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Síndrome del Diente Fisurado: una actualización imprescindible
Abstract
Introducción: El Síndrome del Diente Fisurado ha aumentado su incidencia a nivel mundial y constituye un desafío diagnóstico fundamental en la práctica clínica estomatológica. En Cuba no está incluido en la clasificación vigente de traumatología dental por lo que no se diagnostica ni se trata. Objetivo: describir el Síndrome del Diente Fisurado, como entidad estomatológica frecuente. Metodología: Se realizó una revisión bibliográfica teniendo en cuenta la literatura científica en idioma español e inglés, incluyéndose todos los artículos de investigación originales, artículos de revisión e informes de casos, utilizando las bases de datos Scielo, PubMed, Scopus. Se identificaron alrededor de 63 artículos, de los cuales fueron seleccionados 54 según los criterios académicos de la Escuela Estomatológica Cubana, de ellos el 50% actualizado. Se analizó e integró la información. Resultados: Topográficamente, los dientes del sector posterior resultaron ser los más afectados. Afecta fundamentalmente a adultos en el rango de edad de 30 a 60 años; mientras que el sexo no es una variable determinante en su incidencia. Su causa esencial es la fractura vertical incompleta o fisura en la dentina, que no suelen ser mostradas en la radiografía. Conclusiones: Se concluyó que a pesar de que este síndrome es una entidad clínica común y bien documentada en varios países como una de las afecciones traumáticas que puede evolucionar a una necrosis pulpar, en Cuba, no existe ningún protocolo que regule su identificación.
... Los objetivos principales de clasificar son los siguientes: (18) -Otorgar un idioma común entre profesionales Sin embargo, cualquiera de los motivos expuestos puede presentar dificultades si la clasificación en sí misma no cumple con determinados requisitos de calidad, la literatura recoge ejemplos de clasificaciones clínicas que el motivo de su uso conduce a desenlaces no deseados, así Magariño Abreus y col., (18) plantea que está vigente la clasificación de lesiones traumáticas dentales del noruego Ingeborg Jacobsen por ser la más sencilla y didáctica, sin embargo no permite clasificar y por tanto, diagnosticar un conjunto de entidades erróneamente consideradas como signos aislados de entidades patológicas sí reconocidas por la comunidad científica como el síndrome de diente fisurado. ...
... Los objetivos principales de clasificar son los siguientes: (18) -Otorgar un idioma común entre profesionales Sin embargo, cualquiera de los motivos expuestos puede presentar dificultades si la clasificación en sí misma no cumple con determinados requisitos de calidad, la literatura recoge ejemplos de clasificaciones clínicas que el motivo de su uso conduce a desenlaces no deseados, así Magariño Abreus y col., (18) plantea que está vigente la clasificación de lesiones traumáticas dentales del noruego Ingeborg Jacobsen por ser la más sencilla y didáctica, sin embargo no permite clasificar y por tanto, diagnosticar un conjunto de entidades erróneamente consideradas como signos aislados de entidades patológicas sí reconocidas por la comunidad científica como el síndrome de diente fisurado. ...
Introducción:
toda clasificación clínica se compone de dos elementos; el diagnóstico de la enfermedad y la escala de clasificación, el primero es una clasificación en sí mismo y a él se puede llegar por distintas vías. A la segunda solo se llega siguiendo los elementos de la clínica.
Objetivo:
caracterizar las clasificaciones clínicas usadas en la atención asistencial estomatológica.
Métodos:
se realizó un estudio descriptivo para indagar sobre las características de las clasificaciones clínicas usadas en la atención asistencial estomatológica para lo que se realizó una entrevista semiestructurada a 50 especialistas de las cinco especialidades estomatológicas. Las variables fueron frecuencia, procedencia, validez, motivos y problemas de las clasificaciones clínicas.
Resultados:
se encontró que el 94 % usa las clasificaciones con mucha frecuencia, que el 90 % de las clasificaciones provienen de otros países y se desconoce si han sido validadas el 92 % del total, el motivo la que más se usa en el departamento predominó con un 70 % y el problema que más se presentó fue pacientes que pueden ser ubicados en más de una categoría.
