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de Toubes KMS, Corrêa IS, Valadares RCL, Tonelli SQ, Bruzinga FFB, Silveira FF. Managing Cracked Teeth with Root Extension: A Prospective Preliminary Study Using Biodentine™ Material. Int J Dent 2024; 2024:2234648. [PMID: 38756384 PMCID: PMC11098601 DOI: 10.1155/2024/2234648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/29/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose The authors of this study proposed an innovative approach involving the use of Biodentine™ material as an intraorifice barrier in cracked teeth with root extension to promote internal crack sealing, preventing the possibility of microinfiltration and apical crack propagation. Materials and Methods The dental records of 11 patients with 12 posterior cracked teeth with root extension were included with a precise protocol performed by a senior endodontist. The treatment protocol included pulp diagnosis, crack identification using a dental operating microscope (DOM), endodontic treatment, placing a Biodentine™ as an intraorifice barrier, and immediate full-coverage restoration. The effectiveness of the treatment was assessed at two intervals, 6 months, and 1-3 years posttreatment, evaluating clinical, radiographic, and tomographic aspects. The treatment was deemed successful if there were no indications of radiolucency, sinus tracts, edema, or periodontal pockets associated with the crack line. Results The study observed remarkably positive outcomes during the follow-up period, which spanned from 1 to 3 years. All the cracked teeth (100%) remained asymptomatic, meaning they were free of pain or discomfort. Furthermore, these teeth were in occlusal function. Both radiographic and tomographic assessments revealed the absence of bone loss along the crack line. This outcome signifies that the treatment effectively prevented further deterioration of the surrounding bone. Conclusions Integrating advanced biomaterials and conservative restorative techniques has paved the way for innovative approaches in dental care. This protocol suggests a proactive step for managing cracked teeth with root extension. It addresses both biological aspects by sealing internal cracks and mechanical aspects by preventing crack progression, thereby improving these teeth' prognosis and long-term survival.
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Affiliation(s)
| | - Isabella Sousa Corrêa
- Department of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Frank Ferreira Silveira
- Department of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil
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Michaelson PL. 7.5- to 11.5-Year Follow-up of the Fracture Removal Treatment for Propagated Crown Fractures. J Endod 2024; 50:527-532. [PMID: 38278318 DOI: 10.1016/j.joen.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/18/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
A definitive method to predictably treat propagated longitudinal fractures remains elusive. A proof-of-concept case report series documenting nonsurgical removal of propagated longitudinal fractures has shown up to 5 years of clinical and radiographic success. This installment of the case report series further documents these teeth with 7.5-year to 11.5-year recall evaluations. Three previously reported cases of fracture removal were followed at 11.5 years (1 case), 9.75 years (1 case), and 7.5 years (1 case) after treatment to determine the long-term clinical and radiographic success of nonsurgical fracture removal. This case report series has demonstrated 10-year success (clinically and radiographically) for the treatment of progressive longitudinal fractures. Propagated fractures can be nonsurgically removed and the iatrogenic defect repaired with long-term success providing a foundation for treatment and further investigation.
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Zhang S, Xu Y, Ma Y, Zhao W, Jin X, Fu B. The treatment outcomes of cracked teeth: A systematic review and meta-analysis. J Dent 2024; 142:104843. [PMID: 38272437 DOI: 10.1016/j.jdent.2024.104843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES The aim of this review was to analyze the clinical treatment outcomes of cracked teeth (CT) retaining vital dental pulp (CT-VDP) or undergoing root canal treatment (CT-RCT). SOURCES A systematic search was conducted in Medline, Embase, PubMed, and Cochrane Library databases. STUDY SELECTION Studies evaluating tooth survival rate (TSR), pulp survival rate (PSR), and success rate (SR) with at least a one-year follow-up were included. The risk of bias was evaluated with the Newcastle-Ottawa scale. DATA Twenty-seven studies underwent qualitative analysis, 26 of which were included in the meta-analysis. SR of monitoring without restorative treatments was 80 % at three years. TSR of CT-VDP was 92.8-97.8 % at 1‒6 years, PSR of CT-VDP was 85.6‒90.4 % at 1‒3 years, and SR of CT-VDP was 80.6‒89.9 % at 1‒3 years; TSR of CT-RCT was 90.5‒91.1 % at 1‒2 years, and SR of CT-RCT was 83.0‒91.2 % at 1‒4 years. Direct restorations without cuspal coverage for CT-VDP increased the risk ratio (RR) of pulpal complications (RR=3.2, 95 % CI: 1.51-6.82, p = 0.002) and tooth extraction (RR=8.1, 95 % CI: 1.05-62.5, p = 0.045) compared with full-crown restorations. The CT-RCT without full-crown restorations had an 11.3-fold higher risk of tooth extraction than the CT-RCT with full-crown restorations (p < 0.001). CONCLUSIONS Monitoring without restorative treatments might be an option for the CT without any symptoms. Direct restorations without cuspal coverage for the CT-VDP could significantly increase the RR of pulpal complications and tooth extraction compared with full-crown restorations. Full-crown restorations are strongly recommended for the CT-RCT. CLINICAL SIGNIFICANCE Monitoring without restorative treatments could be a viable option for the CT without any symptoms. Full-crown restorations are strongly recommended for the CT with any symptoms and the CT-RCT.
