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

Restoration of teeth lacking complete ferrules using cast precious metal alloy post-and-cores and knife-edged crowns: A retrospective clinical study

STATEMENT OF PROBLEM

While the presence of a ferrule has been reported to be essential for post-and-core restorations, many extensively damaged teeth lack complete ferrules. The outcome of post-and-core restorations for these teeth remains uncertain.

PURPOSE

The purpose of this retrospective clinical study was to assess the outcome of cast alloy post-and-cores and knife-edged crowns for the restoration of teeth lacking complete ferrules.

MATERIAL AND METHODS

A total of 106 participants with endodontically treated teeth with 2 or fewer walls with ferrules who had received cast precious metal alloy post-and-cores along with knife-edged crowns between 2013 and 2022 were recalled for a clinical examination. The minimum follow-up time was 5 months after restoration, and restoration failure and the periodontal status difference between restored teeth and reference teeth were determined. Kaplan-Meier analysis was performed to obtain success curves. The influence of age, sex, jaw position, tooth type, and antagonistic dentition upon the success function was analyzed with the log-rank or Breslow test (α=.05).

RESULTS

A total of 100 participants with 130 restorations were studied. The success rate of the restorations was 93.85% in a mean ±standard deviation period of 48.3 ±26.1 months. The estimated 5-year cumulative success probability was 91.61%. No significant effect on the success of restorations was found regarding age, sex, jaw position, tooth type, or antagonistic dentition (P>.05). The main failure types were post debonding, root fracture, and apical periodontitis. No statistical difference in tooth mobility (Z=-1.265, P=.206) was found between the restored and the reference teeth, but the plaque index and calculus index of the restored teeth were significantly lower than of the reference teeth (Z=-7.216, P<.001; Z=-7.044, P<.001). Teeth that had received cast post-and-cores and knife-edged crowns were found to have no significant correlation with periodontal disease (χ²=1.131, P=.288) or bleeding on probing (χ²=3.436, P=.064).

CONCLUSIONS

The clinical outcomes for the restoration of teeth with 2 or fewer walls with ferrules using cast precious metal alloy post-and-cores and knife-edged crowns were favorable, exhibiting a high 5-year cumulative success probability and no increased periodontal health risk.

Mind-body exercises for osteoarthritis: an overview of systematic reviews including 32 meta-analyses

PURPOSE

To develop an overview of systematic reviews (SRs) to summarize the current evidence on the effectiveness of mind-body exercises, specifically qigong, tai chi, and yoga, on osteoarthritis-related symptoms.

METHODS

CINAHL, Embase, PsycINFO, PubMed, SPORTDiscus, and the Cochrane Library were searched from inception up to 20 June 2022. Pain, physical function, psychological symptoms, and quality of life were analyzed. AMSTAR 2 was used to assess the methodological quality of SRs. The primary study overlap among SRs was calculated.

RESULTS

A total of 13 SRs were selected, including 32 meta-analyses of interest that comprised 33 distinct primary studies. Overall, qigong, tai chi, and yoga-based interventions may improve osteoarthritis-related symptoms, mainly physical function. However, no SRs were judged to have high methodological quality. Only three SRs judged certainty of evidence using a gold standard for it. The primary study overlap was very high for SRs covering tai chi or yoga trials.

CONCLUSIONS

There was a positive tendency in favor of these mind-body exercises for improving pain, arthritis self-efficacy, and mainly, physical function. Unfortunately, no clinical recommendations can be made due to the high number of methodological concerns that were described above. New high-quality SRs covering this topic are needed.

Modified peptides and organic metabolites of cyanobacterial origin with antiplasmodial properties

As etiological agents of malaria disease, Plasmodium spp. parasites are responsible for one of the most severe global health problems occurring in tropical regions of the world. This work involved compiling marine cyanobacteria metabolites reported in the scientific literature that exhibit antiplasmodial activity. Out of the 111 compounds mined and 106 tested, two showed antiplasmodial activity at very low concentrations, with IC50 at 0.1 and 1.5 nM (peptides: dolastatin 10 and lyngbyabellin A, 1.9% of total tested). Examples of chemical derivatives generated from natural cyanobacterial compounds to enhance antiplasmodial activity and Plasmodium selectivity can be found in successful findings from nostocarboline, eudistomin, and carmaphycin derivatives, while bastimolide derivatives have not yet been found. Overall, 57% of the reviewed compounds are peptides with modified residues producing interesting active moieties, such as α- and β-epoxyketone in camaphycins. The remaining compounds belong to diverse chemical groups such as alkaloids, macrolides, polycyclic compounds, and halogenated compounds. The Dolastatin 10 and lyngbyabellin A, compounds with antiplasmodial high activity, are cytoskeletal disruptors with different protein targets.