Conclusión:
las clasificaciones clínicas estomatológicas en la asistencia se caracterizan por una alta frecuencia de su uso, con una gran representación de clasificaciones extranjeras, de las cuales en una gran representación se desconoce si han sido validadas, cuyo motivo principal para escoger con cuál trabajar es el criterio del departamento y de las que reconocen, una gran parte tiene problemas con el diagnóstico o con la escala de clasificación.
Different restorative techniques have been proposed for the treatment of posterior teeth affected by cracked tooth syndrome (CTS). However, the literature is scarce in protocols of how to solve CTS using ceramic restorations made by computer aided design-computer aided manufacturing (CAD-CAM) system. CAD-CAM provides a fast and efficient restorative treatment usually in a single visit, reducing the risk of contamination and micro-infiltration of the cracked line. The objective of this work was to describe 3 clinical cases of cracked teeth, which presented vertical fracture lines in different directions and extension through the pulp, restored by CAD-CAM system, with 5-year follow-up. Patients with short-term spontaneous masticatory pain, cold sensibility and restored teeth without cuspal coverage were selected. Digital radiographs (DR) were taken to confirm the pulp and periapical status. Periodontal probing depth, sensitivity, percussion, and occlusion tests were performed. The fracture lines with their direction and extension were identified under dental optical microscope (DOM). The treatment plan was performed in two stages: immediate treatment to stabilize the tooth and minimize pain, and final restorative treatment by CAD-CAM system to stabilize the crack. Patients were between the ages of 37 and 45 years. Most of the studied teeth presented extensive restorations without cuspal coverage. The presence of occlusal interference, in lateral movement, was a constant finding. Endodontic treatment was performed in cases of irreversible pulpitis or pulpal necrosis. In all three cases, cavity preparation was performed for full coverage restorations, as the fracture lines extended in several directions, requiring a re-enforcement of the cervical region of the teeth in question. The survival rate of the reported cases was 100% with 5-year clinical and radiographic follow-up, suggesting that CAD-CAM system may be a promising alternative treatment in the management of CTS, improving tooth longevity.
Se describe y reporta el diagnóstico, tipo de tratamiento y seguimiento de un caso con el síndrome del diente fisurado. Una paciente de 26 años acusaba sensibilidad a los cambios térmicos y a la oclusión en el lado izquierdo de la mandíbula. Al examen clínico se observó dos grietas o fisuras pigmentadas en las superficies bucales y linguales de la pieza 36. La colocación de una restauración directa con resina compuesta resolvió los síntomas y alivió por completo el dolor. Dicha situación persistió incluso en el control realizado 7 años después. El diagnóstico y tratamiento para el caso descrito dio como resultado un completo alivio y mantenimiento de la situación alcanzada siete años después.
Objetivo:
Comparar la resistencia compresiva de dientes premolares uniradiculares, tratados endodónticamente restaurados mediante la técnica de monobloque y complementación.
Materiales y métodos:
Se seleccionaron 45 premolares inferiores unirradiculares, los cuales fueron distribuidos aleatoriamente en 3 grupos, según el diseño reconstructivo: monobloque y complementación; el tercer grupo restaurado bajo la técnica de núcleo colado fue utilizado como grupo control. Para determinar diferencias en la resistencia a la fractura, se realizó un análisis de Varianza (ANOVA a una Vía) y test post hoc de Bonferroni.
Resultados:
El promedio de la resistencia fue mayor en el grupo dientes rehabilitados con la técnica convencional, seguido de la técnica de monobloque, y en tercer lugar encontramos la técnica de complementación con el valor más bajo. Sin embargo, las técnicas de monobloque y complementación presentan resistencias similares.
Conclusiones:
La resistencia a la fractura de dientes restaurados con pernos colados es mayor a la de los restaurados con pernos prefabricados fibras de vidrio con técnicas de complementación y monobloque. Sin embargo, producen mayor cantidad de fallas no reparables o de mal pronóstico que los dientes restaurados con pernos prefabricados de fibras de vidrio por su módulo elástico.
Introduction:
Long-term studies examining the treatment outcomes of "cracked teeth" that received orthograde root canal treatment in the United States do not exist. The purpose of the present study was to examine the distribution and 1-year treatment outcomes of cracked teeth receiving orthograde root canal treatment in 1 private endodontic practice over a 25-year period.
