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Choi S, Mo E, Sima C, Wu H, Thakkar-Samtani M, Tranby E, Frantsve-Hawley J, Barrow J. Impact of COVID-19 on Dental Care Utilization and Oral Health Conditions in the United States. JDR Clin Trans Res 2024; 9:256-264. [PMID: 37082861 PMCID: PMC10125887 DOI: 10.1177/23800844231165016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
PURPOSE We aim to understand the impact of the COVID-19 on health care utilization and oral health conditions of patients at federally qualified health centers (FQHCs), where patients are disproportionately low income, publicly insured, or uninsured. METHODS Using deidentified electronic health records of patients at FQHCs in the United States from January 2019 through December 2020 (n = 431,509), variations in health care utilization since the COVID-19 outbreak were observed by procedure types and patient characteristics. Changes in dental utilization and oral health conditions were characterized using mixed-effect negative binomial and logistic regression models. RESULTS Dental utilization decreased more drastically than medical utilization during shelter-in-place periods in 2020 and rebounded more slowly after the reopening. Greater demands for oral surgery and teledentistry and less demands for preventive services were observed in 2020. As compared to 2019, patients experienced more psychological stress-related dental conditions with odds ratios of 1.52 (95% confidence interval [CI], 1.31-1.76) for uninsured, 1.48 (95% CI, 1.07-2.02) for Medicaid enrollees, and 2.38 (95% CI, 1.68-3.40) for private insurance beneficiaries. CONCLUSION As a result of COVID-19, patients received more invasive dental procedures due to delayed treatment and experienced a higher risk of psychological stress-related dental conditions. Continued support for statewide policies to expand access to oral health care and oral health promotion strategies for the vulnerable populations would be encouraged. KNOWLEDGE TRANSFER STATEMENT Our study describes the impact of COVID-19 on dental care use and oral health conditions at Federally Qualified Health Centers, targeted to provide care for some of the most vulnerable populations in the United States. The results of this retrospective cohort study can be used by clinicians and policymakers on understanding the clinical needs of the vulnerable populations after the pandemic. It highlights the need for continued support to expand access to oral health care and oral health promotion to these populations.
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Affiliation(s)
- S.E. Choi
- Department of Oral Health Policy and
Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - E. Mo
- Office of Global and Community Health,
Harvard School of Dental Medicine, Boston, MA, USA
| | - C. Sima
- Department of Oral Medicine, Infection,
and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - H. Wu
- Office of Global and Community Health,
Harvard School of Dental Medicine, Boston, MA, USA
| | - M. Thakkar-Samtani
- Analytics and Evaluation, CareQuest
Institute for Oral Health, Boston, MA, USA
| | - E.P. Tranby
- Analytics and Evaluation, CareQuest
Institute for Oral Health, Boston, MA, USA
| | - J. Frantsve-Hawley
- Analytics and Evaluation, CareQuest
Institute for Oral Health, Boston, MA, USA
| | - J.R. Barrow
- Office of Global and Community Health,
Harvard School of Dental Medicine, Boston, MA, USA
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Oh SL, Hu J, Kwak KH, Chung MK. Survival analysis of teeth following clinical crown lengthening and crown insertion procedures up to 14 years: A retrospective cohort study. J Periodontol 2024. [PMID: 38874285 DOI: 10.1002/jper.24-0118] [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: 02/16/2024] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The purpose of this study was to conduct survival analysis of teeth following clinical crown lengthening procedures (CLPs) and crown insertions via a retrospective cohort study. METHODS Patient- and tooth-related data were collected from 268 participants who received CLPs from 2009 to 2015. The Kaplan-Meier curve and the log-rank tests were used to estimate the probability of survival and compare the survival probabilities among different variables. A Cox multivariate proportional hazard regression model was used to investigate the collective effects of root canal treatment (RCT) and the types of opposing dentition. RESULTS The rate of tooth loss was 21.6% during the observation period from 1 to 14 years, with 58 teeth extracted. The most attributable reason for tooth extraction was coronal tooth fracture, followed by endodontic failure such as root fracture. The survival probability was 0.87 at 5 years and 0.7 at 10 years. No significant differences in the survival probabilities were found among different providers and locations, the presence of a post, and the types of crowns. The hazard ratio for tooth loss was 6.3, 95% confidence interval (CI) [2.6 to 20.9] in the teeth with RCT (p < 0.001) and 2.4, 95% CI [1.1 to 4.8] in the teeth occluding implant-retained prostheses (p = 0.016). CONCLUSIONS Tooth loss following CLPs and crown insertions appeared least among the teeth without RCT when occluding natural teeth, while tooth loss was most among the teeth with RCT when occluding implants.
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Affiliation(s)
- Se-Lim Oh
- Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
| | - Jiaxin Hu
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
| | - Kee Hyun Kwak
- School of Dentistry, University of Maryland, Baltimore, Maryland, USA
| | - Man-Kyo Chung
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
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Zhao W, Luo J, Zhang S, Zhang Z, Su Z, Fu B, Jin X. Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study. Clin Oral Investig 2024; 28:368. [PMID: 38862733 DOI: 10.1007/s00784-024-05735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers. MATERIALS AND METHODS 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate. RESULTS 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%. CONCLUSION Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth. CLINICAL RELEVANCE The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.
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Affiliation(s)
- Weijia Zhao
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310020, Zhejiang, China
| | - Jie Luo
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310020, Zhejiang, China
| | - Sisi Zhang
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310020, Zhejiang, China
| | - Zhengyi Zhang
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310020, Zhejiang, China
| | - Zhiwei Su
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310020, Zhejiang, China
| | - Baiping Fu
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310020, Zhejiang, China.
| | - Xiaoting Jin
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310020, Zhejiang, China.
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Zeng B, Luo B, Hu J, Meng D, Zhang J, Cao X, Jiang Q. Effect of margin designs and loading conditions on the stress distribution of endocrowns: a finite element analysis. BMC Oral Health 2024; 24:657. [PMID: 38840138 PMCID: PMC11151608 DOI: 10.1186/s12903-024-04422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Margin designs and loading conditions can impact the mechanical characteristics and survival of endocrowns. Analyzing the stress distribution of endocrowns with various margin designs and loading conditions can provide evidence for their clinical application. METHODS Three finite element analysis models were established based on the margin designs: endocrown with a butt-joint type margin (E0), endocrown with a 90° shoulder (E90), and endocrown with a 135° shoulder (E135). The E0 group involved lowering the occlusal surface and preparing the pulp chamber. The E90 group created a 90° shoulder on the margin of model E0, measuring 1.5 mm high and 1 mm wide. The E135 group featured a 135° shoulder. The solids of the models were in fixed contact with each other, and the materials of tooth tissue and restoration were uniform, continuous, isotropic linear elasticity. Nine static loads were applied, with a total load of 225 N, and the maximum von Mises stresses and stress distribution were calculated for teeth and endocrowns with different margin designs. RESULTS Compared the stresses of different models under the same loading condition. In endocrowns, when the loading points were concentrated on the buccal side, the maximum von Mises stresses were E0 = E90 = E135, and when there was a lingual loading, they were E0 < E90 = E135. In enamel, the maximum von Mises stresses under all loading conditions were E0 > E90 > E135. In dentin, the maximum von Mises stresses of the three models were basically similar except for load2, load5 and load9. Compare the stresses of the same model under different loading conditions. In endocrowns, stresses were higher when lingual loading was present. In enamel and dentin, stresses were higher when loaded obliquely or unevenly. The stresses in the endocrowns were concentrated in the loading area. In enamel, stress concentration occurred at the cementoenamel junction. In particular, E90 and E135 also experienced stress concentration at the shoulder. In dentin, the stresses were mainly concentrated in the upper section of the tooth root. CONCLUSION Stress distribution is similar among the three margin designs of endocrowns, but the shoulder-type designs, especially the 135° shoulder, exhibit reduced stress concentration.
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Affiliation(s)
- Baijin Zeng
- Department of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Bin Luo
- Department of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Jiangqi Hu
- Department of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Dan Meng
- Department of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Jiebing Zhang
- Department of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Xu Cao
- Department of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tiantanxili, Dongcheng District, Beijing, 100050, China.
| | - Qingsong Jiang
- Department of Prosthodontics, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, No. 4 Tiantanxili, Dongcheng District, Beijing, 100050, China.
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Yu S, Ma L, Gao Y, Zheng H, Hu X, Liu R, Shi Y, Yin W. Effects of fissure length and angle on the fracture modes of 3D printed teeth model: Insights from DIC-based fracture tests and meshless numerical simulations. J Mech Behav Biomed Mater 2024; 154:106512. [PMID: 38554582 DOI: 10.1016/j.jmbbm.2024.106512] [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: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/01/2024]
Abstract
To investigate the influences of teeth fissure properties on their failure modes, 3D Printing technology is used to prepare the teeth models. The strain distributions of the teeth model surfaces at each moment of the loading processes are obtained by the DIC technique. And the progressive failure processes as well as the stress distributions of the teeth models are simulated by the improved Smoothed Particle Hydrodynamics (SPH) Method. Experimental results show that under the action of the steel ball, the teeth models mainly produce two types of cracks: The tensile cracks along the pre-existing fissures and the shear cracks along both sides of the teeth model. The existence of prefabricated fissures greatly reduces the peak strength of the teeth models. Compared with the circumstances containing no pre-existing fissures, the peak strength of d = 1 cm, d = 2 cm and d = 3 cm decreases by 22.33%, 31.79% and 18.94%, respectively, and the peak strength of θ = 30°, θ = 45°, θ = 60° decreases by 10.78%, 44.01% and 34.3%, respectively. Numerical results show that the initiations of tensile cracks are induced by the high tensile stress concentrations at the pre-existing fissure tips, while the shear cracks are caused by the high tensile stress concentrations in the low tensile stress concentration areas after the initiation of tensile cracks. The research results can provide some references for the understandings of teeth failure mechanisms as well as the applications of SPH method into teeth crack propagation simulations.
