Outcome and Survival of Endodontically Treated Cracked Posterior Permanent Teeth: A Systematic Review and Meta-analysis

Position statement on longitudinal cracks and fractures of teeth

This position statement is a consensus view of an expert committee convened by the European Society of Endodontology (ESE). The statement is based on current clinical and scientific evidence as well as the collective reflective practice of the committee. The aim is to provide clinicians with evidence-based, authoritative information on the aetiology, clinical presentation, and management of cracks and fractures that typically manifest along the long axis of the crown and/or root.

Assessing Endodontic Treatment Feasibility for Cracked Teeth Using Quantitative Light-Induced Fluorescence: A Retrospective Clinical Study

INTRODUCTION

Cracked teeth present diagnostic and treatment challenges due to their complex etiology and uncertain prognoses. This study evaluated the potential of quantitative light-induced fluorescence (QLF) technology for diagnosing cracked teeth and its utility in predicting the need for root canal treatment (RCT).

METHODS

A total of 207 cracked teeth from 149 patients diagnosed between April 2019 and April 2023 were analyzed. QLF parameters (ΔF, ΔFmax, ΔR, ΔRmax) were measured using a Qraypen C device and analyzed with specialized software. Clinical characteristics, including age, sex, symptoms, tooth number, restoration type, pulp vitality, and crack direction, were recorded. The patients were monitored until August 2023, with an average follow-up of 19.1 months. Statistical analyses included t tests, analysis of variance, correlation analysis, and logistic regression analyses.

RESULTS

Of the 207 cracked teeth, 44 (21.3%) underwent RCT and 4 (1.9%) were extracted during the follow-up period. The QLF parameters differed significantly between teeth receiving restorative treatment and those requiring RCT (P < .0001). Cracked teeth with ΔF <-10, ΔFmax <-30, ΔR >15, or ΔRmax >30 had approximately 60% probability of undergoing RCT (P < .05). Logistic regression analysis confirmed that all QLF parameters correlated with RCT probability (P < .0001).

CONCLUSIONS

This study demonstrated the utility of QLF technology in diagnosing cracked teeth and aiding treatment decision-making. The results suggest that careful monitoring, based on clinical evidence, is necessary before definitive restoration, particularly for cracked teeth with QLF parameters that exceed certain thresholds. Further studies with standardized protocols are required to validate the clinical application of QLF.

Perspectives of general dental practitioners on restoring endodontically treated molars: a UK-based vignette study

Aims To assess and compare how UK general dental practitioners (GDPs) restore endodontically treated molars and what tooth-related factors they consider relevant to their management.Method An online cross-sectional vignette survey was sent out to UK dentists via email and the use of social media platforms. Three clinical cases were designed.Results In total, 394 participants completed the survey. GDPs showed a preference towards restoring the endodontically treated molars with indirect restorations, such as crowns and onlays. Material selection varied, with a notable inclination towards gold and lithium disilicate. This was influenced by factors such as the number of remaining tooth walls, thickness of walls and the presence of parafunction.Conclusion Clinicians generally agreed on whether to place a direct or indirect restoration but there was greater disagreement when deciding on the type of restoration and material. Further evidence and education are required to help UK dentists decide more objectively whether to place an onlay or a crown, what material to select and what prognostic factors are most pertinent to the case.

The tooth survival of non-surgical root-filled posterior teeth and the associated prognostic tooth-related factors: A systematic review and meta-analysis

BACKGROUND

Analysis of the survival of root-filled posterior teeth and the associated prognostic tooth-related factors will enable clinicians to predict the outcome of root canal treatment.

OBJECTIVES

To investigate (i) the survival of root-filled posterior teeth and (ii) the tooth-related factors that may affect their survival.

METHODS

Randomized controlled trials, comparative studies and observational studies assessing survival rates of root-filled posterior teeth with a minimum 4-year follow-up period were identified through an electronic search of the following databases up to January 2023: The Cochrane Central Register of Controlled Trials, Medline via PubMed, the Cochrane Database of Systematic Reviews, Embase, Web of Science and NIHR centre for reviews and dissemination. Two reviewers (SP and ML) independently selected the final studies based on pre-defined inclusion criteria. The Newcastle Ottawa Scale and the Cochrane Risk of Bias Tool for Randomized Trials were used to assess the risk of bias. Pooled weighted survival rates were analysed using a random effects meta-analysis model using DerSimonean and Laird methods. Descriptive analysis of studies describing any prognostic tooth-related factors was conducted.