Methods:
A total of 3038 cracked teeth were initially examined, and data from 2086 unique patients were analyzed. Pulpal and periapical diagnoses, year of treatment, tooth type, restorative material, and number of restored surfaces at the time of examination were recorded for all patients. Periodontal probing depths were also recorded. The patients' age and sex were added retrospectively for all patients whose data were available. Univariate frequency distributions for all collected variables were evaluated. Bivariate associations were analyzed between explanatory variables and the success of the root canal therapy.
Results:
Of the 2086 cracked teeth observed among unique patients, the most common were mandibular second molars (36%) followed by mandibular first molars (27%) and maxillary first molars (18%). Among the 363 teeth eligible for multivariable regression analysis, 296 (82%) were deemed successes after 1 year. There were no statistically significant differences in success based on pulpal diagnosis (irreversible pulpitis, 85%; necrosis, 80%; previously treated, 74%), patients' age, sex, year of treatment, tooth type, restorative material, or number of restored surfaces at the time of examination. The 3 factors most significant in bivariate analyses were pocket depth, distal marginal ridge crack, and periapical diagnosis, which were used to generate a prognostic index for success of orthograde root canal therapy in cracked teeth called the Iowa Staging Index.
Conclusions:
The results of this study suggest that cracked teeth that received root canal treatment can have prognoses at higher success rates than previously reported. The Iowa Staging Index may prove to be useful in clinical treatment decision making.
Background
The purpose of this study was to analyze the characteristics of cracked teeth and to evaluate pulp status according to periodontal probing depth (PPD). MethodsA total of 182 cracked teeth were included. The location and type of the cracked teeth, age and gender of the patients, restoration type, pulp status, PPD, and radiographic findings were analyzed. ResultsMandibular second molars (25.3%) were the most frequently involved teeth, followed by mandibular first molars (22.5%), maxillary first molars (22.0%), and maxillary second molars (17.6%). The patient age was most frequently 50–59 years. Cracks occurred mainly in nonbonded restorations, such as gold (26.9%), and were usually found in intact teeth (37.9%). A total of 103 teeth (56.6%) had an initial PPD of less than 3 mm, while 40 (22.0%) had a PPD of 4–6 mm, and 39 (21.4%) had PPD of 7 mm or more. A total of 33 cracked teeth (18.1%) were diagnosed with pulp necrosis, 40 (22.0%) with irreversible pulpitis, and 97 (53.3%) with reversible pulpitis. The incidence of pulp necrosis was 31.8% among cracked teeth with a PPD of 4–6 mm, and 28.6% among those with a PPD of 7 mm or more. Conclusions
Cracks occurred mainly in molar teeth, and were commonly found in intact teeth with no restoration. Patients with cracked teeth were most frequently aged 50–59 years. Cracked teeth showing a PPD of more than 4 mm were more likely to show pulp necrosis.
Introduction: dental-alveolar traumas are among the main dentistry emergencies due to the presence of pain, discomfort and sudden functional alteration making the patient to attend to the dentistry office. Objective: to determine the behavior of dental-alveolar traumas in children under 19 years old at "Antonio Briones Montoto" Dentistry Clinic in Pinar del Rio during September 2011 to February 2012. Material and Method: a descriptive and cross-sectional study. The target group matched up the sample, 191 children and adolescents younger than 19 years old attending to the dentistry office during the period mentioned. The variables taken were: age, sex, etiology of trauma and kind of lesion. Results: dental-alveolar traumas affected 29, 32% of patients, male sex prevailed along with ages between 12-14 years old. Non-complicated fracture of crown was observed in half of patients; followed by the enamel un-fracture. Conclusions: the main causes of dental-alveolar traumas were falls and sports practice.
Los traumatismos dentales en los ultimos anos han mostrado una alta predominancia reportada en estudios poblacionales, siendo la edad principalmente comprometida entre los 8 y 12 anos, afectando mayormente al sexo masculino, por lo que representa actualmente un serio problema de salud publica. Se clasifican en fracturas coronarias, luxaciones y avulsiones Estos traumatismos son causadas en su mayoria por caidas y actividades deportivas como el ciclismo, siendo las fracturas coronarias no complicadas las lesiones mas frecuentes. El manejo de estas lesiones es dificil para el clinico, por lo que el objetivo de la presente revision fue brindar informacion actualizada del diagnostico, tratamiento y pronostico de las lesiones traumaticas en la denticion permanente.