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Affiliation(s)
- Shuyang Yu
- School of Transportation and Civil Engineering, Nantong University, Nantong, 226019, China
| | - Li Ma
- Nanjing Health Information Center, Nanjing, 210003, China
| | - Yuan Gao
- School of Transportation and Civil Engineering, Nantong University, Nantong, 226019, China
| | - Hao Zheng
- Nanjing Stomatological Hospital Medical School of Nanjing University, Nanjing, 210008, China
| | - Xueying Hu
- School of Transportation and Civil Engineering, Nantong University, Nantong, 226019, China
| | - Runyu Liu
- School of Transportation and Civil Engineering, Nantong University, Nantong, 226019, China
| | - Yue Shi
- School of Transportation and Civil Engineering, Nantong University, Nantong, 226019, China
| | - Weidong Yin
- Nanjing Health Information Center, Nanjing, 210003, China.
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de Toubes KMS, Corrêa IS, Valadares RCL, Tonelli SQ, Bruzinga FFB, Silveira FF. Managing Cracked Teeth with Root Extension: A Prospective Preliminary Study Using Biodentine™ Material. Int J Dent 2024; 2024:2234648. [PMID: 38756384 PMCID: PMC11098601 DOI: 10.1155/2024/2234648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/29/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose The authors of this study proposed an innovative approach involving the use of Biodentine™ material as an intraorifice barrier in cracked teeth with root extension to promote internal crack sealing, preventing the possibility of microinfiltration and apical crack propagation. Materials and Methods The dental records of 11 patients with 12 posterior cracked teeth with root extension were included with a precise protocol performed by a senior endodontist. The treatment protocol included pulp diagnosis, crack identification using a dental operating microscope (DOM), endodontic treatment, placing a Biodentine™ as an intraorifice barrier, and immediate full-coverage restoration. The effectiveness of the treatment was assessed at two intervals, 6 months, and 1-3 years posttreatment, evaluating clinical, radiographic, and tomographic aspects. The treatment was deemed successful if there were no indications of radiolucency, sinus tracts, edema, or periodontal pockets associated with the crack line. Results The study observed remarkably positive outcomes during the follow-up period, which spanned from 1 to 3 years. All the cracked teeth (100%) remained asymptomatic, meaning they were free of pain or discomfort. Furthermore, these teeth were in occlusal function. Both radiographic and tomographic assessments revealed the absence of bone loss along the crack line. This outcome signifies that the treatment effectively prevented further deterioration of the surrounding bone. Conclusions Integrating advanced biomaterials and conservative restorative techniques has paved the way for innovative approaches in dental care. This protocol suggests a proactive step for managing cracked teeth with root extension. It addresses both biological aspects by sealing internal cracks and mechanical aspects by preventing crack progression, thereby improving these teeth' prognosis and long-term survival.
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Affiliation(s)
| | - Isabella Sousa Corrêa
- Department of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Frank Ferreira Silveira
- Department of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil
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Pu Y, Wang M, Hong Y, Bai J. Prognostic factors associated with pulp status in patients with cracked teeth treated with occlusal veneer: A 6- through 24-month prospective clinical study. J Am Dent Assoc 2024:S0002-8177(24)00075-8. [PMID: 38530693 DOI: 10.1016/j.adaj.2024.02.004] [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: 11/17/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The authors evaluated the prognostic factors associated with pulp status in patients with cracked teeth (CT) treated with occlusal veneer. METHODS An analysis of 80 CT (71 patients) with 1 or more crack lines (CLs) and normal pulp vitality or reversible pulpitis was performed. All patients received occlusal veneer and their demographic and clinical data were recorded. Pulp status and clinical features were recorded at 1 week and posttreatment at 1, 2, 3, 6, 12, 18, and 24 months. RESULTS Maxillary first molars were commonly involved (30 [38%]). The number of CLs on the finish line ranged from 1 through 7 and most had 3 CLs (24 [30%]). The number of CLs through preparation on the finish line ranged from 0 through 4, and 2 CLs (42 [53%]) were the most prevalent. During follow-up, 5 of 80 CT progressed to pulp disease, resulting in a success rate of 93.8%. Results of the Cox model and Kaplan-Meier analysis showed that probing depth greater than 6 mm, widening periodontal ligament of apical area, more than 4 CLs on finish line, and more than 2 CLs through preparation on the finish line were risk factors associated with pulp status (P < .05). CONCLUSIONS Occlusal veneer can protect CT without preventive root canal therapy. PRACTICAL IMPLICATIONS The success rate and risk factors of pulp disease in CT restored with occlusal veneer are reported.
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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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Xie Z, Lu Q, Guo J, Lin W, Ge G, Tang Y, Pasini D, Wang W. Semantic segmentation for tooth cracks using improved DeepLabv3+ model. Heliyon 2024; 10:e25892. [PMID: 38380020 PMCID: PMC10877285 DOI: 10.1016/j.heliyon.2024.e25892] [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: 01/21/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Objective Accurate and prompt detection of cracked teeth plays a critical role for human oral health. The aim of this paper is to evaluate the performance of a tooth crack segmentation model (namely, FDB-DeepLabv3+) on optical microscopic images. Method The FDB-DeepLabv3+ model proposed here improves feature learning by replacing the backbone with ResNet50. Feature pyramid network (FPN) is introduced to fuse muti-level features. Densely linked atrous spatial pyramid pooling (Dense ASPP) is applied to achieve denser pixel sampling and wider receptive field. Bottleneck attention module (BAM) is embedded to enhance local feature extraction. Results Through testing on a self-made hidden cracked tooth dataset, the proposed method outperforms four classical networks (FCN, U-Net, SegNet, DeepLabv3+) on segmentation results in terms of mean pixel accuracy (MPA) and mean intersection over union (MIoU). The network achieves an increase of 11.41% in MPA and 12.14% in MIoU compared to DeepLabv3+. Ablation experiments shows that all the modifications are beneficial. Conclusion An improved network is designed for segmenting tooth surface cracks with good overall performance and robustness, which may hold significant potential in computer-aided diagnosis of cracked teeth.
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Affiliation(s)
- Zewen Xie
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
- School of Physics and Material Science, Guangzhou University, Guangzhou, 510006, China
| | - Qilin Lu
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Juncheng Guo
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Weiren Lin
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Guanghua Ge
- Department of Dentistry, Hospital of Guangdong University of Technology, Guangdong University of Technology, Guangzhou, 510006, China
| | - Yadong Tang
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, 510006, China
| | - Damiano Pasini
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, QC H3A 0C3, Canada
| | - Wenlong Wang
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
- Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, QC H3A 0C3, Canada
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Yap RC, Alghanem M, Martin N. A narrative review of cracks in teeth: Aetiology, microstructure and diagnostic challenges. J Dent 2023; 138:104683. [PMID: 37713950 DOI: 10.1016/j.jdent.2023.104683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES To summarize the available evidence of crack formation in teeth and to discuss the limitations of the current clinical diagnostic modalities for crack detection in teeth. BACKGROUND Cracks are a common clinical finding in teeth and yet clinicians still struggle to identify the full extent and orientation of cracks for their appropriate timely management. The biomechanics of crack development can be due to multiple factors and can differ from an unrestored tooth to a restored or endodontically treated tooth. DATA & SOURCES This narrative review has been designed following the guidelines published by Green et al. 2006 [1] Published literature in the English language that addresses the objectives of this review up to July 2022 was sourced from online databases and reference lists. The relevance of the papers was assessed and discussed by two reviewers. A total of 101 publications were included in this narrative review. CONCLUSIONS The initiation and development of cracks in teeth are likely linked to an interplay between the masticatory forces and fracture resistance of the remaining tooth structure. From the identified literature, the quality and quantity of remaining tooth structure in a restored or endodontically-treated tooth affects the biomechanics of crack development compared to an unrestored tooth. The extent, orientation, and size of the cracks do affect a clinician's ability to detect cracks in teeth. There is still a need to develop reliable diagnostic tools that will accurately identify cracks in teeth beneath restorations to enable effective monitoring of their propagation and provide appropriate interventions. CLINICAL SIGNIFICANCE The development and propagation of cracks in an unrestored tooth differ greatly from a restored and endodontically treated tooth; mainly linked to the quantity and quality of the remaining tooth structure and the forces acting on them. Identifying the extent of cracks in teeth remains challenging for early clinical intervention.
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Affiliation(s)
- Rei Chiel Yap
- DClinDent student, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK.
| | - Meshal Alghanem
- DClinDent student, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK.
| | - Nicolas Martin
- Professor of Restorative Dentistry, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK.
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11
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Long Z, Song R, Zhao C, Miao Y, Luo X, Wu X, Huang D, Zhang L. Quantifiable design and comparative evaluation of straight-line minimally invasive endodontic cavity based on the anatomical features of the coronal part of root canal. J Dent Sci 2023; 18:1621-1629. [PMID: 37799919 PMCID: PMC10547998 DOI: 10.1016/j.jds.2023.02.001] [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: 01/05/2023] [Revised: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
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.
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Affiliation(s)
- Ziteng Long
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Ruijun Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Chenyi Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Yixuan Miao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Xutao Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Xingbo Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Lan Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
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12
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Sheets CG, Quan DA, Wu JC, Earthman JC. An evaluation of quantitative percussion diagnostics for determining the probability of a microgap defect in restored and unrestored teeth: A prospective clinical study. J Prosthet Dent 2023:S0022-3913(23)00272-X. [PMID: 37244793 DOI: 10.1016/j.prosdent.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/29/2023]
Abstract
STATEMENT OF PROBLEM Current dental diagnostics are image based and cannot detect a structural microgap defect such as a crack in a tooth. Whether percussion diagnostics can effectively diagnose a microgap defect is unclear. PURPOSE The purpose of the present study was to determine from a large multicenter prospective clinical study whether quantitative percussion diagnostics (QPD) could detect structural damage in teeth and whether a probability of its presence could be provided. MATERIAL AND METHODS A nonrandomized prospective and multicenter clinical validation study with 224 participants was performed in 5 centers with 6 independent investigators. The study used QPD and the normal fit error to determine whether a microgap defect was present in a natural tooth. Teams 1 and 2 were blinded. Team 1 tested teeth scheduled for restoration with QPD, and Team 2 disassembled the teeth aided by a clinical microscope, transillumination, and a penetrant dye. Microgap defects were documented in written and video formats. Controls were participants without damaged teeth. The percussion response from each tooth was stored on a computer and analyzed. A total of 243 teeth were tested to provide approximately 95% power to test the performance goal of 70%, based on an assumed population overall agreement of 80%. RESULTS Regardless of the collection method, tooth geometry, restoration material used, or restoration type, the data on detecting a microgap defect in a tooth were accurate. The data also reflected good sensitivity and specificity consistent with previously published clinical studies. The combined study data showed an overall agreement of 87.5% with a 95% confidence interval (84.2 to 90.3), beyond the 70% predetermined performance goal. The combined study data determined whether it was possible to predict the probability of a microgap defect. CONCLUSIONS The results showed that the data on detecting microgap defects in a tooth site were consistently accurate and confirmed that QPD provided information to aid the clinician in treatment planning and early preventative treatment. QPD can also alert the clinician of probable diagnosed and undiagnosed structural problems via the use of a probability curve.
