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Seet RF, Chan PY, Sim CPC, Quek HC, Yu VSH, Lui JN. Pulp Survival of Cracked Teeth with Reversible Pulpitis after Orthodontic Banding and Coronal Coverage - A Prospective Cohort Study with One Year Follow Up. J Endod 2024; 50:1082-1090. [PMID: 38782183 DOI: 10.1016/j.joen.2024.05.006] [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: 03/04/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The aim of this prospective study was to investigate the 1-year pulp survival of cracked teeth with reversible pulpitis managed with initial stabilization using orthodontic bands, followed by coronal coverage restorations. METHODS One-hundred-and-twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative patient and tooth data were collected. After definitive pulp diagnoses were determined following an interim period of orthodontic banding, coronal coverage restorations were placed. Cox and logistic regression analyses were used to assess possible prognostic factors and to correlate initial time to pulp stabilization while in orthodontic bands with eventual outcome. Pulp survival was determined using both clinical and radiographic findings. RESULTS One-hundred-and-six cracked teeth were followed up at 1 year. Pulp survival based on clinical and radiographic findings was found in 81 teeth (76.4%). Out of 25 failures, 11 (44%) required root canal treatment (RCT) in the orthodontic band stage and 10 (40%) required RCT during the process of or after coronal coverage restorations. Four teeth (16%) had incidental findings of periapical radiolucencies at the 1-year review without clinical symptoms. Teeth requiring RCT were found to have required longer periods in orthodontic bands prior to a definitive pulp diagnosis (P < .05). CONCLUSION A step-by-step approach by using orthodontic banding to monitor pulp status may reduce the incidence of RCT required through definitive coronal coverage restorations for cracked teeth with reversible pulpitis.
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Affiliation(s)
- Rachel Fangying Seet
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore, Singapore.
| | - Pei Yuan Chan
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore, Singapore
| | - Christina Poh Choo Sim
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore, Singapore
| | - Heng Chuan Quek
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore, Singapore
| | - Victoria Soo Hoon Yu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore; ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore, Singapore
| | - Jeen-Nee Lui
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore, Singapore
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Hu Z, Hu Y, Xu S, Zhuang J, Cao D, Gao A, Xie X, Lin Z. The exploration of a compound cone-beam CT contrast agent for diagnosis of human extracted cracked tooth. Heliyon 2024; 10:e31036. [PMID: 38774323 PMCID: PMC11107363 DOI: 10.1016/j.heliyon.2024.e31036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/27/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024] Open
Abstract
Objectives This study aims to investigate the use of sodium iodide (NaI), dimethyl sulfoxide (DMSO), ethyl alcohol, and ethyl acetate as cone-beam CT (CBCT) contrast agents for diagnosing cracked teeth. The optimal delay time for detecting the number of crack lines beyond the dentino-enamel junction (Nd), the number of cracks extending from the occlusal surface to the pulp cavity (Np), and the depth of the crack lines was explored. Methods 14 human extracted cracked teeth were collected, 12 were used for enhanced scanning, and 2 were used for exploring the characteristic of crack lines. The teeth were scanned in 3 CBCT enhanced scanning (ES) modes: ES1 using meglumine diatrizoate (MD); ES2 using NaI and DMSO, ES3 using NaI, DMSO, ethyl alcohol and ethyl acetate. Three delay times (15mins, 30mins, and 60mins) were set for scanning. Nd, Np, and depth of crack lines were evaluated. Results There were totally 24 crack lines on 12 cracked teeth. Nd was 10 in ES1 at 60mins, 24 in ES2 at 60mins and 24 in ES3 at 15mins. Np was 1 in ES1 at 60mins, 10 in ES2 at 60mins and 21 in ES3 at 60mins, and there were significantly different among them (p < 0.01). The average depth presented on ES3 was significantly deeper than ES1 and ES2 (p < 0.01). Conclusion NaI, DMSO, ethyl alcohol and ethyl acetate show potential as contrast agents for enhanced CBCT scanning in diagnosis of cracked teeth and their depth in vivo. A delay time of 15 min is necessary to confirm the existence of crack lines, while a longer delay time is required to ascertain if these crack lines extend to the pulp cavity.