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Affiliation(s)
- Sisi Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yingcai Xu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yuhan Ma
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Weijia Zhao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiaoting Jin
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Baiping Fu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China.
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Mathew VB, Shamsuddin S, Langaliya A, Rathod PT, Gupta B, Ronsivalle V, Cicciù M, Minervini G. Survivability of endodontically treated cracked tooth: A systematic review. Technol Health Care 2024:THC231993. [PMID: 38517822 DOI: 10.3233/thc-231993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Literature evidence describes various treatment protocols that have been employed for the effectiveness in improving survival and addressing associated symptoms of cracked teeth. OBJECTIVE This systematic review investigates the survivability of endodontically treated cracked teeth and associated assessments, focusing on various treatment protocols. METHODS The PRISMA guidelines were utilised for guiding the article selection framework of this review. A comprehensive search of relevant literature was conducted in May 2023 across various databases, and studies meeting the inclusion criteria were selected. Data extraction, guided by a standardized form, captured crucial details, including study characteristics, treatment protocols, and treatment outcomes, enhancing the consistency and accuracy of information collection. Data extraction and synthesis was done by two reviewers independently. The Newcastle Ottawa tool was used to measure the methodological quality of the study. Six observational studies were eventually included. RESULTS Mandibular molars are particularly prone to developing cracks, with research indicating a heightened susceptibility to this dental issue. Studies reveal that endodontically treated cracked teeth boast robust overall survival rates ranging from 75.8% to 100%. The risk of bias assessment, utilizing the Newcastle Ottawa scale, indicated a moderate risk across studies, highlighting the necessity for careful interpretation of findings. CONCLUSION Endodontically treated cracked teeth show marked success in survival, with the incorporation of crowns post-endodontic treatment significantly enhancing longevity and resilience.
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Affiliation(s)
- Vinod Babu Mathew
- Department of Restorative Dentistry College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | | | - Akshayraj Langaliya
- Department of Conservative Dentistry and Endodontics, AMC Dental College and Hospital, Ahmedabad, India
| | - Priyanka Tikaram Rathod
- Department of Prosthodontics Crown and Bridge and Implantology, SMBT Institute of Dental Sciences and Research, Nashik, India
| | - Bharti Gupta
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Yap RC, Alghanem M, Martin N. A narrative review of cracks in teeth: Aetiology, microstructure and diagnostic challenges. J Dent 2023; 138:104683. [PMID: 37713950 DOI: 10.1016/j.jdent.2023.104683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES To summarize the available evidence of crack formation in teeth and to discuss the limitations of the current clinical diagnostic modalities for crack detection in teeth. BACKGROUND Cracks are a common clinical finding in teeth and yet clinicians still struggle to identify the full extent and orientation of cracks for their appropriate timely management. The biomechanics of crack development can be due to multiple factors and can differ from an unrestored tooth to a restored or endodontically treated tooth. DATA & SOURCES This narrative review has been designed following the guidelines published by Green et al. 2006 [1] Published literature in the English language that addresses the objectives of this review up to July 2022 was sourced from online databases and reference lists. The relevance of the papers was assessed and discussed by two reviewers. A total of 101 publications were included in this narrative review. CONCLUSIONS The initiation and development of cracks in teeth are likely linked to an interplay between the masticatory forces and fracture resistance of the remaining tooth structure. From the identified literature, the quality and quantity of remaining tooth structure in a restored or endodontically-treated tooth affects the biomechanics of crack development compared to an unrestored tooth. The extent, orientation, and size of the cracks do affect a clinician's ability to detect cracks in teeth. There is still a need to develop reliable diagnostic tools that will accurately identify cracks in teeth beneath restorations to enable effective monitoring of their propagation and provide appropriate interventions. CLINICAL SIGNIFICANCE The development and propagation of cracks in an unrestored tooth differ greatly from a restored and endodontically treated tooth; mainly linked to the quantity and quality of the remaining tooth structure and the forces acting on them. Identifying the extent of cracks in teeth remains challenging for early clinical intervention.
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Affiliation(s)
- Rei Chiel Yap
- DClinDent student, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK.
| | - Meshal Alghanem
- DClinDent student, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK.
| | - Nicolas Martin
- Professor of Restorative Dentistry, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK.
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Son SA, Kim JH, Park JK. Clinical applications of a quantitative light-induced fluorescent (QLF) device in the detection and management of cracked teeth: A case report. Photodiagnosis Photodyn Ther 2023; 43:103735. [PMID: 37544373 DOI: 10.1016/j.pdpdt.2023.103735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The aim of this case report was to discuss the clinical application using a quantitative light-induced fluorescent (QLF) device for the diagnosis and treatment of a cracked tooth as visualizing the tooth's crack. CASE REPORT A 39-year-old woman visited a dental hospital complaining of throbbing pain on tooth #36. Observation of the tooth with naked eyes showed that tooth had a ceramic restoration with no specific findings. QLF device's images around the restoration, and after removal of the restoration were taken. In the QLF image after removal of the restoration, clear red-fluorescent crack line was shown, indicating that microorganism had penetrated along the crack path. During root canal treatment, the QLF image of the inside of the pulp chamber showed a pattern in which the crack line progressed into the tooth. During the treatment of the cracked tooth, the crack line was removed as much as possible using the fluorescent information obtained by the QLF device, and crack lines of fluorescence images quantitatively analyzed using a QLF's software. CONCLUSION Images acquired with the QLF device can provide useful information for detecting crack lines, recording the treatment process, and restorative management of cracked teeth.