RESULTS

Of the 72 studies identified, data from 20 studies were included in the survival meta-analysis, and data from 13 of these studies were included in the descriptive analysis of tooth-related factors; 12 studies were retrospective, 7 were prospective, and one was a randomized control trial. The pooled survival rates at 4-7 years and 8-20 years of root-filled posterior teeth regardless of tooth type was 91% (95% CI, 0.85; 0.95) and 87% (95% CI, 0.77; 0.93), respectively. The prognostic tooth-related factors mentioned in the included studies were (i) remaining coronal tooth structure, (ii) ferrule, (iii) crown-to-root ratio (iv) tooth type and location (v) periodontal disease (vi) proximal contacts and (vii) cracks.

CONCLUSIONS

The meta-analysis suggests that root canal treatment has a high medium to long term survival outcome. The narrative summary identified 7 factors that affect tooth survival. However, there is a paucity of evidence, and more research is needed in this area.

REGISTRATION

PROSPERO Registration: CRD42021227213.

Managing Cracked Teeth with Root Extension: A Prospective Preliminary Study Using Biodentine™ Material

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.

The treatment outcomes of cracked teeth: A systematic review and meta-analysis

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.

Survivability of endodontically treated cracked tooth: A systematic review

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.

A narrative review of cracks in teeth: Aetiology, microstructure and diagnostic challenges

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.

Regenerative endodontic treatment of an immature incisor tooth with a novel platelet-rich product: A five-year follow-up case report

This case report presents a five-year follow-up and the management of a necrotic, immature incisor tooth treated by a novel platelet-rich plasma/platelet extract solution and platelet-rich fibrin (PRP-PES/PRF) and the restoration by using a stress-reduced direct composite restoration (SRDC) technique. The patient with a broken maxillary lateral tooth was referred to our clinic. Extra/intra-oral examinations were within normal limits. The nonvital tooth having an apical lesion and open-apical apex was treated with a regenerative endodontic treatment procedure (REP), and further root development with continued apical closure was shown in the follow-ups up to 60 months. In conclusion, the SRDC and PRP-PES/PRF combination can be an opportunity for the teeth requiring post-restoration. In contrast to the treatment strategy susceptible to weakening or fracturing the patient's tooth root, the REP approach may lead to a better prognosis for the patient's tooth.

An Endodontic forecasting model based on the analysis of preoperative dental radiographs: A pilot study on an endodontic predictive deep neural network

INTRODUCTION

This study aimed to evaluate the use of deep convolutional neural network (DCNN) algorithms to detect clinical features and predict the three years outcome of endodontic treatment on preoperative periapical radiographs.

METHODS

A database of single-root premolars that received endodontic treatment or retreatment by endodontists with presence of three years outcome was prepared (n = 598). We constructed a 17-layered DCNN with a self-attention layer (PRESSAN-17), and the model was trained, validated, and tested to 1) detect seven clinical features, i.e., full coverage restoration (FCR), presence of proximal teeth (PRX), coronal defect (COD), root rest (RRS), canal visibility (CAV), previous root filling (PRF), and periapical radiolucency (PAR), and 2) predict the three years endodontic prognosis by analyzing preoperative periapical radiographs as an input. During the prognostication test, a conventional DCNN without a self-attention layer (RESNET-18) was tested for comparison. Accuracy and area under the receiver-operating-characteristic (ROC) curve (AUC) were mainly evaluated for performance comparison. Gradient-weighted class activation mapping (Grad-CAM) was used to visualize weighted heatmaps.

RESULTS

PRESSAN-17 detected FCR (AUC = 0.975), PRX (0.866), COD (0.672), RRS (0.989), PRF (0.879) and PAR (0.690) significantly, compared to the no-information rate (p<0.05). Comparing the mean accuracy of 5-fold validation of two models, PRESSAN-17 (67.0%) showed a significant difference to RESNET-18 (63.4%, p<0.05). Also, the area under average ROC of PRESSAN-17 was 0.638, which was significantly different compared to the no-information rate. Grad-CAM demonstrated that PRESSAN-17 correctly identified clinical features.

CONCLUSIONS

Deep convolutional neural networks may aid in the prognostication of endodontic treatment outcome.

Tooth survival after endodontic treatment

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.

Outcomes reporting in systematic reviews on non-surgical root canal treatment: A scoping review for the development of a core outcome set

BACKGROUND

Studies related to non-surgical root canal treatment are amongst the most frequently performed clinical studies in endodontics. However, heterogeneity in reporting outcomes and lack of standardization is a significant challenge to evidence synthesis and guideline development.