Introducción: hace más de 30 años se describió una condición caracterizada por
la presencia de una fisura dentaria o fractura dentaria incompleta, actualmente una
marcada incidencia ha ocasionado que exista cierta confusión entre los clínicos.
Esta entidad se conoce como Síndrome del Diente Fisurado.
Objetivo: actualizar acerca de un grupo de aspectos relacionados con el Síndrome
del Diente Fisurado.
Material y Métodos: le realizó una revisión bibliográfica teniendo en cuenta la
literatura científica y clásica de los últimos 5 años a la fecha, en idioma español e
inglés, utilizando las bases de datos Ebesco, Scielo y Lis, de lo cual se obtuvieron
más de 140 artículos de 22 países, que fueron decantados a 26 de acuerdo con la
actualidad y ajuste real a los criterios académicos y prácticos de la Escuela
Estomatológica Cubana.
Desarrollo: la dificultad del diagnóstico del Síndrome del Diente Fisurado, el
aumento en su incidencia, los nuevos conocimientos acerca de su etiología y los
Revista Habanera de Ciencias Médicas 2015;14(4):397-408
http://scielo.sld.cu
398
recientes avances en cuanto a los elementos diagnósticos y tratamientos han
hecho que se mantenga como un tema importante dentro de la literatura
especializada contemporánea. En este trabajo se exponen las tendencias
diagnósticas y terapéuticas más novedosas de modo que cada clínico pueda formar
su propio criterio.
Conclusiones: el Síndrome del Diente Fisurado es una de las primeras causas de
extracción dentaria debido a los problemas para su identificación. Es quizás el
problema bucal peor diagnosticado y el más confundido con otras entidades de tipo
pulpar, periodontal o dolor buco-facial.
SUMMARY Cracked tooth syndrome is known to occur most frequently in heavily restored teeth. Nevertheless, when the symptoms occur in intact teeth, there is difficulty in obtaining a correct diagnosis because it is difficult for the dentist to find where the crack is located. This clinical report describes the diagnostic procedures and the direct bonded composite restoration used to restore an incompletely fractured unrestored maxillary premolar in a 22-year-old female patient. To achieve a correct diagnosis, some diagnostic procedures were performed: periapical and bitewing radiographs, percussion and thermal vitality tests, a bite test, and the placement of a stainless steel band. Once the symptoms ceased with band placement, cone beam computed tomography, transillumination, macro photographs, and isolation with a rubber dam helped to visualize the crack line along the occlusal surface involving distal and mesial marginal ridges. The crack was traced using a high-speed tungsten carbide bur until the fracture line was not visible. The tooth was restored with a direct composite resin, associated with a total-etch adhesive system, and the symptoms were immediately eliminated.
Purpose:
To provide an overview of the clinical features, diagnosis, classification and management of cracked teeth which may be a diagnostic challenge in clinical practice.
Results:
Cracks may initiate from coronal tooth structure or from within the root and affect healthy or root treated teeth. There are many terminologies and classifications in the literature for cracked teeth that can be as confusing as the array of clinical symptoms which are associated with this condition. The term "cracked tooth syndrome" is misleading as there are a range of symptoms that do not form a distinct and reliable pattern. Symptoms will vary with teeth that have healthy pulps, for teeth with inflamed or necrotic pulps, and for teeth that have been root treated. The American Association of Endodontists have classified five specific variations of cracked teeth; craze line, fractured cusp, cracked tooth, split tooth, and vertical root fracture. The importance of differentiating dentin, pulpal and periodontal pain for diagnosis and treatment for these specific entities will be elaborated. A decision flow chart indicating the treatment options available is presented.
Objective:
The purpose of this study was to find a reliable method to reproduce biting pain to facilitate an early diagnosis of cracked tooth and to verify the feasibility of the Tooth Slooth in diagnosing a cracked tooth.
