Friday, April 13, 2012

Crack in the Amour

I totally forgot to talk to you about the Masters. I will do that and then I will talk to you about a case I did this week.

First of all, if you are a golfer, YOU HAVE TO GO to the Masters. Everyone says they would love to go. Just go, for crying out loud! It’s just money. This year I was given a ticket, but as you may know, I went about 4 years ago with my father and paid about $270 for a ticket. It was so worth it.

My father said, "I didn't think I would ever get to do this. Thank you so much for taking me." I guess his generation still thinks something like this is unattainable. Ours is the "Let’s do this" kind of generation.
If it costs, so what?

I am trying not to retire at 60 or 65. My plan is to retire a little every year (which is why my wife and I go on big trips). I don't want to wait to do something that is only $270. I realize that is a lot of money, but if you could have seen my dad’s face, you would understand.

Anyway, this year I got a ticket and my buddy bought one ($350). We drove up after church on Sunday. I stayed at a friend’s house that lives about 5 miles from Augusta National. Augusta is kind of a one-horse town but it comes alive for a week in the spring. The club is exclusive and the tickets are hard to get, but once you are in, it is easy. Parking is free. Sandwiches (palmetto cheese) are $1.50, and beers and cokes are $1. No, that is not a misprint.

One thing that gets you is the merchandise store. The only place to get Masters shirts and towels and tees and ball marker stuff is at the Masters. It is not that they charge a lot (most of the stuff is reasonable), but you just end up buying a bunch of stuff.

We got there at 7 a.m, and hadn't spent any money on anything other than gas. I left the merchandise tent at 7:30 a.m. and spent $500. That is also not a misprint. In my life I have spent $500 on clothes but... Two shirts for me, one for my wife, one for my dad, two t-shirts for a couple of friends, a hat and I got a pullover (which was really nice) and BOOM $500.

I just can't describe it. The elevation is unreal. The people are nice. The golfers are thrilled to be there and very friendly. The grass and the course are almost perfect. Remember, if you are a golfer, YOU HAVE TO GO. Doctor’s orders. Anyway, here are the photos.

There is only one way in and this is what it looked like at 7:55 a.m. They open at 8 a.m.

The madness that is the merchandise shop.

Lee Westwood at hole #3

Tiger and Mark O'Meara

The Big Oak by the club house

Hole #10, where Bubba Watson hit that miraculous shot to win the tourney.

This is Amen Corner: the green of #11 is on the right, famous #12 is in the middle, and the tee of #13 is way back on the left.

Now, the blog topic. I have a rash of central incisors that have had vertical cracks in them. In the last couple of months, I have actually recommended crowns to quite a few of these people. Now, you know how conservative I am. But these cracks have been palatable.

Usually when you see craze lines you run your explorer over them and they’re smooth. These really made me think the tooth was cracking in half. I could see the crack in the x-ray. I went back 4 years and looked at their bitewings; I could see the crack getting bigger.

This is a first for me. I have never prepped a central incisor because of this crack. I really felt like the vitality of this tooth was in danger. No symptoms but a huge crack in their front tooth.

I have a woman coming back in a couple of weeks. I recommended both the central be done and another one be done. I prepped this tooth yesterday, and much to my surprise, the crack continued. After I got the enamel off the facial, this allowed more light into the tooth and I could start to see the crack on the ling. So instead of a veneer, which I considered, I did a full coverage crown. You can see on this photo that the crack is still there in the prep.


Here is the picture of the tooth before prepping. Looking at this photo, I know that the other central is definitely in danger of the same thing. I told the patient this. But there is no radiographic crack yet.


I didn't know what to tell this patient. I didn't know if I should tell her that this tooth could possibly act up. I don't know if this tooth is going to need endo in the future. didn't know if this was the ultimate treatment. Does it matter if I do an all-porcelain crown or should I use PFM?

Crazy, but I am going to look at these cracks a lot different now. I still don't think I am going to treat every one of them, but I think if I can see the crack on the x-ray, I definitely am going to start planting the crown seed.

Do you guys see a lot of this? Have you seen someone that has lost a central because of this? Let me know.

Have a great weekend.
john

1 comment:

Anonymous said...

Articles of interest

Articles of interest
http://www.amjdent.com/Archive/ReviewArticles/2008/Kahler%20AJD%2010-08.pdf
http://www.lifetimedentistry.net/article-clark-jerd2003.pdf

Certainly warn the patient and, personally, because of the existing restoration, obvious craze and the state of the other central, I would be suggesting crowning them both, unless I can definitively establish that a particular eccentric occlusion based only on the fractured tooth was to blame or some other specific incident. Always check for posterior prematurities, especially second or third molar contacts in extreme anterior or lateral excursions - it's amazing where some people are able to hold their mandibles!

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