Survival rate after endodontic treatment in general dentistry for cracked teeth with different coronal restorations

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.

Quantifiable design and comparative evaluation of straight-line minimally invasive endodontic cavity based on the anatomical features of the coronal part of root canal

Background/purpose

Minimally invasive endodontics has recently become popular in research. This study aimed to develop a new quantifiable straight-line minimally invasive endodontic cavity (SMIEC) for 3-rooted maxillary first molar based on the anatomical features of the coronal part of root canal.

Materials and methods

Cone-beam computed tomography (CBCT) images of 80 teeth were converted into models in Mimics Research software. Anatomical features of the coronal part of root canal were measured to develop SMIECs with straight-line accesses to root canals in 3-matic Research software. Twenty models were randomly sampled and each was duplicated for 8 simulation groups: non-treated (NT), traditional endodontic cavity (TEC), ninja endodontic cavity (NEC) and 5 SMIECs. Post-simulation models were subjected to finite element analysis to detect von-Mises stresses in ABAQUS software.

Results

Distributions of straight-line accesses to protogenetic root canals had certain manners, hence we developed 5 SMIECs. NEC and SMIECs had less hard tissue loss than TEC and presented different numerical rankings in different structures (P < 0.05). NEC had a less narrow surgery field than SMIECs except SMIEC2/4 (P < 0.05). The peak pericervical stresses of SMIECs were similar, lower than TEC and higher than NEC and NT (P < 0.05). The stress distributions of the 8 groups had certain manners.

Conclusion

Five SMIECs with straight-line accesses to root canals were developed, whose biomechanical properties were worse than NEC but better than TEC. Having appropriate structure preservation and surgery field, SMIEC2/4 was a preferred SMIEC.

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.

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.

Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention

Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth. This article reviews the current literature on cracked tooth syndrome from four aspects, etiology, diagnosis, management, and prevention, to provide readers integrated information about this. The article begins with an introduction to the odontiatrogenic factors and then covers the noniatrogenic factors that induce cracked tooth syndrome. While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome. This is then followed by the description of common clinical diagnosis methods, the prospects of new technologies, and summaries of current clinical management methods, including immediate management and direct and indirect restoration. In the final section, preventive methods and their importance are proposed, with the aim of educating the common population.