Prognostic factors associated with pulp status in patients with cracked teeth treated with occlusal veneer: A 6- through 24-month prospective clinical study

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.

Study on the adverse effect of acid-corrosion on the dentin in terms of degradation of fracture resistance

Human dentin is known for its hierarchical structure through long-term evolution. Dental caries, embodied by dentin demineralization, is ascribed to a different reaction between peritubular dentin (PTD) and intertubular dentin (ITD) to acid dissolution. This study sheds light on the adverse effect of acid on dentin in terms of degradation of its fracture toughness (FT) due to the acid dissolution-induced corrosion of PTD. A scanning electronic microscope (SEM) is utilized to visualize the difference between normal and acid-treated dentin subjected to the same loading method in terms of crack propagation performance. 3D simulative representative volume elements (RVEs) are developed to analyze the effect of PTD missing on the performance of dentin fracture resistance (FR). The results indicate PTD plays a significant role in enhancing dentin FR capability and thus reveals the importance of structural integrity for dentin.

Influence of restorative materials on the mechanical properties of maxillary first molars with different degrees of cryptic fractures and defects: A finite element analysis

This study aimed to apply finite element analysis to evaluate the effects of pile materials with different elastic moduli and cement materials on the stress distribution between the remaining tooth tissue and cryptic fracture defects. A three-dimensional finite element model was established for 20 maxillary first molars with hidden fissures and mesial tongue-tip defects. Two levels of hidden cracks and three types of pile and adhesive materials were used in the design. The stress distribution and maximum stress peak in the remaining tooth tissue and crack defects were determined by simulating the normal bite, maximum bite, and lateral movement forces. When titanium posts, zinc phosphate binders, and porcelain crowns were used to repair the two types of deep cracked teeth, the maximum principal stress at the crack and dentin was the smallest. As the crack depth increased, the maximum principal stress of the residual dentin and crack defects increased.

Biting and thermal sensitivity relief of cracked tooth restored by occlusal veneer: A 12-to 24 months prospective clinical study

OBJECTIVES

To analyze the relief time and risk factors of biting/thermal sensitivity in cracked tooth (CT) restored using occlusal veneer.

METHODS

63 CT were analyzed, and their demographic and clinical data and medical history were collected. Patients were followed-up to examine the relief of thermal/biting sensitivity.

RESULTS

The maxillary first molar was the most prevalent (N = 25, 40%). The number of crack lines on the finish line ranged from 1 to 6 while the number of crack lines through preparation on the finish line from 0 to 4. Pain relief achieved steadily to 52% for thermal and 62% for biting at 1 week to over 90% for each by 3 months and was completely resolved (no pain) for each by 12 months. Painful of lateral percussion was related to a long period of thermal sensitivity (≥1 month) after restoration with occlusal veneer. The number of crack lines through preparation on the finish line >2 was correlated with biting sensitivity (≥1 month) post-treatment.

CONCLUSIONS

Most patients (>90%) became asymptomatic of biting and thermal sensitivity within 3 months of CT restored by occlusal veneer. Lateral percussion and the number of crack lines through preparation on the finish line could be significant factors affecting postoperative symptoms.

CLINICAL SIGNIFICANCE

Occlusal veneer is an ultrathin restoration and had no need for restricting clinical crown height, which could protect and relief the biting/thermal sensitivity of CT without preventive root canal therapy.

School-Based Interventions on Dental Trauma: A Scoping Review of Empirical Evidence

INTRODUCTION

Accidents involving sports or leisure activities, falls, blows from objects, acts of interpersonal violence, and accidents can all result in dental trauma (also known as traumatic dental injuries [TDIs]). School children are one of the population groups that are highly vulnerable to TDIs. Multiple school-based interventions have been conducted around the world on the prevention and management of TDIs; however, no known scoping review has been conducted to map the evidence. Hence, this study aimed to conduct a scoping review of existing school-based interventions on TDIs.