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Affiliation(s)
- Cherilyn G Sheets
- Co-Executive Director, Research & Teaching Divisions, Newport Coast Oral Facial Institute, Newport Beach, Calif
| | - Dennis A Quan
- Chief Technology and Engineering Officer, Perimetrics Inc, Newport Beach, Calif.; Professor, Duke University, Department of Computer Science, Durham, NC
| | - Jean C Wu
- Co-Executive Director, Research & Teaching Divisions, Newport Coast Oral Facial Institute, Newport Beach, Calif
| | - James C Earthman
- Professor, Department of Material Science & Engineering, Department of Biomedical Engineering, University of California, Irvine, Calif.
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Ferracane JL, Hilton TJ, Funkhouser E. Lessons learned from the Cracked Tooth Registry: A 3-year clinical study in the Nation's Network. J Am Dent Assoc 2023; 154:235-244. [PMID: 36690539 PMCID: PMC10686254 DOI: 10.1016/j.adaj.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND This article reviews the most salient lessons learned from a large, multisite, 3-year observational study of posterior teeth with cracks conducted by The National Dental Practice-Based Research Network. TYPES OF STUDIES REVIEWED Eight articles published over a 6-year period (2017-2022) describing clinical characteristics of posterior teeth with cracks and their treatment and outcomes are reviewed and discussed to answer 3 common questions faced by oral health care clinicians: Which cracked teeth will get worse? When should practitioners intervene? What is the best treatment? RESULTS Although cracks in teeth are prevalent, few will fracture (3%) or show crack progression in 3 years (12%). Characteristics that guide the clinician to treatment include active caries, biting pain, and to a lesser degree, having a crack detectable with an explorer, connecting with a restoration, or blocking transilluminated light; the main treatment chosen is a complete crown. Of those teeth treated (36%), few (14%) will need retreatment but will still survive, despite having an internal crack as well. CONCLUSIONS AND PRACTICAL IMPLICATIONS Although cracked teeth often pose a dilemma to clinicians, clincians are generally good at deciding which teeth to treat and when and which to monitor.
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Dorado S, Arias A, Jimenez-Octavio JR. Biomechanical Modelling for Tooth Survival Studies: Mechanical Properties, Loads and Boundary Conditions-A Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7852. [PMID: 36363451 PMCID: PMC9657341 DOI: 10.3390/ma15217852] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Recent biomechanical studies have focused on studying the response of teeth before and after different treatments under functional and parafunctional loads. These studies often involve experimental and/or finite element analysis (FEA). Current loading and boundary conditions may not entirely represent the real condition of the tooth in clinical situations. The importance of homogenizing both sample characterization and boundary conditions definition for future dental biomechanical studies is highlighted. The mechanical properties of dental structural tissues are presented, along with the effect of functional and parafunctional loads and other environmental and biological parameters that may influence tooth survival. A range of values for Young's modulus, Poisson ratio, compressive strength, threshold stress intensity factor and fracture toughness are provided for enamel and dentin; as well as Young's modulus and Poisson ratio for the PDL, trabecular and cortical bone. Angles, loading magnitude and frequency are provided for functional and parafunctional loads. The environmental and physiological conditions (age, gender, tooth, humidity, etc.), that may influence tooth survival are also discussed. Oversimplifications of biomechanical models could end up in results that divert from the natural behavior of teeth. Experimental validation models with close-to-reality boundary conditions should be developed to compare the validity of simplified models.
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Affiliation(s)
- Saúl Dorado
- Department of Mechanical Engineering, Escuela Técnica Superior de Ingeniería ICAI, Universidad Pontificia Comillas, 28015 Madrid, Spain
| | - Ana Arias
- Department of Conservative and Prosthetic Dentistry, School of Dentistry, Complutense University, 28040 Madrid, Spain
| | - Jesus R. Jimenez-Octavio
- Instituto de Investigación Tecnológica, Escuela Técnica Superior de Ingeniería ICAI, Universidad Pontificia Comillas, 28015 Madrid, Spain
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15
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Diagnosis of cracked tooth: Clinical status and research progress. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:357-364. [PMID: 36425316 PMCID: PMC9678967 DOI: 10.1016/j.jdsr.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Cracked tooth is a common dental hard tissue disease.The involvement of cracks directly affects the selection of treatment and restoration of the affected teeth.It is helpful to choose more appropriate treatment options and evaluate the prognosis of the affected tooth accurately to determine the actual involvement of the crack.However, it is often difficult to accurately and quantitatively assess the scope of cracks at present.So it is necessary to find a real method of early quantitative and non-destructive crack detection.This article reviews the current clinical detection methods and research progress of cracked tooth in order to provide a reference for finding a clinical detection method for cracked tooth.
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Lew AJ, Beniash E, Gilbert PUPA, Buehler MJ. Role of the Mineral in the Self-Healing of Cracks in Human Enamel. ACS NANO 2022; 16:10273-10280. [PMID: 35748426 DOI: 10.1021/acsnano.1c10407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Human enamel is an incredibly resilient biological material, withstanding repeated daily stresses for decades. The mechanisms behind this resilience remain an open question, with recent studies demonstrating a crack-deflection mechanism contributing to enamel toughness and other studies detailing the roles of the organic matrix and remineralization. Here, we focus on the mineral and hypothesize that self-healing of cracks in enamel nanocrystals may be an additional mechanism acting to prevent catastrophic failure. To test this hypothesis, we used a molecular dynamics (MD) approach to compare the fracture behavior of hydroxyapatite (HAP) and calcite, the main minerals in human enamel and sea urchin teeth, respectively. We find that cracks heal under pressures typical of mastication by fusion of crystals in HAP but not in calcite, which is consistent with the resilience of HAP enamel that calcite teeth lack. Scanning transmission electron microscopy (STEM) images of structurally intact ("sound") human enamel show dashed-line nanocracks that resemble and therefore might be the cracks healed by fusion of crystals produced in silico. The fast, self-healing mechanism shown here is common in soft materials and ceramics but has not been observed in single crystalline materials at room temperature. The crack self-healing in sound enamel nanocrystals, therefore, is unique in the human body and unique in materials science, with potential applications in designing bioinspired materials.
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Affiliation(s)
- Andrew J Lew
- Laboratory for Atomistic and Molecular Mechanics (LAMM), Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
- Department of Chemistry, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Elia Beniash
- Departments of Oral Biology and Bioengineering, Center for Craniofacial Regeneration, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Pupa U P A Gilbert
- Department of Physics, University of Wisconsin, Madison, Wisconsin 53706, United States
- Departments of Chemistry, Materials Science and Engineering, Geoscience, University of Wisconsin, Madison, Wisconsin 53706, United States
- Chemical Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, United States
| | - Markus J Buehler
- Laboratory for Atomistic and Molecular Mechanics (LAMM), Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
- Center for Computational Science and Engineering, Schwarzman College of Computing, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
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Boonrawd N, Rungsiyakull P, Rungsiyakull C, Louwakul P. Effects of composite resin core level and periodontal pocket depth on crack propagation in endodontically treated teeth: An extended finite element method study. J Prosthet Dent 2022; 128:195.e1-195.e7. [PMID: 35779973 DOI: 10.1016/j.prosdent.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
Abstract
STATEMENT OF PROBLEM Preserving teeth with radicular cracks with or without a periodontal pocket is an alternative to extraction. However, an effective protocol for the restoration of radicular cracks is lacking. PURPOSE The purpose of this study was to examine the composite resin core level and periodontal pocket depth effects on stress distribution, maximum von Mises stress, and crack propagation in endodontically treated teeth by using the extended finite element (FE) method. MATERIAL AND METHODS Four 3-dimensional models of a cracked endodontically treated mandibular first molar were constructed: PP2C2 (periodontal pocket depth, 2 mm; composite resin core level, 2 mm below the canal orifice level); PP2C4 (periodontal pocket depth, 2 mm; composite resin core level, 2 mm below the crack level); PP4C2 (periodontal pocket depth, 4 mm; composite resin core level, 2 mm below the canal orifice level); and PP4C4 (periodontal pocket depth, 4 mm; composite resin core level, 2 mm below the crack level). The crack initiation was at the same level in all models. A static 700-N load was applied to the models in a vertical direction. RESULTS The highest stress in dentin was observed in PP2C2, whereas PP2C4 exhibited the lowest stress and least crack propagation. Stress was high in the dentin and supporting bone. No reduction in crack propagation was observed in the PP4 models, regardless of the composite resin core level. CONCLUSIONS The periodontal pocket depth (2 mm and 4 mm) and composite resin core level (2 mm below the crack level and 2 mm below the canal orifice level) affected stress concentration in dentin, resulting in different patterns of crack propagation in the FE models.
