The Crack Quest – A Case By Dr. Manouchehr Kiaei

This Clinical Case involves a 74-year-old female patient who presented with sharp pain localized to her lower right molar region. Upon examination, it was determined that tooth #47, which had a large amalgam restoration, exhibited a visibly fractured buckle cusp with clear fracture lines extending mesial-distally.

The decision was made to remove the amalgam restoration, after which the fractured buckle cusp was carefully removed, revealing the extent of the fracture. At this stage, a discussion was held with the patient regarding treatment options, including either the placement of a crown or a composite restoration. Due to the patient’s ongoing pain, a temporary filling was placed as an interim measure, and the patient was monitored for a period of two weeks.

After this period, during which the patient experienced resolution of sensitivity and reported no further discomfort, the decision was made to proceed with a definitive restoration. The Predicta Bulk composite material (Parkell) was choses as its bioactive properties may help fill and seal the fracture lines within the tooth.

The unique properties of Predicta Bulk, particularly its ability to facilitate the precipitation of calcium and phosphate ions, were anticipated to support the formation of calcium apatite and enhance the longevity and stability of the restoration. The patient has since been largely symptom-free and has not experienced any recurrence of sensitivity. The case will be followed up over the next few years to monitor the long-term outcomes and durability of the restoration.