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Affiliation(s)
- Ziyang Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
- Department of Stomatology, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yanni Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Shi Xu
- Department of Endodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Jia Zhuang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Dantong Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Antian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
| | - Xin Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - Zitong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China
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Li Y, Wang W, Zeng Q, Tang M, Massey J, Bergeron BE, Gu L, Tay FR. Efficacy of pulpotomy in managing irreversible pulpitis in mature permanent teeth: A systematic review and meta-analysis. J Dent 2024; 144:104923. [PMID: 38461884 DOI: 10.1016/j.jdent.2024.104923] [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: 02/15/2024] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES This paper evaluated the success rates of pulpotomy, compared its efficacy with non-surgical root canal treatment (NSRCT), evaluated different pulpotomy techniques, and analyzed the effectiveness of contemporary bioactive materials in managing irreversible pulpitis in mature permanent teeth. DATA SOURCES A comprehensive literature search was conducted across multiple databases including PubMed, Web of Science, Scopus, and the Cochrane Library. Search was conducted from the inception of each database to the present, adhering to PRISMA 2020 guidelines. STUDY SELECTION Studies were selected through a multi-step screening process, focusing on adult populations, randomized controlled trials, and single-arm trials. DATA Fifteen randomized controlled trials and eight single-arm trials were included. For a follow-up period of more than 24 months, pooled clinical success rate of pulpotomy was 92.9 % (95 %CI;82.1-99.0 %), whereas pooled radiographic success rate was 78.5 % (95 %CI;66.7-88.4 %). Meta-analyses showed that there was no significant difference in success rates between pulpotomy and NSRCT, between full and partial pulpotomy techniques, or between Mineral Trioxide Aggregate pulpotomy and Calcium Enriched Mixture pulpotomy. The results indicated comparable efficacy across these variables. CONCLUSIONS The study highlights the potential of less invasive treatments. Pulpotomy may be a viable alternative to NSRCT for managing irreversible pulpitis in mature permanent teeth. Limitations such as the low quality of some single-arm trials and the high risk of bias in some randomized controlled trials highlight the need for further research to standardize methodologies and broaden literature inclusion for a more comprehensive understanding of the efficacy of pulpotomy, considering the high success rates reported. Clinical Significance This quantitative systematic review recognizes the potential of full or partial pulpotomy as a viable treatment alternative to root canal therapy for managing irreversible pulpitis in mature permanent teeth. Future studies should aim for standardized protocols to validate these findings and improve patient treatment outcomes.
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Affiliation(s)
- Yuanyuan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China; Department of General Dentistry, Xiamen University Affiliated Chenggong Hospital & The 73rd Army Hospital of Chinese PLA, Amoy, Fujian, PR China
| | - Wenying Wang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Qian Zeng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Michelle Tang
- The Dental College of Georgia, Augusta University, GA, USA
| | - Joshua Massey
- The Dental College of Georgia, Augusta University, GA, USA
| | | | - Lisha Gu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China.
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, GA, USA.
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Azizi H, Hadad A, Levy DH, Ben Itzhak J, Kim HC, Solomonov M. Epoxy vs. Calcium Silicate-Based Root Canal Sealers for Different Clinical Scenarios: A Narrative Review. Dent J (Basel) 2024; 12:85. [PMID: 38667997 PMCID: PMC11048901 DOI: 10.3390/dj12040085] [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: 01/02/2024] [Revised: 03/02/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to review the considerations for choosing a suitable sealer according to various endodontic scenarios. An electronic search of PubMed, Scopus, and the Web of Science was undertaken for the keywords of 'sealer choosing', 'appropriate sealer', 'suitable sealer', 'sealer for clinical scenario', and 'sealer for clinical situations'. However, the literature review revealed a lack of studies with practical clinical recommendations regarding the choice of appropriate endodontic root canal sealers for particular clinical situations of root canal treatment. Therefore, a narrative review was undertaken under the basis of the characteristics of an epoxy resin-based sealer (ERS) versus a calcium silicate-based sealer (CSS). Based on the evidence found through the review, the choice of an appropriate sealer in a variety of clinical scenarios was proposed. An ERS is recommended for one-visit non-vital cases, teeth with periodontal involvement, cracked teeth, and internal root resorption without root perforation. A CSS is recommended for vital or non-vital cases in multiple visits, teeth with internal root resorption with perforation or internal approach for external cervical resorption, teeth with open apices, and teeth with iatrogenic aberrations.