OBJECTIVES

The aims of the present scoping review were to (a) identify outcomes reported in systematic reviews evaluating non-surgical root canal treatment; (b) identify how and when the reported outcomes were measured; (c) assess possible selective reporting bias in the included studies. The information obtained in this study should inform the development of a core outcome set (COS) for non-surgical root canal treatment.

METHODOLOGY

Structured literature searches were performed to identify systematic reviews on non-surgical root canal treatments published in English between January 1990 and December 2020. Two reviewers undertook study selection and data extraction. Outcomes were categorized according to a healthcare taxonomy into five core areas (survival, clinical/physiological changes, life impact, resource use, and adverse events). The outcome measurement tools and length of follow-up were recorded.

RESULTS

Seventy-five systematic reviews were included, of which 40 included meta-analyses. Most reviews reported on physiological and clinical outcomes, primarily pain and/or radiographic assessment of periapical status, and a variety of measurement tools and scales were used. Few reviews focused on tooth survival, life impact, resources, and adverse events. The heterogeneity amongst the reviews was large on all parameters. Less than 40% of the reviews assessed the risk of selective reporting.

DISCUSSION

Overall aims of the included reviews were highly heterogenic; thus, outcomes and how they were measured also varied considerably. Patient-centred outcomes and the use of resources were rarely reported on.

CONCLUSIONS

Most studies reported on physiological and clinical outcomes, in particular pain and/or radiographic healing. Measurement tools, scales, thresholds, and follow-up periods varied greatly within each outcome, making comparison across studies complicated. Less than 40% of the reviews assessed risk of selective reporting; thus, selective bias could not be ruled out. The presented information on reported outcomes, measurement tools and scales, and length of follow-up may guide the planning of future research and inform the development of a COS for non-surgical root canal treatment.

Treatment of cracked teeth: A comprehensive narrative review

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.

Wavelet Guided 3D Deep Model to improve Dental Microfracture Detection

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.

CBCT Patterns of Bone Loss and Clinical Predictors for the Diagnosis of Cracked Teeth and Teeth with Vertical Root Fracture

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.

Outcomes of treatment and monitoring of posterior teeth with cracks: three-year results from the National Dental Practice-Based Research Network

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.

A randomized controlled twelve month clinical study on the evaluation of success rate of endodontically treated teeth restored with metal poly-fiber posts and dentin posts

Settings and Design

Department of Prosthodontics, KMSDCH, SVDU, Randomised Controlled study.

Materials and Methods

Thirty-six teeth that satisfied selection criteria were randomly allocated and treated in the two intervention groups - metal fiber post with composite core and dentin post with composite core. Patient characteristics with respect to gender, tooth guidance, type of tooth, and mobility amount of tooth structure left were recorded. The primary outcome of tooth loss and the secondary outcomes of recurrent caries detected at the crown margin, de-cementation of crown, and fracture of the core, post, and root were recorded at baseline, 3, 6, and 12 month follow up.

Statistical Analysis Used

Chi Square test.

Results

Thirty-six teeth in 17 patients (10 males and 7 females) were treated using metal fiber post (18 teeth) and dentin post (18 teeth). No loss of tooth was seen at the end of 3, 6, and 12 months. The secondary outcomes also showed no recurrent caries at margin and no fracture of core, post, and root in both the groups at the end of 3, 6, and 12 months. One case of de-cementation was observed in both the groups at the 12-month period. Periodontal and periapical conditions showed no clinical and radiographic signs at any of the follow-up periods in both the groups.

Conclusion

This twelve month randomized controlled clinical study concluded a similar success rate for endodontically treated teeth restored with crowns on both metal fiber post with composite core and dentin post with composite core.

Clinical outcome of bonded partial indirect posterior restorations on vital and non-vital teeth: a systematic review and meta-analysis

OBJECTIVES

The survival rate of indirect partial adhesive restorations on vital versus endodontically treated teeth is still controversial. The hypothesis is that there may be a difference in the survival rate of partial adhesive restorations performed on non-vital teeth compared to vital teeth.

MATERIALS AND METHODS

This systematic review was conducted following the PRISMA guidelines. The considered clinical studies investigated the outcomes of adhesive inlays, onlays, and overlays conducted over the past 40 years, focusing on Kaplan-Meier survival curves to calculate the hazard ratio (primary objective) and the survival rate (secondary objective) between vital and non-vital teeth. The risk of bias was assessed using the Newcastle-Ottawa Scale. Studies included in the review were identified through bibliographic research on electronic databases ("PubMed," "Scopus," "Cochrane Central Register of Controlled Trial," and "Embase"). The K agreement between the two screening reviewers was evaluated.

