Master Class

PART IV: 7 Symptomatic Cracked Teeth with Pulpal, Periradicular & Periapical Involvements: Diagnosis and Treatment

Preview Only, Purchase Required For Full Program Access.

Effective Date: September 1, 2017
Expiration Date: August 31, 2020
Format: Self Instructional - Audio Visual Voice-Over with Slides
Estimated Completion Time: 2.5 hours

Getting Started

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Program Summary

Part IV of the series focuses on how to apply the information learned in Part I, II and III of the cracked teeth master class series into clinical patient care.

The 4R Operational Diagnosis protocol is used in the diagnosis of the presented seven symptomatic cracked teeth cases, therefore each of the cases will include the 4R protocol findings profiles for:

  1. Patient Pain
  2. Ten Areas of Diagnostic Interest radiographic interpretation
  3. Pulp response
  4. Periodontal response
  5. Crown structure
  6. Pulp chamber content
  7. Canal content

A common diagnostic imaging finding in posterior cracked teeth, is pulp chamber opacity. Pulp Stones, denticles and calcific chamber recession are considered cardinal signs of the pathology commonly called pulpal calcification. the opacity is principally observed in unrestored, posterior cracked teeth or teeth with defective restorations, chronic caries and bacterial leakage.

Pulp calcification has detrimental effects on the dental pulp recovery from injury abilities and response to testing stimuli. Furthermore, it is known to complicate the endodontic treatment procedures. Because of its importance as diagnostic and the treatment risk factor, a special segment on the of pulpal calcification is featured in the introduction.

The 7-cases reviewed in the webinar represent an excellent sampling of the symptomatic cracked teeth cases encountered in general dental practices. Dr. Abou-Rass explains his guiding principles, clinical and biological rationales used in the treatment of each case.

The cases are as follows:

Case #1 Successful Conservative Treatment of a Cracked Tooth with Symptomatic Reversible Pulpitis
Case #2 Unsuccessful Conservative Treatment of a Cracked Tooth with Symptomatic Reversible Pulpitis
Case #3 Cracked Tooth with Symptomatic Irreversible Pulpitis
Case #4 Cracked Tooth with Symptomatic Early Apical Periodontitis or Apical Abscess
Case #5 Cracked Tooth with Symptomatic Chronic Apical Periodontitis without Isolated Periodontal Pocket (IPP)
Case #6 Cracked Tooth with Symptomatic Chronic Apical Periodontitis with Isolated Periodontal Pocket. (None Contributory TSC)
Case #7 Cracked Tooth with Symptomatic Chronic Apical Periodontitis with Isolated Periodontal Pocket. (Contributory TSC)

Target Audience

The target audience for this course is Dentists and Dental Specialists from novice to advanced. No prerequisites required.


Marwan Abou-Rass DDS. MDS. Ph.D

Marwan Abou-Rass DDS, MDS, Ph.D

Professor Emeritus,
Herman Ostrow School of Dentistry
University of Southern California

Dr. Abou-Rass brings nearly fifty years of cutting edge innovations in the field of endodontics and dental education. He pioneered the concept teaching molar versus central teeth as the best sequence for learning endodontic skills and developed the critical error approach to clinical performance evaluation.

In clinical endodontics, Dr. Abou-Rass has made a number of significant new concept and methodology contributions including:

  • Stressed pulp concept
  • Anti-curvature filing method
  • 4R Operational Diagnosis Protocol
  • Composite Post and Core buildup protocol
  • Endodontic Treatment Finalization Protocol
  • Interim Endodontic Therapy for native bone regeneration before implant placement

In addition to his DDS, Dr. Abou-Rass holds a Master’s degree in Dental Science in Prosthodontics , a certificate in Endodontics and a Ph.D., in Higher Education from the University of Pittsburgh, Pennsylvania. Dr. Abou-Rass served as Endodontic Department Chairman and Director of the Advanced Endodontic program at the University of Southern California, School of Dentistry (1971-2000). Dr. Abou-Rass moved to Riyadh, Saudi Arabia in 2000, where he directed the AEGD program at PAADI from 2000 to 2012.