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Affiliation(s)
- Sung-Ae Son
- Department of Conservative Dentistry, Dental and Life Science Institute, Dental Research Institute, School of Dentistry, Pusan National University, Geumo-ro 20, Mulgeum-eup, Box 50612, Yangsan, Republic of Korea
| | - Jae-Hoon Kim
- Department of Dental Education, Dental and Life Science Institute, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Republic of Korea
| | - Jeong-Kil Park
- Department of Conservative Dentistry, Dental and Life Science Institute, Dental Research Institute, School of Dentistry, Pusan National University, Geumo-ro 20, Mulgeum-eup, Box 50612, Yangsan, Republic of Korea.
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Wylie ME, Parashos P, Fernando JR, Palamara J, Sloan AJ. Biological considerations of dental materials as orifice barriers for restoring root-filled teeth. Aust Dent J 2023; 68 Suppl 1:S82-S95. [PMID: 37607102 DOI: 10.1111/adj.12970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
There is ample published literature regarding the technical aspects of restoring root-filled teeth, but little concerning the biological impacts, consequences, and criteria for the selection of direct restorative materials following endodontic treatment. The provision of an effective coronal seal in addition to a sound root filling is known to be important in the prevention of root canal infection. This review seeks to explore the evidence concerning the selection of dental materials in the restoration of root-filled teeth, specifically with a close examination of the properties of commonly used materials as orifice barriers. © 2023 Australian Dental Association.
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Affiliation(s)
- M E Wylie
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Parashos
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - J R Fernando
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Oral Health Research, Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jea Palamara
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - A J Sloan
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Fransson H, Dawson V. Tooth survival after endodontic treatment. Int Endod J 2023; 56 Suppl 2:140-153. [PMID: 36149887 DOI: 10.1111/iej.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome 'healthy periapical tissues' or 'tooth survival' they are equally important to know. Factors affecting the outcome 'healthy periapical tissues' probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst 'tooth survival' is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance. Objective This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus. Method The search was performed in PubMed. Results As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment. Conclusion Of the pre-, peri- and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor. Registration None.
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Affiliation(s)
- Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Victoria Dawson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Jiang J, Sun J, Ma H, Wang J, Huang Z, Zhou S. Stress intensity factor of a cracked molar restored with different materials and designs: A 3D-FEA. J Mech Behav Biomed Mater 2023; 142:105818. [PMID: 37068432 DOI: 10.1016/j.jmbbm.2023.105818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE This work used 3D finite element analysis (FEA) to analyze and directly compare the stress intensity factor (SIF) and stress distribution at the crack tip of identical cracked tooth models restored with different materials and crown parameters. METHODS A 3D model of the cracked tooth was generated. Then, we applied 25 restorative models, including three parameters (shoulder height, width, and degree of polymerization), five restorative materials (GC, IPS, LU, ZC, VE), and two combinations of types of cement (RMGIC and GIC). An occlusal load of 800N was applied to the spherical part along the longitudinal axis. The stress distribution of the preparation and the SIF of the crack tip was analyzed. RESULTS The crack tip SIF was minimal for a shoulder height offset of 0.8 mm (P = 0.032), a shoulder width of 0.6 mm (P = 0.045), a crown material of ZC (P < 2e-16), and a cement material of RMGIC (P < 0.05), respectively. In contrast, the effect of different polymerization degrees on SIF was insignificant (P = 0.95). CONCLUSION Our results suggest that the selection of a larger modulus of elasticity (MOE) material for the crown, the preparation of a smaller shoulder width within a safe range, a reasonable increase in the crown length, and the selection of adhesive materials with high fracture toughness are favorable methods to prevent further crack extension.
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Affiliation(s)
- Jingang Jiang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, 150080, Heilongjiang, PR China; Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, 150080, China.
| | - Jianpeng Sun
- Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, 150080, China
| | - Hongyuan Ma
- Harbin Branch of Taili Communication Technology Limited, China Electronics Technology Group Corporation, Harbin, 150080, Heilongjiang, People's Republic of China
| | - Jingchao Wang
- The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, PR China
| | - Zhiyuan Huang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, 150001, Heilongjiang, PR China
| | - Shan Zhou
- The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, PR China.