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Affiliation(s)
- Hadas Azizi
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Hadad
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Henry Levy
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan 46241, Republic of Korea;
| | - Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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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; 32:2023-2037. [PMID: 38517822 DOI: 10.3233/thc-231993] [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] [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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Wang M, Hong Y, Hou X, Pu Y. Biting and thermal sensitivity relief of cracked tooth restored by occlusal veneer: A 12-to 24 months prospective clinical study. J Dent 2023; 138:104694. [PMID: 37696468 DOI: 10.1016/j.jdent.2023.104694] [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: 07/25/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES To analyze the relief time and risk factors of biting/thermal sensitivity in cracked tooth (CT) restored using occlusal veneer. METHODS 63 CT were analyzed, and their demographic and clinical data and medical history were collected. Patients were followed-up to examine the relief of thermal/biting sensitivity. RESULTS The maxillary first molar was the most prevalent (N = 25, 40%). The number of crack lines on the finish line ranged from 1 to 6 while the number of crack lines through preparation on the finish line from 0 to 4. Pain relief achieved steadily to 52% for thermal and 62% for biting at 1 week to over 90% for each by 3 months and was completely resolved (no pain) for each by 12 months. Painful of lateral percussion was related to a long period of thermal sensitivity (≥1 month) after restoration with occlusal veneer. The number of crack lines through preparation on the finish line >2 was correlated with biting sensitivity (≥1 month) post-treatment. CONCLUSIONS Most patients (>90%) became asymptomatic of biting and thermal sensitivity within 3 months of CT restored by occlusal veneer. Lateral percussion and the number of crack lines through preparation on the finish line could be significant factors affecting postoperative symptoms. CLINICAL SIGNIFICANCE Occlusal veneer is an ultrathin restoration and had no need for restricting clinical crown height, which could protect and relief the biting/thermal sensitivity of CT without preventive root canal therapy.
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Affiliation(s)
- Mengke Wang
- Second Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
| | - Yingying Hong
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
| | - Xiaomei Hou
- Second Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
| | - Yinfei Pu
- Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China.
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Ni J, Xu L, Lin Y, Lai D, Huang X. Effects on different full-coverage designs and materials of crack propagation in first mandibular molar: an extended finite element method study. Front Bioeng Biotechnol 2023; 11:1222060. [PMID: 37650043 PMCID: PMC10464904 DOI: 10.3389/fbioe.2023.1222060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives: This study aims to investigate the biomechanical properties of fracture resistance in cracked teeth using five different full-coverage restorations made of three different materials. Materials and Methods: A 3D model of a mandibular first molar was created to design five different full-coverage repair models: crown, crown with composite resin filling inside, occlusal veneer, occlusal veneer with composite resin filling inside and onlay. These repair models were fabricated using three different materials, namely, zirconia, lithium disilicate (LDS), and a hybrid polymer-infiltrated ceramic network material (PIC). In total, 15 repair models were tested using the extended finite element method (XFEM), with an occlusal load of 5000 N applied slowly to the occlusal surface of the restoration. The analysis of stress distribution in the restoration and dentin crack line was conducted to measure and record the crack initial load on the restoration and dentin. Results: The results showed that restorations on the occlusal surface significantly improved crack resistance, with zirconia exhibiting superior fracture resistance among the materials tested. Restorations of crown with composite resin filling inside demonstrated the highest resistance to fracture, while occlusal veneers showed the lowest. MPS concentration was observed at the interface between the restoration and dentin and at the root bifurcation, with the highest values at the top of crack development. Dentin covered by oxidized restorations had the highest displacement, while PIC restorations exhibited the lowest. Pulp analysis revealed selective MPS concentration and strain patterns in models with zirconia restorations and onlay, with pronounced pulp displacement in zirconia restorations and onlay. Enamel analysis indicated larger MPS values and displacements in zirconia restoration models and onlay, with higher strain in onlay. Restoration played a crucial role in protecting the tooth, with crack propagation initial loads in dentin surpassing restorations in experimental groups. Conclusion: This study confirms that full-coverage restorations significantly increased the fracture resistance of cracked teeth, with zirconia restorations significantly protecting the underlying cracked tooth. Elimination of fracture lines in the restoration design can improve fracture resistance in cracked teeth. The findings have implications for dental prosthetic design and clinical practice.