METHODS

This scoping review adopted the research design presented by Arksey and O'Malley. Eight research databases-PubMed, SCOPUS, APA PsycINFO, CINAHL Ultimate, AMED (The Allied and Complementary Medicine Database), Child Development & Adolescent Studies, Psychology and Behavioral Sciences Collection, and SPORTDiscuss-were searched to retrieve literature relevant to the scoping review question. Some of the retrieved literature existed in duplicate and was deduplicated using Rayyan software. Twenty papers that fulfilled the inclusion criteria were selected and reviewed.

RESULTS

A total of 526 publications were retrieved from the eight databases searched in this scoping review. Ninety-seven publications were duplicates and were removed. After the two-stage screening of the deduplicated copies, only 20 peer-reviewed journal articles were relevant and included in the review. The selected studies sampled a total of 7152 participants whose ages ranged between 9 and 62 years (mean = 10.56 to 46.5; standard deviation = ±0.97 to ±8.1). The findings obtained from the reviewed journal articles revealed that pupils are at high risk of dental trauma and they are more likely to sustain these injuries during school activities. In addition, inadequate understanding, poor attitudes, and low experiential knowledge of dental trauma were found among educators, parents, and even school pupils. The evidence of long-term knowledge retention and a high knowledge score in the experimental groups buttresses the need for continuous first-aid education on dental trauma.

CONCLUSIONS

The application of multiple educational approaches or modalities in schools will reinforce and promote good first-aid skills and management practices that are essential for preserving traumatized teeth.

Biomechanical perspectives on dentine cracks and fractures: Implications in their clinical management

OBJECTIVES

The present review discussed the biomechanical properties of cracks and fractures in crown and root dentine and attempted to explain why cracked teeth and vertical root fractures are so frequent despite the existence of multiple crack toughening mechanisms in dentine. The implications of this knowledge were used to justify how these defects are managed clinically.

DATA, SOURCES AND STUDY SELECTION

Literature search was conducted on PubMed, Web of Science, and Scopus for a narrative review on fracture mechanics of crown and root dentine as well as the clinical management of cracked teeth and teeth with vertical root fracture.

CONCLUSIONS

Although dentine is tougher and less brittle than enamel, it's facture toughness is considerably lower than most ductile metals. Because the initiation toughness of dentine is very low, cracks initiate from incipient damage under low stress While crack toughening mechanisms exist that enable dentine to resist crack extension, these mechanisms are often inadequate for protecting dentine from crack propagation that ultimately leads to catastrophic failure. Additional factors such as ageing also reduces the resistance of dentine to crack growth. Because dentine cracks are eventually filled with bacteria biofilms upon exposure to oral fluids, they enable rapid bacteria ingress into the dental pulp via open dentinal tubules. To date, treatment options for cracked teeth are limited. While most teeth with vertical root fracture are recommended for extraction, new strategies have been reported that appeared to achieve short-term success in preserving these teeth.

CLINICAL SIGNIFICANCE

Current strategies for the management for dentine cracks and fractures are limited and their long-term effectiveness remain uncertain. Understanding the characteristics, toughening mechanism and weakening factors of tooth cracks is helpful in designing better treatment.

[The value of an occlusal adjustment: why?, how?, and when? case report]

The aim of optimal dentistry is to stabilise the stomatognathic system (teeth, periodontium, muscles and temporomandibular joint). All of these must work in harmony, as together they provide optimal care from diagnosis through planning to treatment. However, many clinicians currently give little importance to the identification of premature contacts and/or interferences prior to any dental treatment, which should be taken into account to provide improved stability in mandibular closure, correct anterior and canine guidance in mandibular movements.This clinical case describes the treatment of a patient with a diagnosis of functional occlusal disorder due to premature contact, whose treatment consisted of an occlusal adjustment by selective wear, following the technique described by the author Klineberg, with the aim of preserving the dental structure as much as possible while maintaining control during the occlusal adjustment and returning the greatest number of symmetrical and pointed contacts.