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Nosrat A, Yu P, Verma P, Dianat O, Wu D, Fouad AF. Was the Coronavirus Disease 2019 Pandemic Associated with an Increased Rate of Cracked Teeth? J Endod 2022; 48:1241-1247. [PMID: 35835260 PMCID: PMC9273286 DOI: 10.1016/j.joen.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There is lack of data on whether the coronavirus disease 2019 (COVID-19) pandemic was associated with changes in the etiology of pathosis in endodontic patients. The aim of this study was to determine the rate of cracks and other etiologic factors during the period of March 16th to May 31st in 2020 (COVID-19 initial outbreak) and 2021 (COVID-19 ongoing pandemic) compared with figures from the same period in 2019 (pre-COVID era) in 2 endodontists' practices. METHODS The etiologies of patients' chief complaints were determined from records of 2440 teeth (740 in 2019, 651 in 2020, and 1049 in 2021). Changes in the proportion of etiologic factors among all 3 periods were analyzed. The association between the rate of cracked teeth and patients' age and sex was determined using a logistic regression model. RESULTS The rates of all etiologies collectively during the studied periods showed a significant change (P < .0001). The rate of cracks significantly increased in 2020 (11.8%) (P = .0001) and 2021 (8%) (P = .0018) compared with 2019 (4.3%). The rate of persistent infections decreased in 2020 (22.3%) (P = .0013) and then increased in 2021 (27.5%) (P = .0153) compared with 2019 (30%). Cracked teeth were associated with the age group of 40-60 years (odds ratio [OR] = 1.882; 95% confidence interval [CI], 1.063-3.330) in 2020 and with age ranges of 40-60 years (OR = 2.051; 95% CI, 1.120-3.759) and >60 years (OR = 2.038; 95% CI, 1.050-3.956) and male sex (OR = 1.599; 95% CI, 1.019-2.510) in 2021. CONCLUSIONS The rate of cracked teeth increased during the initial outbreak of the COVID-19 pandemic and 1 year later. This study provided evidence on the association between the COVID-19 pandemic and changes in the rate and presentation of endodontic etiologic factors.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland,Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Peter Yu
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland,Private Practice, Centreville Endodontics, Centreville, Virginia,Private Practice, Capitol Endodontics, Washington, DC
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland,Private Practice, Centreville Endodontics, Centreville, Virginia
| | - Di Wu
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina,Division of Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
| | - Ashraf F. Fouad
- Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, Birmingham, Alabama,Address requests for reprints to Dr Ashraf F. Fouad, Department of Endodontics, School of Dentistry, The University of Alabama at Birmingham, 1919 Seventh Avenue South, Room 610, Birmingham, AL 35294
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Kakka A, Gavriil D, Whitworth J. Treatment of cracked teeth: A comprehensive narrative review. Clin Exp Dent Res 2022; 8:1218-1248. [PMID: 35809233 PMCID: PMC9562569 DOI: 10.1002/cre2.617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives The term “cracked tooth” is used to describe an incomplete fracture initiated from the crown and progressing towards a subgingival direction. Despite the high prevalence of cracked teeth and their frequent association with symptoms and pulpal or periapical pathoses, there is still no consensus in the literature with regard to their restorative and endodontic management. Therefore, the aim of this narrative review was to evaluate the most relevant research and provide an up‐to‐date comprehensive overview regarding the treatment of cracked teeth. Materials and Methods An electronic literature search was carried out in MEDLINE (via Ovid), Embase (via Ovid), Scopus, and Web of Science as well as several “Grey literature” sources up to February 22nd 2022 using a combination of pre‐specified ‘free‐text' terms (keywords) and “subject headings.” The search process was supplemented by handsearching in relevant dental journals and reference lists. This narrative review focused on clinical follow‐up studies (observational or interventional studies, case series/reports), laboratory studies and systematic reviews written in English language that reported data on treatment of permanent cracked teeth. The selection of relevant studies was carried out by two reviewers (AK and DG) working independently in two consecutive stages: title/abstract screening and full‐text retrieval. Any discrepancies in the study selection were resolved by discussion between the reviewers. Results In total, 64 articles were selected for inclusion in this narrative review. Conclusions Cracked teeth with normal pulp or reversible pulpitis have exhibited high pulp and tooth survival rates by the provision of direct or indirect composite restorations. Besides, recent data favour monitoring, especially in the absence of symptoms or compromised tooth structure. When endodontic intervention is required, current evidence suggests that along with appropriate restorative management, outcomes of cracked teeth may be comparable to those of non‐cracked root filled teeth.
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Affiliation(s)
- Angeliki Kakka
- Dental School National and Kapodistrian University of Athens Athens Greece
- Private Practice Athens Greece
| | - Dimitrios Gavriil
- MClinDent Restorative Dentistry Newcastle University Newcastle upon Tyne UK
- Private Practice Korinthos Greece
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Alaugaily I, Azim AA. CBCT Patterns of Bone Loss and Clinical Predictors for the Diagnosis of Cracked Teeth and Teeth with Vertical Root Fracture. J Endod 2022; 48:1100-1106. [PMID: 35714728 DOI: 10.1016/j.joen.2022.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 12/16/2022]
Abstract
AIM This study aimed to identify clinical and radiographic characteristics of teeth with longitudinal fractures to assist in the diagnosis and differentiation between cracked teeth and teeth with vertical root fracture (VRF). METHODS Ninety-five patients (95 teeth) diagnosed with a longitudinal fracture (only cracked teeth or VRF) through clinical visualization of the fracture line were included in this study. Clinical and radiographic data were collected from the patients' record to identify the characteristics associated with each condition. Fifty-four patients (54 teeth) had full radiographic [periapical radiograph (PA) and cone-beam computed tomography scan (CBCT)] and clinical findings (probing depths and clinical images of the fracture line). PA and CBCT images were evaluated by two independent examiners to identify the different patterns of bone loss associated with these teeth (no defect, angular defect, J-shaped defect, combined defect). Cohen Kappa analysis was used to compare the results between the two examiners and between the findings of the PA and the CBCT. Pearson's chi-square analysis, fisher exact test, and Adjusted Bonferroni post Hoc testing were used to establish an association between the type and extension of the longitudinal fracture with the probing depth, the CBCT pattern of bony defects, and the presence/absence of the buccal plate. Also, to compare the clinical and radiographic characteristics of cracked teeth and teeth with VRF (P<0.05). RESULTS CBCT images had 4.4 times the odds of detecting bony defects suggestive of longitudinal fractures compared to PA. Teeth with VRF were more associated with indirect restorations, deep probing (>6mm), absence of the cortical plate and a J-shaped defect on the CBCT (P<0.05). Cracked teeth, on the other hand, were associated with direct restorations, shallow probing (<6mm), intact cortical plate, and the presence of an angular defect on the CBCT (P<0.001). There was a significant correlation between a radicular extension of the fracture line and deep probing, as well as J-shaped defects (P<0.05). CONCLUSION Patterns of bone loss on the CBCT can likely differentiate between cracked teeth and teeth with VRF. The presence of an angular defect may suggest the presence of a crack in the tooth prior to intervention. J-shaped defects, deep probing (>6mm), and loss of the cortical plate are likely suggestive of VRF.