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Affiliation(s)
| | | | | | | | - Xiaohong Huang
- Department of Stomatology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Wang M, Hong Y, Hou X, Pu Y. Management and prognosis of a vital cracked tooth by occlusal veneer for 14 months: A case report. Clin Case Rep 2023; 11:e7714. [PMID: 37564609 PMCID: PMC10410118 DOI: 10.1002/ccr3.7714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023] Open
Abstract
Key Clinical Message An occlusal veneer is an ultrathin restoration method and a minimally invasive approach that can preserve more dental tissue and provide better aesthetic outcomes, thus increasing patient satisfaction. Abstract An occlusal veneer is an ultrathin restoration method and a minimally invasive approach that can preserve more dental tissue and provide better aesthetic outcomes, thus increasing patient satisfaction; however, no previous studies reported on treating cracked teeth using occlusal veneer. Accordingly, we described the diagnosis and treatment process of a cracked tooth using occlusal veneer in a single case. A 29-year-old male presented at our dental clinic complaining of biting pain in the mandibular molar on the right-hand side. A routine oral examination with radiography was performed to evaluate the oral condition and treatment planning. The #16 tooth had a crack line surrounding the whole distal-lingual cusp from the occlusal surface. After discussing various therapeutic options with the patient, an occlusal veneer was performed. One week after treatment with occlusal veneer, the patient had no complaints. A 14-month follow-up showed promising clinical and radiographic outcomes. Occlusal veneer is an alternative treatment option for a cracked tooth, as it can preserve more dental tissue and potentially save pulp vitality.
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Affiliation(s)
- Mengke Wang
- Second Clinical DivisionPeking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical DevicesBeijingPeople's Republic of China
| | - Yingying Hong
- First Clinical DivisionPeking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical DevicesBeijingPeople's Republic of China
| | - Xiaomei Hou
- Second Clinical DivisionPeking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical DevicesBeijingPeople's Republic of China
| | - Yinfei Pu
- Department of Oral EmergencyPeking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical DevicesBeijingPeople's Republic of China
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Khazin SM, Abdullah D, Cheen ALK. Response to the commentary on the article 'pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study'. AUST ENDOD J 2023; 49:460-461. [PMID: 35904463 DOI: 10.1111/aej.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Sobrina Mohamed Khazin
- Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Selangor, Malaysia
| | - Dalia Abdullah
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amy Liew Kia Cheen
- Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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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] [Key Words] [MESH Headings] [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 SchoolNational and Kapodistrian University of AthensAthensGreece
- Private PracticeAthensGreece
| | - Dimitrios Gavriil
- MClinDent Restorative DentistryNewcastle UniversityNewcastle upon TyneUK
- Private PracticeKorinthosGreece
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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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Seet RF, Chan PY, Khoo ST, Yu VSH, Lui JN. Characteristics of Cracked teeth with Reversible Pulpitis after Orthodontic Banding - a Prospective Cohort Study. J Endod 2022; 48:1476-1485.e1. [PMID: 36150561 DOI: 10.1016/j.joen.2022.09.002] [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: 04/24/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cracked teeth with reversible pulpitis can be managed with orthodontic bands in the interim before definitive restorations. The aim of this study was to determine short-term outcomes of these teeth following orthodontic band placement. The time taken for definitive pulp diagnoses after orthodontic band placement and associated prognostic factors was also analyzed. METHODS One hundred and twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Pre-operative data including patient and tooth factors were collected. Cracked teeth were banded and reviewed until symptoms resolved before referral for coronal coverage. Kaplan-Meier and Cox analyses were performed to analyze pulp survival of these teeth. Prognostic factors were investigated using Pearson's Chi-Square and Student's T-Test. RESULTS One hundred and twenty-two cracked teeth were analyzed. One hundred and thirteen (92.6%) teeth had the pulpitis resolved within two months (Median 40.0; IQR 28-61). The median time taken for progression to irreversible pulpitis or pulp necrosis for teeth that required root canal treatment was three months (Median 90.0; IQR 68-110). No prognostic factors were associated with the resolution of pulpal symptoms. However, higher pre-operative triggered pain scores (p<0.05, HR 1.547) and absence of a distal marginal ridge crack (p<0.05, HR 0.638) were correlated with a longer duration before definitive pulp diagnoses. CONCLUSION Following orthodontic band placement, a normal pulp diagnosis was achieved in 92.6% of cracked teeth with pre-operative reversible pulpitis. Definitive pulp diagnoses could be determined in approximately two months. Teeth with higher pre-operative triggered pain scores may require a longer review period.