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Affiliation(s)
- Narissara Boonrawd
- Graduate student, Department of Restorative Dentistry and Periodontology, Endodontic Division, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Pimduen Rungsiyakull
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chaiy Rungsiyakull
- Assistant Professor, Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand
| | - Phumisak Louwakul
- Assistant Professor, Department of Restorative Dentistry and Periodontology, Endodontic Division, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
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18
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Guo J, Wu Y, Chen L, Long S, Chen D, Ouyang H, Zhang C, Tang Y, Wang W. A perspective on the diagnosis of cracked tooth: imaging modalities evolve to AI-based analysis. Biomed Eng Online 2022; 21:36. [PMID: 35706023 PMCID: PMC9202175 DOI: 10.1186/s12938-022-01008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Despite numerous clinical trials and pre-clinical developments, the diagnosis of cracked tooth, especially in the early stages, remains a challenge. Cracked tooth syndrome is often accompanied by dramatic painful responses from occlusion and temperature stimulation, which has become one of the leading causes for tooth loss in adults. Current clinical diagnostical approaches for cracked tooth have been widely investigated based on X-rays, optical light, ultrasound wave, etc. Advances in artificial intelligence (AI) development have unlocked the possibility of detecting the crack in a more intellectual and automotive way. This may lead to the possibility of further enhancement of the diagnostic accuracy for cracked tooth disease. In this review, various medical imaging technologies for diagnosing cracked tooth are overviewed. In particular, the imaging modality, effect and the advantages of each diagnostic technique are discussed. What's more, AI-based crack detection and classification methods, especially the convolutional neural network (CNN)-based algorithms, including image classification (AlexNet), object detection (YOLO, Faster-RCNN), semantic segmentation (U-Net, Segnet) are comprehensively reviewed. Finally, the future perspectives and challenges in the diagnosis of the cracked tooth are lighted.
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Affiliation(s)
- Juncheng Guo
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Yuyan Wu
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Lizhi Chen
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Shangbin Long
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Daqi Chen
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Haibing Ouyang
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Chunliang Zhang
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Yadong Tang
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, 510006, China
| | - Wenlong Wang
- School of Mechanical and Electrical Engineering, Guangzhou University, Guangzhou, 510006, China.
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Gund MP, Wrbas KT, Hannig M, Rupf S. Apical periodontitis after intense bruxism. BMC Oral Health 2022; 22:91. [PMID: 35331220 PMCID: PMC8951715 DOI: 10.1186/s12903-022-02123-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Bruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism. CASE PRESENTATION This article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed. CONCLUSIONS Incomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.
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Affiliation(s)
- Madline P Gund
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany.
| | - Karl-Thomas Wrbas
- Department of Operative Dentistry and Periodontology, Centre for Dental Medicine, Oral and Maxillofacial Surgery, Medical Centre, University of Freiburg, Freiburg i.Br., Germany.,Division of Endodontics, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University, 3500, Krems, Austria
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
| | - Stefan Rupf
- Chair of Synoptic Dentistry, Saarland University, Kirrbergerstr. 100, Building 73, 66421, Homburg, Germany
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20
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Shenoy N, Shenoy A. Periodontal Manifestations in Vertical Root Fractured Teeth. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0041-1741416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractVertical root fractures are more commonly encountered following endodontic treatment and in teeth without endodontic treatment, with habits like bruxism and eating coarse, hard food. The teeth most predisposed to fracture are the premolars of the maxilla and mandible, the mesial roots and mesiobuccal roots of the mandibular molars, maxillary molars and the mandibular incisors. Timely identification of cracked teeth and fractures is the key since it permits a conservative and preventive approach. Delay in diagnosis and treatment will result in the involvement of the underlying periodontium, causing periodontal pockets, abscess formation, and bone loss, thereby further complicating the outcome. Appropriate diagnosis, education, and counseling of the patient by the dentist and coronal restoration following root canal treatment are mandatory to prevent the loss of teeth in patients. The prognosis of multirooted teeth is more favorable. Affected single-rooted teeth may, however, require immediate extraction. MEDLINE database and Scopus search (www.scopus.com) were performed using the key words “vertical root fracture” or “longitudinal root fracture.” Text book chapters were manually checked.
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Affiliation(s)
- Nina Shenoy
- Department of Periodontics, AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Arvind Shenoy
- Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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21
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Lin F, Ordinola-Zapata R, Ye N, Xu H, Fok AS. Fatigue analysis of restored teeth longitudinally cracked under cyclic loading. Dent Mater 2022; 38:204-213. [PMID: 34949478 PMCID: PMC8792291 DOI: 10.1016/j.dental.2021.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/10/2021] [Accepted: 12/08/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the fatigue behavior of restored teeth, in particular the mechanisms of longitudinal dentinal cracking under cyclic mechanical loading, using finite element analysis (FEA) and the stress-life (S-N) approach. METHODS Ten root-filled premolars restored with resin composites were subjected to step-stress cyclic loading to produce longitudinal cracks. Fracture loads and number of cycles completed at each load level were recorded. FEA was used to predict the stress amplitude of each component under the global cyclic load. Both intact and debonded conditions were considered for the dentin-composite interface in the FEA. The predicted stress concentrations were compared with the fracture patterns to help elucidate the failure mechanisms. The S-N approach was further used to predict the lifetimes of the different components in the restored teeth. Cumulative fatigue damage was represented by the sum of the fractions of life spent under the different stress amplitudes. RESULTS Longitudinal cracks were seen in ~50% of the samples with a mean fracture load of 770 ± 45 N and a mean number of cycles to failure of 32,297 ± 12,624. The longitudinal dentinal cracks seemed to start near the line angle of the cavity, and propagated longitudinally towards the root. The sum of fractions of life spent for the dentin-composite interface exceeded 1 after ~7000 cycles when that for dentin was much lower than 1, indicating that interfacial debonding would occur prior to dentin fracture. This was supported by micro-CT images showing widened interfacial space in the cracked samples. In the debonded tooth, FEA showed dentinal stress concentrations at the gingival wall of the cavity, which coincided with the longitudinal cracks found in the cyclic loading test. The sum of fractions of life spent for dentin was close to 1 at ~30,000 cycles, similar to the experimental value. SIGNIFICANCE Debonding of the dentin-composite interface may occur prior to longitudinal cracking of dentin in root-filled teeth under cyclic loading. The approximate time of occurrence for these events could be estimated using fatigue analysis with stresses provided by FEA. This methodology can therefore be used to evaluate the longevity of restoration designs for root-filled teeth.
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Affiliation(s)
- Fei Lin
- Department of Cariology and Endodontology, Peking University School and Hospital of Stomatology, Beijing, 100081, China,Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Ronald Ordinola-Zapata
- Division of Endodontics, Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Ning Ye
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, 55455, USA,Department of Mechanical Engineering, College of Science and Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Haiping Xu
- Department of Stomatology, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
| | - Alex S.L. Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, 55455, USA,Corresponding author at: 16-212 Moos Health Science Tower, 515 Delaware Street S.E., Minneapolis, MN 55455, USA. (A.S.L. Fok)
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22
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Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention. Pain Res Manag 2021; 2021:3788660. [PMID: 34956432 PMCID: PMC8694987 DOI: 10.1155/2021/3788660] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 01/28/2023]
Abstract
Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth. This article reviews the current literature on cracked tooth syndrome from four aspects, etiology, diagnosis, management, and prevention, to provide readers integrated information about this. The article begins with an introduction to the odontiatrogenic factors and then covers the noniatrogenic factors that induce cracked tooth syndrome. While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome. This is then followed by the description of common clinical diagnosis methods, the prospects of new technologies, and summaries of current clinical management methods, including immediate management and direct and indirect restoration. In the final section, preventive methods and their importance are proposed, with the aim of educating the common population.
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23
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Infrared Clinical Enamel Crack Detector Based on Silicon CCD and Its Application: A High-Quality and Low-Cost Option. J Imaging 2021; 7:jimaging7120259. [PMID: 34940726 PMCID: PMC8703581 DOI: 10.3390/jimaging7120259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
Enamel cracks generated in the anterior teeth not only affect the function but also the aesthetics of the teeth. Chair-side tooth enamel crack detection is essential for clinicians to formulate treatment plans and prevent related dental disease. This study aimed to develop a dental imaging system using a near-IR light source to detect enamel cracks and to investigate the relationship between anterior enamel cracks and age in vivo. A total of 68 subjects were divided into three groups according to their age: young, middle, and elderly. Near-infrared radiation of 850 nm was used to identify enamel cracks in anterior teeth. The results of the quantitative examination showed that the number of enamel cracks on the teeth increased considerably with age. For the qualitative examination, the results indicated that there was no significant relationship between the severity of the enamel cracks and age. So, it can be concluded that the prevalence of anterior cracked tooth increased significantly with age in the young and middle age. The length of the anterior enamel cracks tended to increase with age too; however, this result was not significant. The silicon charge-coupled device (CCD) with a wavelength of 850 nm has a good performance in the detection of enamel cracks and has very good clinical practicability.
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Shahmoradi M, Wan B, Zhang Z, Swain M, Li Q. Mechanical failure of posterior teeth due to caries and occlusal wear- A modelling study. J Mech Behav Biomed Mater 2021; 125:104942. [PMID: 34800891 DOI: 10.1016/j.jmbbm.2021.104942] [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: 08/16/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of the present work is to explore the effect of occlusal wear and different types and degrees of caries on the mechanical performance and structural integrity of posterior teeth. METHODS Three-dimensional (3D) computational models with different combinations of caries parameters (caries location, caries size and caries induced pulp shrinkage) and occlusal wear factors (enamel thickness, marginal ridge height and cuspal slope) were developed and analyzed using the extended finite element method (XFEM) to identify the stress distribution, crack initiation load and ultimate fracture load values. The effect of a non-drilling conservative treatment using resin infiltration on the recovery of mechanical properties of carious molar teeth was also investigated. RESULTS Presence of fissural caries, worn proximal marginal ridge and decreased enamel thickness due to occlusal wear, imparted a significant negative effect on the crack initiation load value of the lower molar models. Accordingly, models with intact and strong proximal marginal ridge, generally exhibited higher crack initiation loading, regardless of caries size and location. Presence of fissure caries drastically decreased (55%-70%) the crack initiation load compared to sound teeth. The depth of the fissural lesion and the presence of proximal caries did not have a major effect on crack initiation load values. However, increasing the caries size resulted in lower final fracture load values in most of the cases. Accordingly, the groups with combined and connected large fissural and proximal lesions experienced the largest drop in the fracture load values compared to sound tooth models. The worst condition consisted of two connected large proximal and fissural caries with no proximal marginal ridge, in which the fracture load dramatically decreased to only 25% of that for sound teeth with intact marginal ridge. On the other hand, decreased cuspal slope due to occlusal wear and shrinkage of the pulp due to caries appeared to have a protective role and a direct relation with the fracture resistance of the tooth. Following the application of resin infiltration on the carious models, the crack initiation load and the fracture load could recover up to 75% and 90% of the values for the corresponding sound tooth models, respectively. SIGNIFICANCE Presence of fissural caries, if not treated (either with remineralization, resin infiltration or restoration), can be a major risk factor in the initiation of tooth fracture. When combined with decreased enamel thickness and loss of proximal marginal ridge due to mechanical or chemical wear, the weakening effect of the caries will be amplified specially in teeth with steep cuspal slopes. The application of a conservative treatment with resin infiltration can be an effective approach in prevention of further mechanical failure of demineralized enamel. The findings of this study emphasize the importance of early interventions in the management of caries for the prevention of future cuspal or tooth fracture especially in subjects with higher risk factors for tooth fracture such as caries, wear and bruxism.