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Affiliation(s)
- Ibrahim Alaugaily
- Division of Endodontics, University at Buffalo, School of dental medicine; Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Adham A Azim
- Division of Endodontics, University at Buffalo, School of dental medicine; Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry.
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Patel S, Bhuva B, Bose R. Vertical root fractures in root treated teeth-current status and future trends. Int Endod J 2022; 55 Suppl 3:804-826. [PMID: 35338655 PMCID: PMC9324143 DOI: 10.1111/iej.13737] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
Vertical root fracture (VRF) is a common reason for the extraction of root filled teeth. The accurate diagnosis of VRF may be challenging due to the absence of clinical signs, whilst conventional radiographic assessment is often inconclusive. However, an understanding of the aetiology of VRFs, and more importantly, the key predisposing factors, is crucial in identifying teeth that may be susceptible. Thorough clinical examination with magnification and co-axial lighting is essential in identifying VRFs, and although CBCT is unable to reliably detect VRFs per se, the pattern of bone loss typically associated with VRF can be fully appreciated, and therefore, increases the probability of correct diagnosis and management. The prevalence of VRFs in root filled teeth is significantly greater than in teeth with vital pulps, demonstrating that the combination of loss of structural integrity, presence of pre-existing fractures and biochemical effects of loss of vitality, are highly relevant. Careful assessment of the occlusal scheme, presence of deflective contacts and identification of parafunctional habits is imperative in both preventing and managing VRFs. Furthermore, anatomical factors such as root canal morphology, may predispose certain teeth to VRF. The influence of access cavity design and root canal instrumentation protocols should be considered although the impact of these on the fracture resistance of root filled teeth is not clearly validated. The post-endodontic restoration of root filled teeth should be expedient and considerate to the residual tooth structure. Posts should be placed 'passively' and excessive 'post-space' preparation should be avoided. This narrative review aims to present the aetiology, potential predisposing factors, histopathology, diagnosis and management of VRF and present perspectives for future research. Currently, there are limited options other than extraction for the management of VRF, although root resection may be considered in multi-rooted teeth. Innovative techniques to 'repair' VRFs using both orthograde and surgical approaches require further research and validation. The prevention of VRFs is critical; identifying susceptible teeth, utilizing conservative endodontic procedures, together with expedient and appropriate post-endodontic restorative procedures is paramount to reducing the incidence of terminal VRFs.
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Affiliation(s)
- Shanon Patel
- Department of Endodontology, King's College London Dental Institute, London, UK.,Specialist Practice, London, UK
| | - Bhavin Bhuva
- Department of Endodontology, King's College London Dental Institute, London, UK
| | - Raul Bose
- Department of Endodontology, King's College London Dental Institute, London, UK
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Ferracane JL, Hilton TJ, Funkhouser E, Gordan VV, Gilbert GH, Mungia R, Burton V, Meyerowitz C, Kopycka-Kedzierawski DT. Outcomes of treatment and monitoring of posterior teeth with cracks: three-year results from the National Dental Practice-Based Research Network. Clin Oral Investig 2022; 26:2453-2463. [PMID: 34628545 PMCID: PMC8898304 DOI: 10.1007/s00784-021-04211-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe treatment and monitoring outcomes of posterior teeth with cracks at baseline followed in the National Dental Practice-Based Research Network for up to three years. MATERIALS AND METHODS Two hundred and nine dentists enrolled a convenience sample of 2,858 patients, each with a posterior tooth with at least one visible crack and followed them for three years. Characteristics at the patient, tooth, and crack level were recorded at baseline and at annual recall visits. Data on all teeth referred for extraction were reviewed. Data on all other teeth, treated or monitored, seen at one or more recall visits were reviewed for evidence of failure (subsequent extraction, endodontics, or recommendation for a re-treatment). RESULTS The survival rate for teeth with cracks at baseline exceeded 98% (only 37 extractions), and the failure rate for teeth that were treated restoratively was only 14%. Also, only about 14% of teeth recommended at baseline for monitoring were later recommended to be treated, and about 6.5% of teeth recommended for monitoring at baseline were later treated without a specific recommendation. Thus, about 80% of teeth recommended at baseline for monitoring continued with a monitoring recommendation throughout the entire three years of the study. Treatment failures were associated with intracoronal restorations (vs. full or partial coverage) and male patients. CONCLUSIONS In this large 3-year practice-based study conducted across the USA, the survival rate of posterior teeth with a visible crack exceeded 85%. Clinical relevance Dentists can effectively evaluate patient-, tooth-, and crack-level characteristics to determine which teeth with cracks warrant treatment and which only warrant monitoring.