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Affiliation(s)
- Rachel Fangying Seet
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore.
| | - Pei Yuan Chan
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore
| | - Shi-Tien Khoo
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore
| | - Victoria Soo Hoon Yu
- Faculty of Dentistry, National University of Singapore, Singapore; ORCHIDS: Oral Care Health Innovations and Designs Singapore, National University of Singapore, Singapore
| | - Jeen-Nee Lui
- Department of Restorative Dentistry, National Dental Centre of Singapore, Singapore
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Sahu P, Vicory J, McCormick M, Khan A, Geha H, Paniagua B. Wavelet Guided 3D Deep Model to improve Dental Microfracture Detection. APPLICATIONS OF MEDICAL ARTIFICIAL INTELLIGENCE : FIRST INTERNATIONAL WORKSHOP, AMAI 2022, HELD IN CONJUNCTION WITH MICCAI 2022, SINGAPORE, SEPTEMBER 18, 2022, PROCEEDINGS. AMAI (WORKSHOP) (1ST : 2022 : SINGAPORE ; ONLINE) 2022; 13540:150-160. [PMID: 38623420 PMCID: PMC11017217 DOI: 10.1007/978-3-031-17721-7_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Epidemiological studies indicate that microfractures (cracks) are the third most common cause of tooth loss in industrialized countries. An undetected crack will continue to progress, often with significant pain, until the tooth is lost. Previous attempts to utilize cone beam computed tomography (CBCT) for detecting cracks in teeth had very limited success. We propose a model that detects cracked teeth in high resolution (hr) CBCT scans by combining signal enhancement with a deep CNNbased crack detection model. We perform experiments on a dataset of 45 ex-vivo human teeth with 31 cracked and 14 controls. We demonstrate that a model that combines classical wavelet-based features with a deep 3D CNN model can improve fractured tooth detection accuracy in both micro-Computed Tomography (ground truth) and hr-CBCT scans. The CNN model is trained to predict a probability map showing the most likely fractured regions. Based on this fracture probability map we detect the presence of fracture and are able to differentiate a fractured tooth from a control tooth. We compare these results to a 2D CNN-based approach and we show that our approach provides superior detection results. We also show that the proposed solution is able to outperform oral and maxillofacial radiologists in detecting fractures from the hr-CBCT scans. Early detection of cracks will lead to the design of more appropriate treatments and longer tooth retention.