Currently he is USC Professor Emeritus and publisher of Dental Economics MENA Journal and

Educational Objectives

At the end of this educational activity the dental professional should be able to:

  1. Describe the 4Rs operational diagnosis protocol findings for the following seven symptomatic cracked teeth conditions:
    • Symptomatic reversible pulpitis (successful TX)
    • Symptomatic reversible pulpitis (unsuccessful TX)
    • Symptomatic irreversible pulpitis
    • Symptomatic early apical periodontitis
    • Symptomatic chronic apical periodontitis without isolated periodontal pocket IPP.
    • Symptomatic chronic apical periodontitis with IPP. (Non-contributory crack)
    • Symptomatic chronic apical periodontitis with IPP. (Contributory)
  2. Distinguish between normal and abnormal diagnostic imaging of the pulpal and periodontal tissues using the 10 Areas of Diagnostic Interest (ADI) guidelines.
  3. Identify the different images of pulpal calcifications and pulp stones.
  4. Analyze endodontic treatment outcomes to determine the contributory or non-contributory role of TSC
  5. Classify TSC as contributory if it causes endodontic or periodontic pathology in the cracked tooth.
  6. Classify TSC as non-contributory if the cracked tooth pathology resolves following endodontic treatment.
  7. Describe the effects of contributory line cracks on the diagnostic image of the pulp chamber
  8. Describe the effects of contributory fissure and fracture crack on the diagnostic image of periodontal supporting tissue
  9. List the endodontic treatment measures that should be observed to prevent crack initiation or provocation
  10. List the restorative treatment measures that should be observed in order to prevent crack initiation or provocation.
  11. List the criteria for the restoration of cracked tooth with line crack in a tooth with healthy pulp.
  12. List the criteria for the endodontic treatment of a cracked tooth with line crack.

Recognition and Credits

ADA CERP and PennWell Logos

PennWell Corporation is an ADA CERP recognized provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Continuing education credits awarded for participating in the CE activity may or may not apply toward license renewal or specific license requirements in all states. It is the responsibility of each participant to verify the requirements of his/her state licensing board(s).

PennWell designates this activity for 2.5 credit hours of continuing education credits.

Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at

AGD PACE LogoThe PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to (12/31/2019) Provider ID# 320452.

Dental Board of California: Provider 4527, course registration number 01-4527-15160.
“This course meets the Dental Board of California’s requirements for 2.5 unit of continuing education.”

Requirements For Successful Completion

To receive credit for your participation in this webinar you will be required to complete the online program examination. To complete the online examination participants must be registered and signed-in to this website and have reviewed the program in its entirety. At the end of the program a link will be provided directing you to the program course exam. Once completed and submitted an immediate grade report will be displayed. All participants scoring at least 70% on the examination will receive a CE Verification Form verifying 2.5 CE credits. Verification forms may be viewed and printed immediately as well as accessed anytime in the future (24/7) from within the user records page of this website.

Not enough time to complete your online examination? No problem, online examinations may be completed anytime during the effective period of the program. Participants requiring more time to complete an examination may return to this website, sign-in and complete the online examination.

Disclosure Declaration

Presenter Disclosure: Dr. Abou-Rass, has no financial interest in any of the products or manufacturers mentioned

Commercial Support: This course was developed without commercial support.

Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity, No manufacturer or third party has had any input into the development of course content.

CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with any commercial supporter, or with products or services discussed in this educational activity. Heather can be reached at

Image Authenticity: No images in this educational activity have been modified or altered.

Scientific Basis: All content has been derived from references listed and/or the author’s clinical experience.

Known Benefits and Limitations: Information presented in this educational activity represents best practices in evidenced based dentistry with potential benefit for the patient and clinician. No off label or experimental treatments are discussed.

Educational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

Viewing Information

System Hardware/Software and Internet Connection Requirements

The following information is provided for your reference in conjunction with review of this program.

General System and Internet Requirements:  Speakers or Headphones, High Speed Internet connection, Wireless 3G and 4G,
Web browsers: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher and Chrome.

Operating Systems:  Windows 2000 or higher, (MS Surface and other MS mobile devices compatible), MAC OSX 10.3 or higher, Mac iOS 5.0 or higher (iPad, iPhone compatible), Android 4.3 or higher (most Android mobile devices compatible).