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Affiliation(s)
- Jack L. Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042
| | - Thomas J. Hilton
- School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042
| | - Ellen Funkhouser
- School of Medicine, University of Alabama, Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0007
| | - Valeria V. Gordan
- Department of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Rahma Mungia
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio
| | - Vanessa Burton
- HealthPartners, 5901 John Martin Dr., Brooklyn Center, MN 55430
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 601 Elmwood Avenue, Box 686, Rochester, NY 14642
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Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention. Pain Res Manag 2021; 2021:3788660. [PMID: 34956432 PMCID: PMC8694987 DOI: 10.1155/2021/3788660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/28/2023]
Abstract
Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth. This article reviews the current literature on cracked tooth syndrome from four aspects, etiology, diagnosis, management, and prevention, to provide readers integrated information about this. The article begins with an introduction to the odontiatrogenic factors and then covers the noniatrogenic factors that induce cracked tooth syndrome. While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome. This is then followed by the description of common clinical diagnosis methods, the prospects of new technologies, and summaries of current clinical management methods, including immediate management and direct and indirect restoration. In the final section, preventive methods and their importance are proposed, with the aim of educating the common population.
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"THE CORRELATION OF CRACK LINES AND DEFINITIVE RESTORATIONS WITH THE SURVIVAL AND SUCCESS RATES OF CRACKED TEETH: A LONG-TERM RETROSPECTIVE CLINICAL STUDY". J Endod 2021; 48:190-199. [PMID: 34752828 DOI: 10.1016/j.joen.2021.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cracked teeth (CT) frequently require protective adhesive restorations. This long-term, longitudinal retrospective clinical study aimed to evaluate the factors influencing the success and survival rates of CT with crack lines (CLs) in different directions, when restored early with onlays or full-coverage crowns. METHODS The dental records of 71 patients with a total of 86 CT, with different pulpal and periapical diagnoses, and with follow-ups spanning over 1-11 years were included. Data regarding the demographics; clinical symptoms and signs; bruxism; occlusal interferences; eating habits; pulpal and periapical diagnoses; number, direction, location, and extent of crack lines; probing depth; and coronary condition before and after the placement of definitive restorations were collected. Univariate associations between tooth survival and explanatory variables were assessed. The long-term survival rate was estimated using the Kaplan-Meier analysis and the log-rank test. A multivariate analysis was performed using Cox regression analysis. RESULTS The overall success rate was 93.0%, and the overall survival estimates of CT restored early were 98.6%, 94.9% and 55.9% at the 1-, 5-, and 11-year follow-ups, respectively. The direction of the CLs did not influence the survival of the tooth. No significant association was observed between the type of tooth, probing depth, root canal treatment (RCT), and tooth loss (P>0.05). The multivariate analysis showed that previously treated CT (P<0.05), provision of onlay restorations (P<0.05), and placement of posts (P<0.05) had higher correlations with tooth loss. Additionally, placement of full-coverage crowns resulted in lower tooth loss compared with the placement of onlays (P<0.05). CONCLUSION Previous endodontic treatment in teeth that subsequently develop CLs has a negative impact on the survival rate of the teeth. Moreover, early placement of full-coverage crowns should be implemented for CT, regardless of the direction or number of CLs, since it is associated with a higher cracked tooth survival rate.
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Son SA, Kim JH, Park JK. The Effectiveness of a Quantitative Light-induced Fluorescent Device for the Diagnosis of a Cracked Tooth: A Case Report. J Endod 2021; 47:1796-1800. [PMID: 34437880 DOI: 10.1016/j.joen.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
Diagnosing a cracked tooth is a challenge for dental clinicians. This report describes the use of a quantitative light-induced fluorescent (QLF) device that detects fluorescence reactions with visible light (405 nm) to visually identify microscopic tooth cracks during the diagnosis and treatment of cracked teeth that caused pulp disease. Fluorescence images of the occlusal surface, before and after removal of the restoration, and inside of the access cavity for root canal treatment were obtained using an intraoral capture-type QLF device (Q-ray penC; AIOBIO, Seoul, Korea). The device provided visual information such as enhanced magnification and fluorescent images to identify cracks on the exterior of the tooth, around restorations, and inside the cavity after removal of the restoration by a simple image capture process. The device was able to demonstrate the existence of the crack line and to predict the depth of cracks during treatment.The QLF device showed a potential benefit in the diagnosis and characterization, including the location and depth, of tooth cracks.
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Affiliation(s)
- Sung-Ae Son
- Department ofConservative Dentistry, Dental and Life Science Institute, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Republic of Korea
| | - Jae-Hoon Kim
- Department ofDental Education, Dental and Life Science Institute, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Republic of Korea
| | - Jeong-Kil Park
- Department ofConservative Dentistry, Dental and Life Science Institute, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Republic of Korea.