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Affiliation(s)
| | | | | | - Asma Khan
- University of Texas in San Antonio, USA
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Tadano M, Nakamura T, Hoshikawa S, Hino R, Maruya Y, Yamada A, Fukumoto S, Saito K. The Retention Effect of Resin-Based Desensitizing Agents on Hypersensitivity-A Randomized Controlled Trial. MATERIALS 2022; 15:ma15155172. [PMID: 35897604 PMCID: PMC9330500 DOI: 10.3390/ma15155172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022]
Abstract
Recently, the development of dental materials has increased the availability of various hyperesthesia desensitizers. However, there are no studies on the duration of retreatment in terms of adherence rates. Thus, the adhesion rates of resin-based desensitizers were investigated. We used a conventional desensitizer and a recently developed desensitizer containing calcium salt of 4-methacryloxyethyl trimellitic acid (C-MET) and 10-methacryloyloxydecyl dihydrogen calcium phosphate (MDCP). These colored agents were applied to the surfaces of premolars and molars, and the area was measured from weekly oral photographs. Areas were statistically analyzed and mean values were calculated using 95% confidence intervals. A p-value of <0.05 was considered statistically significant. These rates were significantly higher on the buccal side of the maxilla and lower on the lingual side of the maxilla. In addition, the desensitizer containing C-MET and MDCP displayed significantly higher adhesion rates. It is suggested that this will require monthly follow-ups and reevaluation because both agents cause less than 10% adherence and there is almost no sealing effect after 4 weeks. In addition, the significantly higher adhesion rate of the desensitizer containing C-MET and MDCP indicated that the novel monomer contributed to the improvement in the adhesion ability.
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Affiliation(s)
- Manami Tadano
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
| | - Tomoaki Nakamura
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
| | - Seira Hoshikawa
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
| | - Ryoko Hino
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
| | - Yuriko Maruya
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
| | - Aya Yamada
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
| | - Satoshi Fukumoto
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
- Section of Oral Medicine for Children, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Kan Saito
- Division of Pediatric Dentistry, Department of Oral Health and Development Sciences, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan; (M.T.); (T.N.); (S.H.); (R.H.); (Y.M.); (A.Y.); (S.F.)
- Correspondence: ; Tel./Fax: +81-22-717-8382
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Does bidirectional splinting improve outcomes in cracked teeth with reversible pulpitis? Evid Based Dent 2021; 22:152-153. [PMID: 34916646 DOI: 10.1038/s41432-021-0223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/08/2022]
Abstract
Aim To investigate the success rate of 'bidirectional' splinting - both internal and external - of teeth with longitudinal cracks and reversible pulpitis, as well as to identify any signs or symptoms that could give a prognostic indication of success.Design Cohort study.Cohort selection Thirty-four teeth from 33 patients visiting the Department of Conservative Dentistry at the Yonsei University Dental Hospital, Seoul, South Korea, between June 2016 and November 2017, diagnosed with longitudinal cracked teeth with reversible pulpitis. Teeth with signs of pulp necrosis, irreversible pulpitis or other types of longitudinal cracks were excluded.Data analysis These teeth were treated by a systematic protocol of initial external splinting with a metal band, crack removal and internal splinting with composite resin, placement of a temporary crown, before a final permanent crown. Symptoms and vitality were assessed at every stage and root canal treatment provided where deemed necessary. The teeth were then followed up for up to four years to assess tooth survival and pulp vitality.Results Accounting for five dropouts during the treatment protocol, 29 teeth reached at least a one-year recall. Of these, 21 (72%) had pulp survival, eight (28%) had required root canal treatment - six of those before final crown cementation - and zero teeth required extraction (100% survival rate). Cracked teeth without initial tenderness to percussion showed a 94% pulp survival rate, while those with tenderness had only a 46% pulp survival rate.Conclusions A systematic approach to treating cracked teeth with reversible pulpitis should be utilised to maintain tooth vitality and survival. Using a bidirectional splinting method provides good outcomes for these teeth. Tenderness to percussion is a significant prognostic indicator of pulp vitality and whether root canal treatment should be initiated.