RESULTS

A total of 55,793 records were identified on PubMed, Scopus, and other bibliographic sources, and after the application of the eligibility and inclusion criteria, eight articles were included for qualitative analysis and six for quantitative analysis. The meta-analysis of the primary and secondary outcomes demonstrated that hazard ratios (HR = 8.41, 95% CI: [4.50, 15.72]) and survival rates (OR = 3.24, 95% CI: [1.76, 5.82]) seemed more favorable for indirect partial adhesive restorations on vital teeth than for those on endodontically treated teeth.

CONCLUSIONS

Within the limits of this study, these findings suggest that the risk of failure of indirect partial adhesive restorations on endodontically treated teeth is higher than on vital teeth.

CLINICAL RELEVANCE

The use of partial adhesive restorations on vital and endodontically treated teeth showed different long-term clinical outcomes.

"THE CORRELATION OF CRACK LINES AND DEFINITIVE RESTORATIONS WITH THE SURVIVAL AND SUCCESS RATES OF CRACKED TEETH: A LONG-TERM RETROSPECTIVE CLINICAL STUDY"

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.

Management of Cracked Teeth: Perspectives of General Dental Practitioners and Specialists

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.

Repair of teeth with cracks in crowns and roots: An observational clinical study

AIM

This retrospective observational study investigated the survival rate of teeth with radicular cracks that were restored using composite materials.

METHODOLOGY

The study was approved by the Ethical Committee of Sistema Sanitario Nazionale (prot. N°2370CELazio1), Clinicaltrials.gov identifier: NCT04430205. Between 1991 and 2019, 87 teeth with radicular cracks (87 patients [46 men, 41 women, mean age 50.2 years]) were treated with adhesive composite restorations. Forty-five cracks were observed in the maxillary posterior teeth (molars and premolars), 40 in the mandibular posterior teeth and only two cracks in the anterior teeth, both in maxilla. Based on the depth of the crack, teeth were categorized as proximal radicular cracked teeth (PRCT), in which the fracture line was restricted within the pulpal floor or the coronal one-third of the root and deep radicular cracked teeth (DRCT), in which the fracture line extended to the middle and apical thirds of the root canal up to the apex. Bone loss/recovery was evaluated radiographically at 1-year follow-up. All patients were treated using surgical microscopy by the same operator. Logistic regression analysis was performed to determine independent predictors of extraction. Kaplan-Meier survival curves were used to analyse PRCT and DRCT.

RESULTS

Among 87 cracked teeth, 66 were molars, 19 premolars and 2 incisors. Fifty-two were DRCT, 35 were PRCT, 46 had a periodontal probing defect. Patients were followed up for a mean of 66.9 months (standard deviation 44.6, min 1 to max 172). Lack of probing depth was a significant protective factor against extraction (odds ratio [OR] 0.027, 95% confidence interval [CI] 0.003-0.27, p < .05), whereas further bone loss (OR 10.63, 95% CI 2.08-54.36, p < .05) was a risk factor for extraction. More than 50% of teeth treated with the adhesive protocol were functional (46 of 87 teeth [χ² test], p < .05) at 5-year follow-up. Among the PRCT group, a 78% survival rate at 5 years was found, while among the DRCT group, a 58% survival rate was found.

CONCLUSION

Composite resin restorations resulted in tooth survival in >50% of patients; 85.4% of PRCT and 61.5% of DRCT were functional after 5 years of follow-up.

What is the evidence of outcomes of endodontically treated cracked teeth?

Data sources Ovid, PubMed and Cochrane were searched using the indexed terms. Additional searches were made using endodontic textbooks and endodontic-related journals.Study selection Two independent reviewers screened the titles, abstracts and/or full text for clinical studies evaluating the treatment outcomes of healthy patients over 18 years of age who received root canal treatment with at least one year in occlusal function.Results The study included four articles and reported an overall survival of 84% after 60 months in endodontically treated cracked teeth. The authors reported that teeth with single crack, cracks contained within crowns and teeth with pre-treatment periodontal probing less than 3 mm had a lower risk of being extracted.Conclusion This study reported a moderately high survival rate of endodontically treated cracked teeth.

Facts About Cracks in Teeth

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.

Factors Related to the Outcomes of Cracked Teeth after Endodontic Treatment

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.