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Mannocci F, Bhuva B, Roig M, Zarow M, Bitter K. European Society of Endodontology position statement: The restoration of root filled teeth. Int Endod J 2021; 54:1974-1981. [PMID: 34378217 DOI: 10.1111/iej.13607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This position statement on the restoration of root filled teeth represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Current clinical and scientific evidence, as well as the expertise of the committee, have been used to develop this statement. The aim is to provide clinicians with evidence-based principles for decision-making on the choice of restoration following the completion of root canal treatment. By discussing the evidence in relation to key topics regarding post-endodontic restoration, a series of clinical recommendations are made. The scientific basis of the recommendations made in this paper can be found in a recently published review article (Bhuva et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13438). It is the intention of the committee to update this statement as further evidence emerges.
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Affiliation(s)
| | - Francesco Mannocci
- Faculty of Dentistry, Oral & Craniofacial Sciences, Department of Endodontics, King's College London, Guy's Hospital, London, UK
| | - Bhavin Bhuva
- Faculty of Dentistry, Oral & Craniofacial Sciences, Department of Endodontics, King's College London, Guy's Hospital, London, UK
| | - Miguel Roig
- Section for Endodontology, Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Kerstin Bitter
- Department of Operative and Preventive Dentistry, Charité - University Medicine, Berlin, Germany
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19
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Yap EXY, Chan PY, Yu VSH, Lui JN. Management of Cracked Teeth: Perspectives of General Dental Practitioners and Specialists. J Dent 2021; 113:103770. [PMID: 34363892 DOI: 10.1016/j.jdent.2021.103770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The main aim of this study was to compare how general dental practitioners (GDPs), endodontists and prosthodontists diagnose, prognosticate, and treat cracked teeth. The secondary aim was to highlight factors influencing GDPs' referral practices of cracked teeth to specialists. MATERIALS AND METHODS Questionnaires were used to collect information from GDPs, prosthodontists, and endodontists, on their use of diagnostic methods to identify cracked teeth, prognostication, and their management and referral practices for cracked teeth. Descriptive statistics were used to summarize the quantitative data. Pearson's Chi-Square test or Fisher's Exact test was applied to categorical variables while Kruskal-Wallis or Spearman's correlation coefficient was applied to continuous variables (p <0.05). Content analysis was performed for qualitative data. RESULTS 207 dentists responded, resulting in a response rate of 83.5%. Endodontists used more diagnostic tools as compared to prosthodontists and GDPs. For pulpally involved cracked teeth, endodontists were more likely to recommend root canal treatment (RCT) and cuspal coverage compared to extraction, followed by prosthodontists then GDPs. Main reasons for referral of cracked teeth to specialists include uncertainty in diagnosis, difficulty in crack visualization after endodontic access, and cracked teeth indicated for RCT. CONCLUSION GDPs, prosthodontists, and endodontists differ in terms of their diagnosis, prognostication, and treatment of cracked teeth. GDPs refer cracked teeth to specialists due to challenges faced in diagnosis and treatment. Future research and education are required to provide evidence-based guidelines in the management of cracked teeth so that patients with cracked teeth can receive standardized care.
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Affiliation(s)
- Elyssa Xiang Ying Yap
- Endodontic Unit, Department of Restorative Dentistry, National Dental Centre Singapore, Department of Restorative Dentistry, National Dental Centre of Singapore, 5 Second Hospital Avenue, Singapore 168938
| | - Pei Yuan Chan
- Consultant, Endodontic Unit, Department of Restorative Dentistry, National Dental Centre Singapore, Address: Department of Restorative Dentistry, National Dental Centre of Singapore, 5 Second Hospital Avenue, Singapore 168938
| | - Victoria Soo Hoon Yu
- Associate Professor, Vice Dean Graduate Studies, Graduate Endodontics Residency Training Programme Director, Course Director, Undergraduate Endodontics, Faculty of Dentistry, National University of Singapore, Singapore, Senior Consultant, National University Hospital Singapore, Faculty of Dentistry, National University of Singapore, Singapore, 9 Lower Kent Ridge Rd, Singapore 119085
| | - Jeen-Nee Lui
- Head, Department of Restorative Dentistry, Senior Consultant, Endodontic Unit, Department of Restorative Dentistry, National Dental Centre Singapore, Address: Department of Restorative Dentistry, National Dental Centre of Singapore, 5 Second Hospital Avenue, Singapore 168938
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20
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Liao WC, Tsai YL, Chen KL, Blicher B, Chang SH, Yeung SY, Chang MC, Jeng JH. Cracked teeth: Distribution and survival at 6 months, 1 year and 2 years after treatment. J Formos Med Assoc 2021; 121:247-257. [PMID: 33858736 DOI: 10.1016/j.jfma.2021.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/PURPOSE The unpredictable condition of cracked teeth warrants further investigation and clinical experiences. The purpose of this study was to collect and record data on demographics, clinical characteristics, different treatment modalities and survival of cracked teeth at 6-month, 1-year and 2-year recalls. METHODS 77 cracked teeth from 65 patients were included. Data on demographics, clinical parameters, treatment modalities and recall were collected. Binomial, multinomial and chi square tests were used for statistical analysis. RESULTS Most cracked teeth occurred in patients greater than 40 years old (p < 0.01). Cracked teeth themselves were most often molars (79.22%; p < 0.01), a non-terminal tooth in the arch (62.34%; p < 0.05) and nonendodontically-treated teeth (94.81%; p < 0.01). Cracked teeth exhibited pain to percussion (63.64%, p < 0.05) or biting (74.03%; p < 0.01), and no or only positive mobility (76.62%; p < 0.01). Cracks were most often oriented in the mesiodistal direction (68.83%; p < 0.01). Higher survival rates were noted in cracked teeth lacking pre-operative pain to palpation or spontaneous pain, and with no or only positive mobility at 6-month and 1-year recalls. In vital cracked teeth, higher survival rates were noted in teeth lacking pre-operative pain to palpation and with no or only positive mobility at 2-year recalls. CONCLUSION The absence of pre-operative palpation discomfort, spontaneous pain and minimal mobility, as well as the presence of pulp vitality were associated with higher survival rates of cracked teeth at all recall times. Results are useful for diagnosis and outcomes-based treatment planning of cracked teeth.