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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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Hu Z, Wang T, Pan X, Cao D, Liang J, Gao A, Xie X, Xu S, Miao L, Lin Z. Comparison of diagnosis of cracked tooth using contrast-enhanced CBCT and micro-CT. Dentomaxillofac Radiol 2021; 50:20210003. [PMID: 33877874 DOI: 10.1259/dmfr.20210003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic accuracy using sodium iodide (NaI) and dimethyl sulfoxide (DMSO) as contrast agent in cone beam computed tomography (CBCT) scanning, and compare this with micro-CT. METHODS 18 teeth were cracked artificially by soaking them cyclically in liquid nitrogen and hot water. After pre-treatment with artificial saliva, the teeth were scanned in four modes: CBCT routine scanning without contrast agent (RS); CBCT with meglumine diatrizoate (MD) as contrast agent (ES1); CBCT with NaI + DMSO as contrast agent (ES2); and micro-CT (mCT). The number of crack lines was evaluated in all four modes. Depth of crack lines and number of cracks presented from the occlusal surface to the pulp cavity (Np) in ES2 and micro-CT images were evaluated. RESULTS There were 63 crack lines in all 18 teeth. 45 crack lines were visible on ES2 images as against four on the RS and ES1 images (p<0.05) and 37 on micro-CT images (p>0.05). Further, 34 crack lines could be observed on both ES2 and micro-CT images, and the average depth presented on ES2 images was 4.56 ± 0.88 mm and 3.89 ± 1.08 mm on micro-CT images (p<0.05). More crack lines could be detected from the occlusal surface to the pulp cavity on ES2 images than on micro-CT images (22 vs 11). CONCLUSION CBCT with NaI +DMSO as the contrast agent was equivalent to micro-CT for number of crack lines and better for depth of crack lines. NaI + DMSO could be a potential CBCT contrast agent to improve diagnostic accuracy for cracked tooth.
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Affiliation(s)
- ZiYang Hu
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - TieMei Wang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiao Pan
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - DanTong Cao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - JiaHao Liang
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - AnTian Gao
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Xie
- Department of Stomatology, Third People's Hospital of Danyang City, Danyang, China
| | - Shi Xu
- Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - LeiYing Miao
- Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - ZiTong Lin
- Department of Dentomaxillofacial Radiology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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Effect of Root Canal Therapy Combined with Full Crown Restoration on the Level of Inflammatory Factors and Chewing Function in Patients with Cracked Teeth and Chronic Pulpitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3299349. [PMID: 34504533 PMCID: PMC8423566 DOI: 10.1155/2021/3299349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/21/2021] [Indexed: 12/21/2022]
Abstract
Objective To explore the clinical effect of root canal therapy combined with full crown restoration in patients with cracked teeth and chronic pulpitis. Methods From May 2018 to June 2020, 87 patients with cracked teeth and chronic pulpitis in our hospital were selected; the patients were randomly divided into the control group and the research group by random number method. The control group only used root canal therapy; the research group used root canal therapy combined with full crown restoration. The therapeutic effect, levels of inflammatory factors, chewing function, periodontal index, complications, and quality of life were compared between the two groups. Results The total effective rate of the research group (97.78%) was better than the total effective rate of the control group (85.71%) (P < 0.05). Compared with before treatment, the serum levels of interleukin-1β (IL-1β), IL-6, and C-reactive protein (CRP) of the two groups of patients decreased after treatment. After treatment, compared with the control group, the serum levels of IL-1β, IL-6, and CRP in the research group decreased (P < 0.05). Compared with before treatment, the bite force of teeth and chewing efficiency of the two groups of patients increased after treatment. After treatment, compared with the control group, the bite force of teeth and chewing efficiency of the research group increased (P < 0.05). Compared with before treatment, the plaque index (PLI), probing depth (PD), gingival sulcus bleeding index (BI), and gingival index (GI) of the two groups of patients decreased after treatment. After treatment, compared with the control group, the PLI, PD, BI, and GI of the research group decreased (P < 0.05). The total incidence of complications in the research group was (11.11%), and the total incidence of complications in the control group was (16.67%); there was no significant difference between the two groups (P > 0.05). After treatment, compared with the control group, the quality of life scores of the patients in the research group were reduced (P < 0.05). Conclusion Root canal therapy and full crown restoration have a definite curative effect in patients with cracked teeth and chronic pulpitis, which can improve the inflammatory response, restore chewing function, maintain periodontal health, improve the quality of life, and do not increase the incidence of complications, so it has good application value.