Method and materials:
In this study, 46 intact teeth diagnosed as cracked teeth were selected. Patients were asked to bite wet cotton rolls and the Tooth Slooth, and clinical findings were recorded. The difference in the relevance ratio between these two bite test methods was determined.
Results:
The relevance ratio of biting pain by the Tooth Slooth and wet cotton rolls was 91.3% and 32.6%, respectively. There was a statistically significant difference between these two bite tests (P < .001).
Conclusions:
Within the limitations of this study, the relevance ratio of biting pain by the Tooth Slooth was significantly higher than that of the wet cotton rolls. The Tooth Slooth was a reliable method to reproduce biting pain and was useful for early diagnosis of cracked teeth.
Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996‐2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, nonspecific keywords, no language restrictions and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12‐year‐olds, incidence rate to any tooth for any age, male‐to‐female prevalence ratio (PR) in 12‐year‐olds, with 95% confidence intervals (95CIs), were extracted/calculated. Study quality, Z‐score distribution, funnel plot symmetry analysis, between‐study heterogeneity, sensitivity and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268,755 individuals; median age, 13.8 years), 46 (primary dentition; 59,436 individuals; median age, 3.4 years), 42 (12‐year‐olds; 33,829 individuals), 11 (incidence rate; 233,480 person‐years; median age, 7.8 years), 31 (PR; 16,003 males, 16,006 females). World TDI frequency resulted: permanent dentition prevalence 15.2% (95CI, 13.0‐17.4%); primary dentition prevalence 22.7% (95CI, 17.3‐28.7%); 12‐year‐olds prevalence 18.1% (95CI, 15.3‐21.0%); incidence rate, 2.82 (95CI, 2.28‐3.42) per 100 person‐years; PR, 1.43 (95CI, 1.34‐1.52). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.
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Objectives:
The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain.
Methods:
Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2,858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p < 0.05) independent odds ratios (OR) associated with teeth that were painful for 10 outcomes based on types of pain and combinations thereof.
Results:
Overall, 45% of cracked teeth had one or more symptoms. Pain to cold was the most common symptom, which occurred in 37% of cracked teeth. Pain on biting (16%) and spontaneous pain (11%) were less common. Sixty-five percent of symptomatic cracked teeth had only one type of symptom, of these 78% were painful only to cold. No patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Positive associations for various combinations of pain symptoms were present with cracks that: (1) were on molars; (2) were in occlusion; (3) had a wear facet through enamel; (4) had caries; (5) were evident on a radiograph; (6) ran in more than one direction; (7) blocked transilluminated light; (8) connected with another crack; (9) extended onto the root; (10) extended in more than one direction; or (11) were on the distal surface. Persons who were < 65 yo or who clench, grind, or press their teeth together also were more likely to have pain symptoms. Pain was less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites.
Conclusions:
Although pain to cold was the most commonly noted pain associated with symptomatic cracked teeth, no patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Characteristics were only associated with pain on biting and/or spontaneous pain with or without pain to cold.
Clinical significance:
Although often considered the most reliable diagnosis for a cracked tooth, pain on biting is not the most common symptom of a tooth with a visible crack, but rather pain to cold.
Cracked tooth syndrome is a commonly encountered condition in dental practice which frequently causes diagnostic and management challenges. This paper provides an overview of the diagnosis of this condition and goes on to discuss current short and long-term management strategies applicable to dental practitioners. This paper also covers the diagnosis and management of this common condition and aims to inform clinicians of the current thinking, as well as to provide an overview of the techniques commonly used in managing cracked tooth syndrome.
Introduction:
Previous studies have suggested that masticatory forces are associated with cracked teeth, but it is not clear which specific poor oral masticatory habits may be more likely to cause cracks. The aim of this study was to quantitatively assess risk factors for cracked teeth among poor oral masticatory habits and create a model for individualized risk predictions.
Methods:
We enrolled 35 patients with cracked teeth matched to 70 controls without cracked teeth by age, sex, position of the affected tooth, presence/absence of systemic disease, and diagnosis of symptomatic irreversible pulpitis from the Stomatology Hospital of Tianjin Medical University, Tianjin, China. Odds ratios (ORs) were calculated using conditional logistic regression analysis.