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Affiliation(s)
- Wan-Chuen Liao
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ling Tsai
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Liang Chen
- Department of Dentistry, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Shu-Hui Chang
- School of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sin-Yuet Yeung
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Mei-Chi Chang
- Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University of Science and Technology, Kwei-Shan, Taoyuan, Taiwan.
| | - Jiiang-Huei Jeng
- School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Abstract
Examining the nature of stress distribution within the intact tooth can aid in understanding how natural tooth structures are able to resist mechanical forces during masticatory function. Identification of potential fractures in teeth on clinical examination is essential for correct diagnosis, particularly if there is pulpal involvement. This discussion will consider the different types of fracture, their identification and management. This paper will highlight management of tooth fractures, including identifying prognostic indicators, which are largely dependent on the extent of the fracture within the tooth structure.
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Affiliation(s)
- Sanjeev Bhanderi
- Specialist in Endodontics, Senior Lecturer, University of Liverpool Dental School; ENDO61 Specialist practice, Manchester
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22
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Bhuva B, Giovarruscio M, Rahim N, Bitter K, Mannocci F. The restoration of root filled teeth: a review of the clinical literature. Int Endod J 2021; 54:509-535. [PMID: 33128279 DOI: 10.1111/iej.13438] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
Clinicians often face dilemmas regarding the most appropriate way to restore a tooth following root canal treatment. Whilst there is established consensus on the importance of the ferrule effect on the predictable restoration of root filled teeth, other factors, such as residual tooth volume, tooth location, number of proximal contacts, timing of the definitive restoration and the presence of cracks, have been reported to influence restoration and tooth survival. The continued evolution of dental materials and techniques, combined with a trend towards more conservative endodontic-restorative procedures, prompts re-evaluation of the scientific literature. The aim of this literature review was to provide an updated overview of the existing clinical literature relating to the restoration of root filled teeth. An electronic literature search of the PubMed, Ovid (via EMBASE) and MEDLINE (via EMBASE) databases up to July 2020 was performed to identify articles that related the survival of root filled teeth and/or restoration type. The following and other terms were searched: restoration, crown, onlay, root canal, root filled, post, clinical, survival, success. Wherever possible, only clinical studies were selected for the literature review. Full texts of the identified articles were independently screened by two reviewers according to pre-defined criteria. This review identifies the main clinical factors influencing the survival of teeth and restorations following root canal treatment in vivo and discusses the data related to specific restoration type on clinical survival.
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Affiliation(s)
- B Bhuva
- Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - M Giovarruscio
- Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - N Rahim
- Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - K Bitter
- Department of Operative and Preventive Dentistry, Charité - University Medicine, Berlin, Germany
| | - F Mannocci
- Department of Endodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Chen YT, Hsu TY, Liu H, Chogle S. Factors Related to the Outcomes of Cracked Teeth after Endodontic Treatment. J Endod 2020; 47:215-220. [PMID: 33275995 DOI: 10.1016/j.joen.2020.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cracked teeth are a common clinical finding; however, their presence renders diagnosis and prognosis unreliable. The purpose of this research was to assess the correlations of multiple factors on the prognosis of cracked teeth that had undergone endodontic treatment. METHODS A total of 3680 patients who received endodontic treatment by an advanced postdoctoral education program in endodontics with follow-up records of at least 1 year were assessed. From this sample, 62 patients met the inclusion criteria and were included in the final analysis. The factors being evaluated included demographics, clinical symptoms and signs, radiographic findings, and restoration type. Statistical analysis was then completed using the chi-square and Fisher exact tests. RESULTS The mean follow-up period was 23.3 months, with an overall tooth success rate of 75.8%. The success rates differed significantly when the patient had an existing preoperative periapical lesion, lacked a proper permanent restoration on the treated tooth, or had a post placed after root canal treatment. Data analysis showed that restoring the tooth after endodontic treatment was the single most important factor for prognosis. In fact, the endodontically treated teeth with definitive full-coverage restorations had a 2-year success rate of 93.6%. CONCLUSION Full-coverage restorations should be considered an important part of the treatment plan for cracked teeth treated endodontically.
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Affiliation(s)
- Yen-Tung Chen
- Department of Endodontics, Boston University, Boston, Massachusetts
| | - Tun-Yi Hsu
- Department of Endodontics, Boston University, Boston, Massachusetts
| | - Hongsheng Liu
- Department of Endodontics, Boston University, Boston, Massachusetts
| | - Sami Chogle
- Department of Endodontics, Boston University, Boston, Massachusetts.
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24
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Insights into the July 2019 Issue of the Journal of Endodontics. J Endod 2019; 45:829-830. [PMID: 31255304 DOI: 10.1016/j.joen.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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