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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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Lee J, Kim S, Kim E, Kim KH, Kim ST, Jeong Choi Y. Survival and prognostic factors of managing cracked teeth with reversible pulpitis: A 1- to 4-year prospective cohort study. Int Endod J 2021; 54:1727-1737. [PMID: 34245604 DOI: 10.1111/iej.13597] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/26/2022]
Abstract
AIM This prospective clinical study evaluated the clinical performance of managing cracked teeth with reversible pulpitis through a combination of internal and external splinting and investigated factors that can affect pulp survival after splinting. METHODOLOGY Thirty-four teeth diagnosed with cracks and reversible pulpitis were enrolled and treated with bidirectional crack splinting: 1) immediate splinting with a stainless-steel band, 2) internal splinting with crack line removal and resin filling and 3) external splinting with a temporary crown followed by final crown placement. If the symptoms remained/recurred, root canal treatment was performed. Patients were followed up at 3, 6 and 12 months, then annually thereafter. Kaplan-Meier survival analysis to calculate the survival of the treated teeth and Cox univariate proportional hazards regression model to investigate prognostic factors were performed. RESULTS Twenty-nine (97%) teeth were followed up for up to 4 years. The pulp survival rate was 72% after banding and 91% after final crown cementation. No tooth was extracted (100% tooth survival rate). In the univariate Cox proportional hazard test, pain on percussion was the only statistically significant factor (hazard ratio = 11.77). Teeth with pain on percussion at the first visit had a pulp survival rate of 46% during the follow-up period. In comparison, their counterparts without pain had a 94% pulp survival rate. CONCLUSIONS Bidirectional splinting successfully managed cracked teeth with reversible pulpitis. Pain on percussion (mechanical allodynia) may be an important factor in deciding whether to attempt root canal treatment on symptomatic cracked teeth. A step-by-step approach with bidirectional crack splinting should be encouraged for a cracked tooth with a vital pulp without mechanical allodynia rather than pre-emptive root canal treatment.
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Affiliation(s)
- Junghoon Lee
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Sunil Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea.,Department of Electrical & Electronic Engineering, BK21 FOUR Project, Yonsei University College of Engineering, Yonsei University College of Dentistry, Seoul, Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea.,Department of Orthodontics, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Seong Taek Kim
- Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea.,Department of Mechanical Engineering, College of Engineering, Yonsei University, Seoul, Korea
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22
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Lin F, Ordinola-Zapata R, Xu H, Heo YC, Fok A. Laboratory simulation of longitudinally cracked teeth using the step-stress cyclic loading method. Int Endod J 2021; 54:1638-1646. [PMID: 33852743 DOI: 10.1111/iej.13530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022]
Abstract
AIM To simulate in a laboratory setting longitudinal cracking in root filled premolar teeth, using cyclic mechanical fatigue. METHODOLOGY Mesial-occlusal-distal (MOD) cavities were prepared in twenty root filled, single-rooted, mandibular premolars restored with fibre posts and resin composites. The samples were randomly divided into two groups based on the loading approaches: static loading with a crosshead speed of 0.5 mm/min and step-stress cyclic loading (1 Hz) with increasing amplitude. The loads and numbers of cycles to failure were recorded. Micro-CT was also used to identify the fracture modes. Statistical analysis was performed using Student's t-test. The level of significance was set at 0.05. RESULTS The mean fracture loads for the static loading and cyclic loading groups were 769 ± 171 N and 720 ± 92 N, respectively. There was no significant difference between the two groups (P > 0.05). The proportions of longitudinal, cuspal and mixed-mode fractures under cyclic loading were 50%, 20% and 30%, respectively. Longitudinal fractures occurred with larger numbers of cycles and higher average loads per cycle compared with the other fractures. Static loading produced only cuspal fractures. CONCLUSIONS Longitudinally cracked premolar teeth with root fillings were successfully produced using the step-stress cyclic loading method. This provides a more clinically representative methodology for studying cracked teeth in a laboratory setting.
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Affiliation(s)
- F Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, China.,Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - R Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - H Xu
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Y C Heo
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
| | - A Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, USA
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23
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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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