Results:
Thermal cycling eating habits (OR = 3.296; 95% confidence interval [CI], 1.684-6.450), eating coarse foods (OR = 2.727; 95% CI, 1.340-5.548), chewing on hard objects (OR = 2.087; 95% CI, 1.041-4.182), and unilateral mastication (OR = 2.472; 95% CI, 1.255-4.869) were independent risk factors for cracked teeth. The corresponding risk scores were 2.182, 1.691, 1.467, and 1.589, respectively. The area under the receiver operating characteristic curve and its 95% CI were 0.920 (0.868-0.973); the sensitivity and specificity were 0.943 and 0.800, respectively.
Conclusions:
Thermal cycling eating habits were strongly associated with cracked teeth, whereas eating coarse foods, chewing on hard objects, and unilateral mastication were also independent risk factors for cracked teeth. These findings yield insights into ways to promote the prevention of risky behaviors for cracked teeth.
Introduction:
The aims of this study were to analyze the distribution and characteristic features of cracked teeth and to evaluate the outcome of root canal treatments (RCTs) for cracked teeth. The prognostic factors for tooth survival were investigated.
Methods:
Over the 5-year study period, 175 teeth were identified as having cracks. Data were collected regarding the patients' age, sex, tooth type, location and direction of cracks, probing depth, pulp vitality, type of restoration, cavity classification, opposing teeth, and previous endodontic treatment history. Cracked teeth were managed via various treatment methods, and the 2-year survival rate after RCT was analyzed using the Kaplan-Meier method in which significance was identified using the log-rank test. Possible prognostic factors were investigated using Cox multivariate proportional hazards modeling.
Results:
One hundred seventy-five teeth were diagnosed with cracks. Most of the patients were aged 50-60 years (32.0%) or over 60 (32.6%). The lower second molar was the most frequently (25.1%) affected tooth. Intact teeth (34.3%) or teeth with class I cavity restorations (32.0%) exhibited a higher incidence of cracks. The 2-year survival rate of 88 cracked teeth after RCT was 90.0%. A probing depth of more than 6 mm was a significant prognostic factor for the survival of cracked teeth restored via RCT. The survival rate of root-filled cracked teeth with a probing depth of more than 6 mm was 74.1%, which is significantly lower than that of teeth with probing depths of less than 6 mm (96.8%) (P = .003).
Conclusions:
Cracks were commonly found in lower second molars and intact teeth. RCT was a reliable treatment for cracked teeth with a 2-year survival rate of 90.0%. Deep probing depths were found to be a significant clinical factor for the survival of cracked teeth treated with RCT.
The purpose of this study was to compare endodontically versus nonendodontically treated teeth with respect to clinical features, including patient age and gender and tooth types of vertical root fractures.
A total of 315 consecutive cases of vertical root fracture occurring in 274 Chinese patients during a 1 3-year period were reviewed. Age and gender, as well as tooth type and root distribution of vertical root fractures, were presented and compared in endodontically versus nonendodontically treated teeth.
Most patients (87%) had 1 fractured tooth; the others had 2 or 3 fractured teeth. Of all vertical root fractures, 40% occurred in nonendodontically treated teeth. In comparison with those in endodontically treated teeth, vertical root fractures in nonendodontically treated teeth tended to occur in patients with a higher mean age (55 years vs. 51 years) and were more frequent in male patients (78% vs. 58%). Vertical root fractures occurred in nonendodontically treated teeth more often in molars (84% vs. 53%), less often in premolars (16% vs. 33%), and seldom in anteriors (1 tooth vs. 27 teeth).
Vertical root fractures in nonendodontically treated teeth are not uncommon and comprise a large proportion of such fractures in Chinese patients. Differences between endodontically and nonendodontically treated teeth in patient age and gender, as well as in tooth types of vertical root fractures, were demonstrated.
The treatment plan for cracked teeth depends on the extent of the crack. A tooth with an extensive crack of long duration may be more likely to require root canal treatment. The purpose of this study was to analyze the characteristics of cracked teeth and to assess the outcome of different treatment protocols depending on the pulpal and periapical diagnoses.
Seventy-two of 476 crown-restored teeth were diagnosed as cracked teeth. The location of the cracked teeth, age and sex of the patients, restoration materials, a diagnosis of pulp and apex, and the periodontal probing depth were analyzed. Cracked teeth were treated by different treatment protocols depending on the pulpal and periapical diagnoses.