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Affiliation(s)
- Mahdi Shahmoradi
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Boyang Wan
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Zhongpu Zhang
- School of Computing, Engineering and Mathematics, Western Sydney University, Penrith, NSW, 2751, Australia.
| | - Michael Swain
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Qing Li
- School of Aerospace, Mechanical and Mechatronic Engineering, The University of Sydney, Sydney, NSW, 2006, Australia.
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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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The effect of dental restoration geometry and material properties on biomechanical behaviour of a treated molar tooth: A 3D finite element analysis. J Mech Behav Biomed Mater 2021; 125:104892. [PMID: 34688146 DOI: 10.1016/j.jmbbm.2021.104892] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To test the hypothesis that restoration of class II mesio-occlusal-distal (MOD) cavities can be strengthened through judicious choice of restoration geometry and material properties. METHODS An intact extracted human maxillary molar tooth was digitized, segmented, reconstructed, and four 3D restored tooth models were developed with four different restoration geometries: one straight, one single-curved, and two double-curved. Stress analysis was conducted for representative loading using finite element analysis, and maximum principal stresses were determined at the dentine-enamel and restoration-enamel junctions. A range of restorative material elastic moduli (5-80 GPa) and Poisson's ratios (0.25-0.35) were studied. Vertical loads of 400 N were applied on occlusal points, while the roots of the molar teeth, below the crevices, were supported in all directions. All the materials were modelled as homogeneous, isotropic, and elastic. RESULTS The maximum principal stresses at the restoration-enamel junctions were strongly dependent on the MOD restoration geometries. Peak stresses occurred along the palatal surface of the restoration rather than the opposite buccal surface. Double-curved restorations showed the lowest peak stress at restoration-enamel junctions. Choice of the mechanical properties of restorative material in the range of 5-35 GPa further reduced stress concentrations on the enamel. SIGNIFICANCE Class II MOD restorations may be stronger if designed with double-curved marginal geometries that can reduce stress concentrations. Designs with convex and concave geometries were particularly effective because they reduced stress concentrations dramatically. Results suggest that relatively minor changes to the geometry of a restoration can have a substantial effect on stress at the restoration-enamel junction and motivate future experimental analysis.
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27
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Duanmu Z, Liu L, Deng Q, Ren Y, Wang M. Development of a biomechanical model for dynamic occlusal stress analysis. Int J Oral Sci 2021; 13:29. [PMID: 34493701 PMCID: PMC8423745 DOI: 10.1038/s41368-021-00133-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023] Open
Abstract
The use of traditional finite element method (FEM) in occlusal stress analysis is limited due to the complexity of musculature simulation. The present purpose was to develop a displacement boundary condition (DBC)-FEM, which evaded the muscle factor, to predict the dynamic occlusal stress. The geometry of the DBC-FEM was developed based on the scanned plastic casts obtained from a volunteer. The electrognathographic and video recorded jaw positional messages were adopted to analyze the dynamic occlusal stress. The volunteer exhibited asymmetrical lateral movements, so that the occlusal stress was further analyzed by using the parameters obtained from the right-side eccentric movement, which was 6.9 mm long, in the stress task of the left-side eccentric movement, which was 4.1 mm long. Further, virtual occlusion modification was performed by using the carving tool software aiming to improve the occlusal morphology at the loading sites. T-Scan Occlusal System was used as a control of the in vivo detection for the location and strength of the occlusal contacts. Data obtained from the calculation using the present developed DBC-FEM indicated that the stress distribution on the dental surface changed dynamically with the occlusal contacts. Consistent with the T-Scan recordings, the right-side molars always showed contacts and higher levels of stress. Replacing the left-side eccentric movement trace by the right-side one enhanced the simulated stress on the right-side molars while modification of the right-side molars reduced the simulated stress. The present DBC-FEM offers a creative approach for pragmatic occlusion stress prediction.
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Affiliation(s)
- Zheng Duanmu
- grid.443248.d0000 0004 0467 2584Key Laboratory of the Ministry of Education for Optoelectronic Measurement Technology and Instrument, Beijing Information Science and Technology University, Beijing, China
| | - Lu Liu
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Qi Deng
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Yuanyuan Ren
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Meiqing Wang
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
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28
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Son SA, Kim JH, Park JK. The Effectiveness of a Quantitative Light-induced Fluorescent Device for the Diagnosis of a Cracked Tooth: A Case Report. J Endod 2021; 47:1796-1800. [PMID: 34437880 DOI: 10.1016/j.joen.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022]
Abstract
Diagnosing a cracked tooth is a challenge for dental clinicians. This report describes the use of a quantitative light-induced fluorescent (QLF) device that detects fluorescence reactions with visible light (405 nm) to visually identify microscopic tooth cracks during the diagnosis and treatment of cracked teeth that caused pulp disease. Fluorescence images of the occlusal surface, before and after removal of the restoration, and inside of the access cavity for root canal treatment were obtained using an intraoral capture-type QLF device (Q-ray penC; AIOBIO, Seoul, Korea). The device provided visual information such as enhanced magnification and fluorescent images to identify cracks on the exterior of the tooth, around restorations, and inside the cavity after removal of the restoration by a simple image capture process. The device was able to demonstrate the existence of the crack line and to predict the depth of cracks during treatment.The QLF device showed a potential benefit in the diagnosis and characterization, including the location and depth, of tooth cracks.
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Affiliation(s)
- Sung-Ae Son
- Department ofConservative Dentistry, Dental and Life Science Institute, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Republic of Korea
| | - Jae-Hoon Kim
- Department ofDental Education, Dental and Life Science Institute, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Republic of Korea
| | - Jeong-Kil Park
- Department ofConservative Dentistry, Dental and Life Science Institute, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Republic of Korea.
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29
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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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30
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Wang L, Cao S, Jiang X, Salje EKH. Cracking of human teeth: An avalanche and acoustic emission study. J Mech Behav Biomed Mater 2021; 122:104666. [PMID: 34229170 DOI: 10.1016/j.jmbbm.2021.104666] [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: 05/06/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
Teeth are the hardest part of the human body. Cracking of human teeth under compression progresses by avalanches emitting acoustic noise. Acoustic emission (AE) spectroscopy reveals that tooth avalanches are statistically fully compatible with predictions of mean field (MF) theory. Avalanche energies collapse into a power law distributed which is stable over more than five decades with an energy exponent ε = 1.4. Acoustic amplitudes (exponent ~τ), durations (~α), correlations between amplitudes and energies (~x), and correlations between amplitude and duration (~χ) follow equally power laws with MF values of all exponents. The exponents correlation: τ-1 = x(ε-1) = (α-1)/χ is confirmed. Crack propagation bifurcates and shows the hallmarks of avalanches where main cracks nucleate secondary cracks.
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Affiliation(s)
- Lei Wang
- School of Civil Engineering, Chongqing University, 400045, Chongqing, People's Republic of China
| | - Shutian Cao
- Department of Geotechnical Engineering College of Civil Engineering, Tongji University, 200092, Shanghai, People's Republic of China
| | - Xiang Jiang
- School of Civil Engineering, Chongqing University, 400045, Chongqing, People's Republic of China; Department of Earth Sciences, Cambridge University, Cambridge CB2 3EQ, UK.
| | - Ekhard K H Salje
- School of Civil Engineering, Chongqing University, 400045, Chongqing, People's Republic of China; Department of Earth Sciences, Cambridge University, Cambridge CB2 3EQ, UK
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Lee TY, Yang SE, Kim HM, Kye MJ. Characteristics, Treatment, and Prognosis of Cracked Teeth: A Comparison with Data from 10 Years Ago. Eur J Dent 2021; 15:694-701. [PMID: 34171933 PMCID: PMC8630975 DOI: 10.1055/s-0041-1728842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives
The purpose of this study was to analyze and to compare retrospectively the characteristics, the treatment process, and the prognosis of cracked teeth by comparing recent data with data from 10 years ago.
Materials and Methods
Sixty-eight cracked teeth from March 2009 to June 2010 (2009 data) and 185 cracked teeth from March 2019 to June 2020 (2019 data) were analyzed. The characteristics of cracked teeth and the treatment method depending on probing depth, caries, and symptoms, and prognosis depending on pocket depth and apical lesions were analyzed using R version 3.3.3 (R Foundation for Statistical Computing, Vienna, Austria) and T&F version 3.0 (YooJin BioSoft, Korea). To compare proportions, the two-sample proportion test was performed. The distribution of proportions within the samples from 2009 and 2019 data was analyzed using the Chi-square test or binomial test. A
p
-value <0.05 was considered to indicate statistical significance.
Results
Significantly fewer cracked teeth received root canal treatment before crown in 2019 than in 2009 (
p
= 0.032). In both 2009 and 2019, symptomatic cracked teeth and those with deep periodontal pockets (>6 mm) were significantly more likely to receive root canal treatment. In both years, cracked teeth with a probing depth less than 6 mm or without an apical lesion were significantly more likely to be asymptomatic at 3-month and 6-month follow-ups (
p
< 0.001).
Conclusion
Cracked teeth with a deep periodontal pocket or symptoms had a higher likelihood of endodontic treatment, and the presence of a deep periodontal pocket or apical lesion was associated with a higher risk of persistent symptoms. Therefore, clinicians should consider these factors when planning treatment and predicting patients’ prognosis.
