal fracture planes can develop inside a tooth without showing visible crack lines on the external surface of the tooth, if the fracture plane is subgingival, or if the fracture plane has not expanded enough in area to reach the external tooth surface [Figure 9]. A dentist may not treat such a tooth due to inability to locate a crack line,[41,42] and the tooth may feel sensitive for a long time; later, a cusp may break off, and the sensitivity may consequently end. The diagnosis of a crack in a tooth with no visible crack line requires presumption, and the patient's conviction of which tooth is sensitive. Cementing an orthodontic band[41,43,44,45] on such a tooth aids in the diagnosis if doing so eventually reduces the discomfort.
A radiograph of a maxillary molar that contains minimal remaining coronal tooth structure that can help to retain the large mesial-occlusal-distal restoration. The remaining tooth structure is under higher stress levels from retaining the restoration. Part of the distal aspect of the remaining tooth structure fractured, showing that the remaining tooth structure is not strong enough to retain this direct restoration without developing cracks
A dentist may be tempted to drill out a crack line until the dentist has reached healthy tooth structure, and then place a direct restoration, to seal the tooth structure. However, a crown may be needed to prevent the original causes of the crack from causing further crack propagation.[65] Drilling into a fracture plane by following a crack line theoretically should not substantially reduce the structural stability of the tooth, since tooth structure along a fracture plane is not chemically bonded and therefore does not help to bind the tooth together. Such crack line drilling should be done with a thin bur to ensure a conservative, narrow drilling width that preserves dentin, with microscopes ensuring that the dentist does not drill past the apical extent of the fracture plane.
Microscopes facilitate observation of microscopic crack lines that may show minimal color contrasts against a desiccated tooth surface [Figure 12], without needing trans-illumination or dyes to observe crack lines. Microscopically precise tactile sensation permits verification of a crack by associating the tactile sensation of an explorer tip falling into a cleft with the microscopic point on a crack line where the tip is located. Microscopes permit detecting microscopic amounts of debris in the cleft,[5] or microscopic differences, in the respective directions of movement, of separate tooth structures shifting independently of one another around a cleft [Figure 13]. Stripping a microscopically thin layer from a surface with a deep craze line may reveal uncracked underlying tooth structure, indicating that the crack is superficial.
Microscopes permit accurate visual estimation of the steepness of cuspal inclines, and allow precise observation of where a pointy lingual plunger cusp occludes into an opposing tooth, and observation if a microscopic crack line is developing around this contact area. Microscopic amounts of chalky white or beige discoloration underneath a cusp can be indicative of caries under the cusp, which sometimes can be overlying a fracture plane. Microscopes facilitate observing microscopic gaps or elevations of restoration margins, which may indicate cracks. Microscopes improve the ability to understand the dimensions of foreshortened surfaces. This facilitates observing a marginal ridge crack from an occlusal viewing vantage point, to assess how closely to the gingiva the crack has propagated.
Using microscopes and co-axial illumination, a dentist may drill an exploratory column through a crack line, to observe the depth at which the crack line disappears, or to assess if the crack line extends into the pulp chamber roof. Sometimes, such exploratory drilling may be necessary to allow a dentist to discover that an asymptomatic tooth has a fracture plane that extends into the pulp chamber. Discovering this allows a dentist to diagnose that this asymptomatic tooth has a necrotic nerve. Although such exploratory drilling is not necessarily superior to thermal, and electric pulp testing for diagnosing a necrotic nerve, such exploratory drilling may be a useful diagnostic adjunct if the thermal and electric pulp testing results are inconclusive.
A compression fracture forms in the spine when the vertebrae suffer any sort of trauma that causes them to crack under an overload of pressure. Vertebral compression fractures can develop due to sudden trauma from a fall or injury, but they most commonly occur as a result of decreased bone density or bone strength. Weakened bones make the vertebrae more susceptible to a compression fracture from even minor occurrences, such as sneezing aggressively, missing a stair and stepping down sharply, or lifting a heavy object.
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Endodontists specialize in saving cracked teeth and will cater treatment to the type, location, and extent of the crack. The sooner your tooth is treated, the better the outcome. Once treated, most cracked teeth continue to function as they should, for many years of pain-free biting and chewing.
To understand why a cracked tooth hurts, it helps to know something about the anatomy of the tooth. Inside the tooth, under the white enamel and a hard layer called the dentin, is the inner soft tissue called the pulp. The pulp contains the tooth's nerves and blood vessels.
When the outer hard tissues of the tooth are cracked, chewing can cause movement of the pieces, and the pulp can become irritated. Eventually, the pulp will become damaged to the point that it can no longer heal itself.
The tooth will not only hurt when chewing but may also become sensitive to temperature extremes. In time, a cracked tooth may begin to hurt all by itself. Extensive cracks can lead to infection of the pulp tissue, which can spread to the bone and gum surrounding the tooth.
A cracked tooth means a crack extends from the chewing surface of your tooth vertically toward the root. The tooth is not yet separated into pieces, though the crack may gradually spread. Early diagnosis is important in order to save the tooth. If the crack has extended into the pulp, the tooth can be treated with a root canal procedure and a crown to protect the crack from spreading.
A split tooth is often the result of the long-term progression of a cracked tooth. The split tooth is identified by a crack with distinct segments that can be separated. A split tooth cannot be saved intact. The position and extent of the crack, however, will determine whether any portion of the tooth can be saved. In some cases, endodontic treatment may be performed to save a portion of the tooth.
Vertical root fractures are cracks that begin in the root of the tooth and extend toward the chewing surface. They often show minimal signs and symptoms and may, therefore, go unnoticed for some time. Vertical root fractures are often discovered when the surrounding bone and gum become infected. Treatment may involve extraction of the tooth. However, endodontic surgery is sometimes appropriate if a tooth can be saved by removal of the fractured portion.
Unlike a broken bone, the fracture in a cracked tooth will not heal. In spite of treatment, some cracks may continue to progress and separate, resulting in loss of the tooth. Placement of a crown on a cracked tooth provides maximum protection but does not guarantee success in all cases. 2ff7e9595c
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