Mandibular first molars (27.8%) were the most frequently involved teeth followed by maxillary first molars (25%), maxillary second molars (22.2%), and mandibular second molars (19.4%). The most frequently involved ages were 40-49 and 50-59 years. Cracks occurred mainly in nonbonded restorations such as gold (26.4%) and amalgam (12.5%), and 48.6% of cracks were found in intact teeth. In this study, 60 teeth (83.3%) were treated with root canal treatment before being restored with a permanent crown, and only 12 teeth (16.7%) remained vital and were restored with a permanent crown without root canal treatment. The proportion of teeth treated with root canal treatment increased along with a deep periodontal probing depth corresponding to the crack. The prognosis was less favorable in cracked teeth with a deep probing depth.
In this study, the proportion of root canal treatment in the cracked teeth was higher than other studies. Many patients are referred to an endodontist in a university hospital after a long time has passed since the symptom started. Early recognition can help to avoid the propagation of a crack into the pulp chamber or subgingival level. Furthermore, it is important to investigate factors related to cracked teeth and develop different treatment protocols for different pulpal and periapical diagnoses.
The incidences of cracks in teeth seem to have increased during the past decade. Dental practitioners need to be aware of cracked tooth syndrome (CTS) in order to be successful at diagnosing CTS. Early diagnosis has been linked with successful restorative management and predictably good prognosis. The purpose of this article is to highlight factors that contribute to detecting cracked teeth.
The purpose of this study was to analyze the characteristics, distribution, and associated factors of longitudinal fractured teeth according to the well-defined criteria of the American Association of Endodontists (AAE).
One hundred seven teeth with longitudinal fracture from 103 patients were diagnosed and analyzed. The patients' signs, symptoms, age, and sex were noted as well as the tooth number, dental arch, filling materials, size/classification of restoration, crack direction, pulp vitality, whether the patient had undergone endodontic treatment, bite test results, percussion test results, wear facet, and periodontal pocket depth.
Eighty-seven teeth were diagnosed with a cracked tooth (81.3%), 14 were diagnosed with vertical root fracture (VRF, 13.1%), 4 had a split tooth (3.7%), and 2 had a fractured cusp (1.9%); 82.2% showed a sensitive reaction on the bite test. Longitudinal tooth fractures were observed most frequently in patient in their 40s. The upper first molar (28.0%) was most frequently cracked, followed by the lower first molar (25.2%), the lower second molar (20.6%), and the upper second molar (16.8%). Most longitudinal tooth fractures (72.0%) occurred mainly in restored teeth, whereas only 28.0% were found in intact teeth. Compared with resin (4.7%) or porcelain (0.9%), the use of nonbonded inlay restoration materials such as gold (20.5%) or amalgam (18.7%) increased the occurrence of longitudinal tooth fractures. Out of 107 of longitudinal fractured teeth, 33 (30.8%) were treated endodontically and 74 (69.2%) were not. VRF was associated with endodontic treatment.
The bite test is most reliable for reproducing symptoms. The combined use of various examination methods is recommended for detecting cracks and minutely inspecting all directions of a tooth.
The therapy of dilacerated permanent anterior teeth usually involves surgically removing the tooth. Subsequently, orthodontic methods for closing the space or keeping it open are preferred until the patient reaches an age when definitive implantological or prosthetic treatments may be used. Anterior tooth transplantation should be considered as an alternative to surgically extracting the tooth. This study describes a period of investigation covering 3 years during which neither replacement resorption nor inflammatory resorption was diagnosed in the five transplanted teeth. The clinical tooth mobility was similar to that of the adjacent teeth. In spite of the vertical loss of bone shown radiographically no pathologically enlarged pockets or recessions have been found. It is not yet possible to make any comments on the prognosis for the long term.
A case of severe lateral luxation and root fracture in upper incisors is reported. Treatment involved the repositioning and fixation of the injured teeth and endodontic treatment with calcium hydroxide. The importance of long-term follow-up is emphasized.
El Síndrome del Diente Fisurado: Etiología, Diagnóstico y Tratamiento (tesis de pregrado)
- A Avendaño
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