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Affiliation(s)
- Tae Yeon Lee
- Department of Conservative Dentistry, College of Medicine, Yeouido ST. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Yang
- Department of Conservative Dentistry, College of Medicine, Seoul St. Mary's Dental Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Min Kim
- Department of Conservative Dentistry, College of Medicine, Seoul St. Mary's Dental Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Joo Kye
- Department of Conservative Dentistry, College of Medicine, Seoul St. Mary's Dental Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Chotvorrarak K, Suksaphar W, Banomyong D. Retrospective study of fracture survival in endodontically treated molars: the effect of single-unit crowns versus direct-resin composite restorations. Restor Dent Endod 2021; 46:e29. [PMID: 34123765 PMCID: PMC8170375 DOI: 10.5395/rde.2021.46.e29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives This study was conducted to compare the post-fracture survival rate of endodontically treated molar endodontically treated teeth (molar ETT) restored with resin composites or crowns and to identify potential risk factors, using a retrospective cohort design. Materials and Methods Dental records of molar ETT with crowns or composite restorations (recall period, 2015–2019) were collected based on inclusion and exclusion criteria. The incidence of unrestorable fractures was identified, and molar ETT were classified according to survival. Information on potential risk factors was collected. Survival rates and potential risk factors were analyzed using the Kaplan-Meier log-rank test and Cox regression model. Results The overall survival rate of molar ETT was 87% (mean recall period, 31.73 ± 17.56 months). The survival rates of molar ETT restored with composites and crowns were 81.6% and 92.7%, reflecting a significant difference (p < 0.05). However, ETT restored with composites showed a 100% survival rate if only 1 surface was lost, which was comparable to the survival rate of ETT with crowns. The survival rates of ETT with composites and crowns were significantly different (97.6% vs. 83.7%) in the short-term (12–24 months), but not in the long-term (> 24 months) (87.8% vs. 79.5%). Conclusions The survival rate from fracture was higher for molar ETT restored with crowns was higher than for ETT restored with composites, especially in the first 2 years after restoration. Molar ETT with limited tooth structure loss only on the occlusal surface could be successfully restored with composite restorations.
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Affiliation(s)
- Kanet Chotvorrarak
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Warattama Suksaphar
- Department of Endodontics, College of Dental Medicine, Rangsit University, Pathum Thani, Thailand
| | - Danuchit Banomyong
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Nguyen Thi W, Jansson L. Survival rate after endodontic treatment in general dentistry for cracked teeth with different coronal restorations. Acta Odontol Scand 2021; 79:256-261. [PMID: 33103524 DOI: 10.1080/00016357.2020.1834615] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to analyse the survival rate of cracked teeth after endodontic treatment. The secondary aim was to compare the survival rate of cracked teeth restored with composite filling/crown and those restored with a full crown. MATERIALS AND METHODS The study was conducted retrospectively from three general dental clinics in Stockholm, which are all part of the national dental service organisation. Two-hundred patients with teeth receiving endodontic treatment due to symptomatic cracks were included. The patient data range from year 2001 to 2016. RESULTS The mean age of the patients was 48 years (range 29-69). Fifty-five per cent had cracks located above the pulpal cavity, 11% within the pulpal cavity and 3% located in the root canal. The cracks were located most commonly on the proximal surfaces. The survival rate for teeth with cracks was 68% and 54% after 5 and 10 years, respectively. The survival rate was significantly higher (97%) for cracked teeth receiving a full crown after endodontic treatment compared to teeth restored with either a composite filling or composite crown. CONCLUSION The overall survival rate for cracked teeth was 68% after 5 years, while it was significantly higher for cracked teeth restored with a full crown. The results suggest within the limitations of this study that cracked teeth should be restored with a full crown after endodontic treatment.
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Affiliation(s)
- Winnie Nguyen Thi
- Department of Endodontology, Public Dental Service at Eastmaninstitutet, Stockholm County Council, Stockholm, Sweden
| | - Leif Jansson
- Department of Periodontology, Public Dental Service at Eastmaninstitutet, Stockholm County Council, Stockholm, Sweden
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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35
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Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Gordan VV, Kopycka-Kedzierawski DT, Meyerowitz C, Mungia R, Burton V. Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2020; 152:146-156. [PMID: 33358237 DOI: 10.1016/j.adaj.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-, and crack-level characteristics with these outcomes. METHODS Two-hundred-and-nine National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2,601 participants with a cracked vital posterior tooth that had been examined for at least 1 recall visit over 3 years. Data were collected at the patient, tooth, and crack levels at baseline, annual follow-up visits, and any interim visits. Associations between these characteristics and the subsequent same-tooth fractures and crack progression were quantified. RESULTS Of the 2,601 teeth with a crack or cracks at baseline, 78 (3.0%; 95% confidence interval, 2.4% to 3.7%) subsequently developed a fracture. Of the 1,889 patients untreated before year 1, 232 (12.3%; 95% confidence interval, 10.9% to 13.8%) had some type of crack progression. Baseline tooth-level characteristics associated with tooth fracture were the tooth was maxillary and had a wear facet through enamel and a crack was detectable with an explorer, on the facial surface, and in a horizontal direction. Crack progression was associated with males and teeth with multiple cracks at baseline; teeth with a baseline facial crack were less likely to show crack progression. There was no commonality between characteristics associated with tooth fracture and those associated with crack progression. CONCLUSIONS Development of tooth fractures and crack progression over 3 years were rare occurrences. Specific characteristics were associated with the development of tooth fracture and crack progression, although none were common to both. PRACTICAL IMPLICATIONS This information can aid dentists in assessing factors that place posterior cracked teeth at risk of experiencing adverse outcomes.
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Root fractures in seniors: Consequences of acute embrittlement of dentin. Dent Mater 2020; 36:1464-1473. [DOI: 10.1016/j.dental.2020.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 12/17/2022]
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Association between longitudinal tooth fractures and visual detection methods in diagnosis. J Dent 2020; 101:103466. [DOI: 10.1016/j.jdent.2020.103466] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/23/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022] Open
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Schürz A, Gehrig H, Schuessler DL, Mente J. Preservation of a Split Tooth: Nonsurgical Clinical Management. J Endod 2020; 46:1002-1008. [DOI: 10.1016/j.joen.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/28/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
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Li Z, Holamoge YV, Li Z, Zaid W, Osborn ML, Ramos A, Miller JT, Li Y, Yao S, Xu J. Detection and analysis of enamel cracks by ICG-NIR fluorescence dental imaging. Ann N Y Acad Sci 2020; 1475:52-63. [PMID: 32519363 DOI: 10.1111/nyas.14374] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/13/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
Cracked teeth are the third most common cause of tooth loss, but there is no reliable imaging tool for the diagnosis of cracks. Here, we demonstrate the feasibility of indocyanine green near-infrared fluorescence (ICG-NIRF) dental imaging for the detection of enamel cracks and enamel-dentin cracks in vitro in the first (ICG-NIRF-I, 700-950 nm) and second (ICG-NIRF-II, 950-1700 nm) imaging windows with transmission excitation light, and compared ICG-NIRF with conventional NIR illumination-II (NIRi-II) and X-ray imaging. Dentin cracks were detected by CT scan, while most enamel cracks, undetectable under X-ray imaging, were clearly visible in NIR images. We found that ICG-NIRF-II detected cracks more effectively than NIRi-II, and that light orientation is an important factor for crack detection: an angled exposure obtained better image contrast of cracks than parallel exposure, as it created a shadow under the crack. Crack depth could be evaluated from the crack shadow in ICG-NIRF and NIRi-II images; from this shadow we could determine crack depth and discriminate enamel-dentin cracks from craze lines. Cracks could be observed clearly from ICG-NIRF images with 1-min ICG tooth immersion, although longer ICG immersion produced images with greater contrast. Overall, our data show that ICG-NIRF dental imaging is a useful tool for diagnosing cracked teeth at an early stage.
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Affiliation(s)
- Zhongqiang Li
- Division of Electrical and Computer Engineering, College of Engineering, Louisiana State University, Baton Rouge, Louisiana
| | - Yoshita V Holamoge
- Division of Electrical and Computer Engineering, College of Engineering, Louisiana State University, Baton Rouge, Louisiana
| | - Zheng Li
- Division of Electrical and Computer Engineering, College of Engineering, Louisiana State University, Baton Rouge, Louisiana
| | - Waleed Zaid
- Oral and Maxillofacial Surgery, School of Dentistry, Louisiana State University Health Science Center, Baton Rouge, Louisiana
| | - Michelle L Osborn
- Department of Comparative Biomedical Science, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Alexandra Ramos
- Department of Comparative Biomedical Science, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Jacob T Miller
- Division of Electrical and Computer Engineering, College of Engineering, Louisiana State University, Baton Rouge, Louisiana
| | - Yanping Li
- School of Environment and Sustainability, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shaomian Yao
- Department of Comparative Biomedical Science, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - Jian Xu
- Division of Electrical and Computer Engineering, College of Engineering, Louisiana State University, Baton Rouge, Louisiana
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Rosen E, Volmark Y, Beitlitum I, Nissan J, Nemcovsky CE, Tsesis I. Dental implant placement is a possible risk factor for the development of multiple cracks in non-endodontically treated teeth. Sci Rep 2020; 10:8527. [PMID: 32444845 PMCID: PMC7244581 DOI: 10.1038/s41598-020-65408-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to evaluate potential risk factors, including the placement of dental implants, for the development of tooth cracks. A series of 212-patients, who were referred for endodontic treatment, were retrospectively screened, of which 72 (34%) patients had been diagnosed with 80-cracked teeth confirmed with an operating microscope. These patients had an average age of 53-years and were equally distributed between genders. Forty-one percent of the cracked teeth were diagnosed after the placement of dental implants, with an average of 3-implants per patient. Seventy percent of the cracks were diagnosed more than 1-year after implant loading. Implant placement was associated with higher odds of having multiple cracks (OR = 9.78, CI:2.320, 41.216)(p < 0.05). The proportion of cracked premolars was relatively high (30%), and most cracked teeth (79%) were vital and with a normal periapical diagnosis (86%). Most cracked teeth (71%) had an amalgam restoration, and teeth restored with amalgam were at a higher risk of having multiple cracks (p < 0.05). Clinicians should be aware of a common profile of endodontic patients with multiple cracks in a non-endodontically treated premolar, restored with an amalgam restoration, which was diagnosed with the cracks more than 1-year after reconstruction utilizing multiple implants.
