Diagnosis

The most important part of preparing a tooth to receive a crown, a fixed partial denture or a removable partial denture retainer is the diagnostic evaluation of the tooth before any treatment is initiated. Periodontal, radiographic and occlusal evaluations are all necessary to properly evaluate each tooth. This can avoid unforeseen complications that lead to stress for the practitioner and patient. Before tooth preparation is begun, the tooth must be evaluated with respect to caries, periodontal disease including gingival inflammation, a history of bruxism or clenching and a history of trauma. If one or more of these factors is present, it can greatly change the prognosis for hypersensitivity after tooth preparation and cementation procedures.

A history of deep caries may affect the ability of the pulp to readily recover from the trauma of tooth preparation. The postoperative hyperemia may last for an extended period of time before it is resolved and can be responsible for thermal or percussive hypersensitivity.

A history of periodontal disease may result in gingival recession over time that exposes the root surface. The exposed root surfaces can become very sensitive.

Parafunctional habit patterns may result in hypersensitivity of the teeth. The teeth are subjected to an abnormal amount of stress due to the forces generated by the muscles of mastication during clenching and bruxing. This may impair the ability of the pulp to recover following tooth preparation.¹

Trauma from motor vehicle accidents or athletic activities can have a long-term effect on the pulpal health of affected teeth. Traumatized teeth experience a much higher incidence of resorption.² Following tooth preparation, these teeth may respond similarly to the teeth that have extensive caries or periodontal disease.

It is important to evaluate these four conditions prior to tooth preparation. The patient can then be properly informed regarding the condition of their teeth and the potential need for root canal therapy. This should be carefully evaluated prior to tooth preparation and endodontic treatment initiated if the practitioner feels it is indicated.

It has been shown to be beneficial to place the patient on 0.12 percent chlorhexidine gluconate rinses for a period of two weeks prior to tooth preparation. Sorenson et al., has shown that this reduces gingival inflammation around the teeth to be prepared.³ The reduction of bacterial numbers from these rinses promotes a healthy preparation environment.