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Affiliation(s)
- Eyal Rosen
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv, Israel.
| | - Yael Volmark
- Department of Prosthodontics, Hebrew University - Hadassah, School of Dental Medicine, Jerusalem, Israel
| | - Ilan Beitlitum
- Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Nissan
- Oral-Rehabilitation & Implant-Prosthodontics, Rabin Medical-Center, Belinson Hospital, Petah-Tikva, Israel
- Department of Oral-Rehabilitation, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carlos E Nemcovsky
- Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Tsesis
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Olivieri JG, Elmsmari F, Miró Q, Ruiz XF, Krell KV, García-Font M, Durán-Sindreu F. Outcome and Survival of Endodontically Treated Cracked Posterior Permanent Teeth: A Systematic Review and Meta-analysis. J Endod 2020; 46:455-463. [DOI: 10.1016/j.joen.2020.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 12/24/2022]
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Fleck C, Burke M, Ganzosch G, Müller C, Currey JD, Zaslansky P. Breaking crown dentine in whole teeth: 3D observations of prevalent fracture patterns following overload. Bone 2020; 132:115178. [PMID: 31816420 DOI: 10.1016/j.bone.2019.115178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/04/2019] [Accepted: 11/26/2019] [Indexed: 12/19/2022]
Abstract
Teeth with intact crowns rarely split or fracture, despite decades of cyclic loading and occasional unexpected overload. This is largely attributed to the presence of dentine, since cracking and fracture of enamel have been frequently reported. Dentine is similar to bone, comprising mineralised collagen fibres as a main constituent. Unlike cortical bone, however, where microcracking and damage arrest are essential for re/modelling and healing, dentine can neither remodel nor regenerate. This raises questions regarding the evolutionary benefits of toughening, leading to uncertainty whether cracks actually appear in dentine in situ. Here we study the notion that circumpulpal dentine is usually protected against, rather than damaged by severe overloads, even though it is not much more massive or stronger than it needs to be. To address this, we examined hydrated teeth still within whole jawbones of freshly-slaughtered skeletally mature pigs, mechanically loaded until fracture. Force displacement curves, optical and electron microscopy combined with 3D microstructural analysis by conventional micro-computed tomography (μCT) revealed mostly brittle fracture paths in circumpulpal crown dentine. Once overload cracks reach this mass of dentine they propagate rapidly along straight paths often parallel to the enamel flanks of the oblong shovel shaped premolars. We find infrequent signs of active toughening mechanisms with minimal crack diversion, ligament bridging and microcracking. When such toughening is seen, it mainly appears in softer dentine in the root, or near the dentine-enamel-junction (DEJ) in mantle dentine. We observed shear bands in overloaded circumpulpal dentine, due to mutual gliding of upper and lower segments. These shear bands are formed as periodic arrays of rotated dentine fragments. The 3D data consistently demonstrate the importance of the layered tooth structure, containing a stiff outer enamel shell, a soft sub-DEJ interlayer and a stiff circumpulpal dentine bulk, for deflecting cracks from splitting the tooth.
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Affiliation(s)
- Claudia Fleck
- Technische Universität Berlin, Chair of Materials Science and Engineering, Institute of Materials Science and Technologies, Str. des 17. Juni 136 - Sekr. EB13, 10623 Berlin, Germany.
| | - Martin Burke
- Technische Universität Berlin, Chair of Materials Science and Engineering, Institute of Materials Science and Technologies, Str. des 17. Juni 136 - Sekr. EB13, 10623 Berlin, Germany; Charité - Universitätsmedizin Berlin, Department for Operative and Preventive Dentistry, Aßmannshauser Str. 4-6, 14297 Berlin, Germany
| | - Gregor Ganzosch
- Technische Universität Berlin, Institute of Mechanics, Chair of Continuum Mechanics and Materials Theory, Einsteinufer 5 - Sekr. MS2, 10587 Berlin, Germany
| | - Cecilia Müller
- Technische Universität Berlin, Chair of Materials Science and Engineering, Institute of Materials Science and Technologies, Str. des 17. Juni 136 - Sekr. EB13, 10623 Berlin, Germany
| | - John D Currey
- The University of York, Department of Biology, Wentworth Way, York YO10 5DD, United Kingdom
| | - Paul Zaslansky
- Charité - Universitätsmedizin Berlin, Department for Operative and Preventive Dentistry, Aßmannshauser Str. 4-6, 14297 Berlin, Germany.
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Prechtel A, Stawarczyk B, Hickel R, Edelhoff D, Reymus M. Fracture load of 3D printed PEEK inlays compared with milled ones, direct resin composite fillings, and sound teeth. Clin Oral Investig 2020; 24:3457-3466. [PMID: 31989370 DOI: 10.1007/s00784-020-03216-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/17/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this in vitro study was to investigate fracture load, fracture types, and impact of chewing simulation of human molars restored with 3D printed indirect polyetheretherketone (PEEK) inlays and compare these with milled indirect PEEK inlays, direct resin composite fillings, and sound teeth. MATERIALS AND METHODS A total of 112 molars with form congruent class I cavities were restored with (n = 16/group) 3D printed indirect PEEK inlays via fused layer manufacturing (FLM): (1) Essentium PEEK (ESS), (2) KetaSpire PEEK MS-NT1 (KET), (3) VESTAKEEP i4 G (VES), (4) VICTREX PEEK 450G (VIC), (5) milled indirect PEEK inlays JUVORA Dental Disc 2 (JUV), and (6) direct resin composite fillings out of Tetric EvoCeram (TET). Sound teeth (7) acted as positive control group. Half of the specimens of each group (n = 8) were treated in a chewing simulator combined with thermal cycling (1.2 million × 50 N; 12,000 × 5 °C/55 °C). Fracture load and fracture types of all molars were determined. Statistical analyses using Kolmogorov-Smirnov test and two-way ANOVA with partial eta squared (ηp2) followed by Scheffé post hoc test, chi square test and Weibull modulus m with 95% confidence interval were computed (p < 0.05). RESULTS ESS and TET demonstrated the lowest fracture load with a minimum of 956 N, whereas sound molars showed the highest values of up to 2981 N. Chewing simulation indicated no impact (p = 0.132). With regard to Weibull modulus, KET presented a lower value after chewing simulation than JUV, whereas TET had the highest value without chewing simulation. All indirect restorations revealed a tooth fracture (75-100%), direct resin composite fillings showed a restoration fracture (87.5%), and 50% of the sound teeth fractured completely or had cusp fractures. CONCLUSIONS All 3D printed and milled indirect PEEK inlays as well as the direct resin composite fillings presented a higher fracture load than the expected physiological and maximum chewing forces. CLINICAL RELEVANCE 3D printing of inlays out of PEEK via FLM provided promising results in mechanics, but improvements in terms of precision and esthetics will be required to be practicable in vivo to represent an alternative dental material.
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Affiliation(s)
- Alexander Prechtel
- Department of Prosthetic Dentistry, Ludwig-Maximilians-Universität Munich, Goethestrasse 70, 80336, Munich, Germany.
| | - Bogna Stawarczyk
- Department of Prosthetic Dentistry, Ludwig-Maximilians-Universität Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-Universität Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, Ludwig-Maximilians-Universität Munich, Goethestrasse 70, 80336, Munich, Germany
| | - Marcel Reymus
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-Universität Munich, Goethestrasse 70, 80336, Munich, Germany
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Wellman KY, Dixon PM. A Study on the Potential Role of Occlusal Fissure Fractures in the Etiopathogenesis of Equine Cheek Teeth Apical Infections. J Vet Dent 2020; 36:171-178. [DOI: 10.1177/0898756419894653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thirty-nine equine cheek teeth diagnosed as having anachoretic apical infections and also having occlusal fissure fractures, but without occlusal pulpar exposure, that had been orally extracted without causing occlusal damage and 10 control teeth were used in this study. The teeth were individually imaged by computed tomography, occlusally stained with methylene blue and visually reexamined, then sectioned subocclusally at 5 mm intervals until the fissure fractures could no longer be detected. A limited histological study was then performed on 7 apically infected and 5 control teeth. Standard computed tomography only detected 1 of 39 fissure fractures. Thirteen of the 39 stained teeth had subocclusal fissure fractures visually identified at approximately 6 mm beneath the surface, and in 9 of these 13 teeth the fissure fractures had deeper staining to a level immediately above or into a pulp horn, indicating a potential route for bacterial pulpitis. However, the current study cannot rule out the possibility that the extraction process, long-term formalin storage, or the processing of teeth may have allowed for deeper staining. Additionally, methylene blue may penetrate dental tissue more readily than bacteria can invade. Further studies on the potential role of fissure fractures in the etiopathogenesis of cheek teeth apical infection are warranted.
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Affiliation(s)
- Katherina Y. Wellman
- Department of Clinical Veterinary Studies, Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, EH25 9RG, Scotland, United Kingdom
| | - Padraic M. Dixon
- Department of Clinical Veterinary Studies, Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, EH25 9RG, Scotland, United Kingdom
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45
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Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Gordan VV, Bennett S, Bone J, Richardson PA, Malmstrom H. Symptom changes and crack progression in untreated cracked teeth: One-year findings from the National Dental Practice-Based Research Network. J Dent 2019; 93:103269. [PMID: 31899264 DOI: 10.1016/j.jdent.2019.103269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The study objective was to: (1) quantify symptom (pain) and crack changes during one year of follow-up, among teeth that had at least one visible crack at baseline but which did not receive treatment for those cracks; (2) identify any patient traits/behaviors and external tooth/crack characteristics correlated with these changes. METHODS In this observational study, 209 National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2858 subjects, each with a single, vital posterior tooth with at least one observed external crack; 1850 teeth remained untreated after one year of follow-up and were the cohort for analyses. Data were collected at the patient-, tooth-, and crack-level at baseline, one-year follow up (Y1), and interim visits. Associations between changes in symptoms and cracks were identified, as were changes in symptoms associated with baseline treatment recommendations. RESULTS Changes in pain symptoms were observed in 32% of patients; decreases were twice as common as increases (23% vs. 10%). More changes were observed in cold pain than in biting pain and spontaneous pain combined; 2% had increases in biting pain and 2% in spontaneous pain. Only 6% had an increase in the number of cracks. Changes in pain symptoms were not associated with an increase in the number of cracks, but were associated with baseline treatment recommendations. Specifically, pain symptom changes (especially decreases) were more common when the tooth was recommended for treatment at baseline. CONCLUSIONS Cracked teeth that have not received treatment one year after baseline do not show meaningful progression as measured by increased symptoms or number of cracks during follow-up. CLINICAL SIGNIFICANCE Untreated cracked teeth, most of which were recommended for monitoring at baseline and some of which were recommended for treatment but did not receive treatment, remained relatively stable for one year with little progression of cracks or symptoms.
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Affiliation(s)
- Thomas J Hilton
- School of Dentistry, Oregon Health &, Science University, 2730 S.W. Moody Ave, Portland, OR 97201-5042, United States.
| | - Ellen Funkhouser
- School of Medicine, University of Alabama, Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0007, United States
| | - Jack L Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave, Portland, OR 97201-5042, United States
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, United States
| | - Sandra Bennett
- Private Practice, 22400 SE Stark Street, Gresham, OR 97030, United States
| | - Jennifer Bone
- Private Practice, 710 Hill Country Drive, Suite 1, Kerrville, TX 78028, United States
| | - Peggy A Richardson
- Private Practice, 7060 Centennial Drive, Suite 103, Tinley Park, IL 60477, United States
| | - Hans Malmstrom
- Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, United States
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Sapra A, Darbar A, George R. Laser-assisted diagnosis of symptomatic cracks in teeth with cracked tooth: A 4-year in-vivo follow-up study. AUST ENDOD J 2019; 46:197-203. [PMID: 31815331 DOI: 10.1111/aej.12391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to determine whether a near-infrared diode laser could be used as an adjunct to help identify and localise symptomatic cracks in patients with cracked tooth. An 810-nm diode laser at 1 W continuous wave energy with a 200 micro-fibre tip was used to scan the offending tooth. Crack identified during the laser scan was removed, restored and reviewed after four weeks and after 4 years. The laser was able to significantly (P = 0.0001) identify suspected cracked teeth from non-cracked control teeth. Of the twelve patients examined, ten participants experienced discomfort as the laser passed over a crack line. At 4-week and 4-year recall, a majority of the ten treated patients responded positively to the management of crack. This study showed that diode laser could be an adjunctive tool for early detection and management of symptomatic cracks with the possibility of improving long-term survival.
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Affiliation(s)
- Ashita Sapra
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - Arun Darbar
- Private Practice, Smile Creations Dental Innovations, Leighton Buzzard, UK
| | - Roy George
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
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47
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Outcomes of endodontically treated cracked teeth: a systematic review and meta-analysis. Clin Oral Investig 2019; 24:465-473. [DOI: 10.1007/s00784-019-03139-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023]
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Sheets CG, Zhang L, Wu JC, Earthman JC. Ten-year retrospective study of the effectiveness of quantitative percussion diagnostics as an indicator of the level of structural pathology in teeth. J Prosthet Dent 2019; 123:693-700. [PMID: 31653402 DOI: 10.1016/j.prosdent.2019.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM Conventional dental diagnostic aids are only partially effective in diagnosing structural defects such as cracks in teeth. A more predictable diagnostic for structural instability in the mouth is needed. PURPOSE The purpose of this clinical study with an increased population size was to evaluate the effectiveness of diagnosing structural instability by using the quantitative percussion diagnostics (QPD) system and to evaluate the influence of independent variables on the relationship between normal fit error (NFE) and observed structural instability found during the clinical disassembly of teeth. MATERIAL AND METHODS Twenty-two participants with 264 sites needing restoration were enrolled in an institutional review board-approved 10-year retrospective clinical study. Each site had been tested with the QPD system before being disassembled microscopically with video documentation, and the clinical disassembly results were recorded on a defect-assessment sheet. The NFE data were separately recorded from the preexisting records. The classification of structural pathology based on the disassembly observations for each of the 264 sites was conducted by the clinical researcher (C.G.S.) who was blinded to the NFE values. RESULTS The 264 sites from 22 patients were classified as 8 in the none group, 87 in the moderate group, and 169 in the severe group based on the disassembly findings. The NFE data for the sites were analyzed by using the predefined NFE cutoffs that were independently generated from the previous cumulative logistic regression and decision tree model. For the cumulative logistic regression, 235 out of 264 sites were correctly classified with an agreement of 0.89 (adjusted 95% CI: 0.83-0.95). The number of correctly classified sites for the decision tree model was 234, and the agreement was also 0.89 (adjusted 95% CI: 0.83-0.94). For both cumulative logistic regression and decision tree models, the overall misclassification rate was less than 20% for any restoration material or restoration type. Therefore, the overall performance of NFE classification was consistently good, regardless of restoration material or type. In addition, the sensitivity of the severe category was above 90% for any restoration material or type for the decision tree model. CONCLUSIONS The QPD system was found to be a reliable diagnostic aid for classifying structural damage in the categories of none, moderate, or severe based on clinical disassembly findings under the clinical microscope and NFE values. Furthermore, it was determined that restoration type and restoration design were not significant factors in correlating structural pathology with NFE.
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Affiliation(s)
- Cherilyn G Sheets
- Co-Executive Director, Newport Coast Oral-Facial Institute, Newport Beach, Calif.
| | - Lishi Zhang
- Senior Biostatistician, Institute for Clinical and Translational Science, University of California, Irvine, Calif
| | - Jean C Wu
- Co-Executive Director, Newport Coast Oral-Facial Institute, Newport Beach, Calif
| | - James C Earthman
- Professor, Departments of Materials Science and Engineering, and Biomedical Engineering, University of California, Irvine, Calif
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49
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Mahgoli HA, Arshad M, Rasouli K. Restoration of endodontically treated cracked maxillary teeth: A case series. Clin Case Rep 2019; 7:1951-1956. [PMID: 31624616 PMCID: PMC6787784 DOI: 10.1002/ccr3.2391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/27/2019] [Accepted: 08/06/2019] [Indexed: 11/08/2022] Open
Abstract
Cracks adversely affect the prognosis and survival of the teeth. Thus, the possibility of presence of crack should be considered after endodontic treatment and before the initiation of periodontal/prosthetic treatments. Attempts must be made to restore cracked teeth with efficient restorative materials to increase their survival and prevent additional costs.
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Affiliation(s)
- Hossein Ali Mahgoli
- Dental Research Center, Dentistry Research InstituteTehran University of Medical SciencesTehranIran
- Department of Prosthodontics, School of DentistryTehran University of Medical SciencesTehranIran
- International Campus, School of DentistryTehran University of Medical SciencesTehranIran
| | - Mahnaz Arshad
- Dental Research Center, Dentistry Research InstituteTehran University of Medical SciencesTehranIran
- Department of Prosthodontics, School of DentistryTehran University of Medical SciencesTehranIran
- International Campus, School of DentistryTehran University of Medical SciencesTehranIran
| | - Kamran Rasouli
- International Campus, School of DentistryTehran University of Medical SciencesTehranIran
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Hilton TJ, Funkhouser E, Ferracane JL, Schultz-Robins M, Gordan VV, Bramblett BJ, Snead RM, Manning W, Remakel JR. Recommended treatment of cracked teeth: Results from the National Dental Practice-Based Research Network. J Prosthet Dent 2019; 123:71-78. [PMID: 31202547 DOI: 10.1016/j.prosdent.2018.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 10/26/2022]
Abstract
STATEMENT OF PROBLEM Despite the high prevalence of posterior cracked teeth, questions remain regarding the best course of action for managing these teeth. PURPOSE The purpose of this clinical study was to identify and quantify the characteristics of visible cracks in posterior teeth and their association with treatment recommendations among patients in the National Dental Practice-Based Research Network. MATERIAL AND METHODS Network dentists enrolled patients with a single, vital posterior tooth with at least 1 observable external crack. Data were collected at the patient, tooth, and crack levels, including the presence and type of pain and treatment recommendations for subject teeth. Frequencies according to treatment recommendation were obtained, and odds ratios (ORs) comparing recommendations for the tooth to be restored versus monitored were calculated. Stepwise regressions were performed using generalized models to adjust for clustering; characteristics with P<.05 were retained. RESULTS A total of 209 dentists enrolled 2858 patients with a posterior tooth with at least 1 crack. Mean ±standard deviation patient age was 54 ±12 years; 1813 (63%) were female, 2394 (85%) were non-Hispanic white, 2213 (77%) had some dental insurance, and 2432 (86%) had some college education. Overall, 1297 (46%) teeth caused 1 or more of the following types of pain: 1055 sensitivity to cold, 459 biting, and 367 spontaneous. A total of 1040 teeth were recommended for 1 or more treatments: restoration (n=1018; 98%), endodontics (n=29; 3%), endodontic treatment and restoration (n=20; 2%), extraction (n=2; 0.2%), and noninvasive treatment, for example, occlusal device, desensitizing (n=11; 1%). The presence of caries (OR=67.3), biting pain (OR=7.3), and evidence of a crack on radiographs (OR=5.0) were associated with over 5-fold odds of recommending restoration. Spontaneous pain was associated with nearly 3-fold odds; pain to cold, having dental insurance, a crack that was detectable with an explorer or blocked transilluminated light, or connected with a restoration were each weakly associated with increased odds of recommending a restoration (OR<2.0). CONCLUSIONS Approximately one-third of cracked teeth were recommended for restoration. The presence of caries, biting pain, and evidence of a crack on a radiograph were strong predictors of recommending a restoration, although the evidence of a crack on a radiograph only accounted for a 3% absolute difference (4% recommended treatment versus 1% recommended monitoring).
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Affiliation(s)
- Thomas J Hilton
- Alumni Centennial Professor in Operative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, Ore.
| | - Ellen Funkhouser
- Associate Professor, School of Medicine, University of Alabama, Birmingham Ala
| | - Jack L Ferracane
- Chair, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, Ore
| | - Michele Schultz-Robins
- Clinical Assistant Professor, Restorative Department, Rutgers School of Dental Medicine, Newark, NJ
| | - Valeria V Gordan
- Professor, Department of Restorative Dental Sciences, University of Florida, Gainesville, Fla
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