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

Olivieri, Juan Gonzalo; Elmsmari, Firas; Miró, Queralt; Ruiz, Xavier-Fructuós; Krell, Keith V.; García‐Font, Marc; Durán-Sindreu, Fernando

doi:10.1016/j.joen.2020.01.006

Cited by 35 publications

(31 citation statements)

References 38 publications

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“…Continued mastication and progression of the process towards complete fracture (split tooth) lead to bacterial penetration of the periodontium, and this complication together with active pressure from impaction results in bone loss. An important diagnostic clinical sign is the detection of a probing defect; absence of this defect (OR 0.027, 95% CI 0.003–0.27, p < .05) serves as a protective prognostic factor, which indicates longer survival (Walton & Tamse, 2015, Olivieri et al 2020). Longitudinal tooth fractures can produce a unique pattern of bone resorption around the fracture line, which is pathognomonic of the condition and enables definitive diagnosis (Rovai et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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

Malentacca¹,

Zaccheo²,

Scialanca³

et al. 2021

Int Endodontic J

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Aim This retrospective observational study investigated the survival rate of teeth with radicular cracks that were restored using composite materials. Methodology The study was approved by the Ethical Committee of Sistema Sanitario Nazionale (prot. N°2370CELazio1), Clinicaltrials.gov identifier: NCT04430205. Between 1991 and 2019, 87 teeth with radicular cracks (87 patients [46 men, 41 women, mean age 50.2 years]) were treated with adhesive composite restorations. Forty‐five cracks were observed in the maxillary posterior teeth (molars and premolars), 40 in the mandibular posterior teeth and only two cracks in the anterior teeth, both in maxilla. Based on the depth of the crack, teeth were categorized as proximal radicular cracked teeth (PRCT), in which the fracture line was restricted within the pulpal floor or the coronal one‐third of the root and deep radicular cracked teeth (DRCT), in which the fracture line extended to the middle and apical thirds of the root canal up to the apex. Bone loss/recovery was evaluated radiographically at 1‐year follow‐up. All patients were treated using surgical microscopy by the same operator. Logistic regression analysis was performed to determine independent predictors of extraction. Kaplan–Meier survival curves were used to analyse PRCT and DRCT. Results Among 87 cracked teeth, 66 were molars, 19 premolars and 2 incisors. Fifty‐two were DRCT, 35 were PRCT, 46 had a periodontal probing defect. Patients were followed up for a mean of 66.9 months (standard deviation 44.6, min 1 to max 172). Lack of probing depth was a significant protective factor against extraction (odds ratio [OR] 0.027, 95% confidence interval [CI] 0.003–0.27, p < .05), whereas further bone loss (OR 10.63, 95% CI 2.08–54.36, p < .05) was a risk factor for extraction. More than 50% of teeth treated with the adhesive protocol were functional (46 of 87 teeth [χ2 test], p < .05) at 5‐year follow‐up. Among the PRCT group, a 78% survival rate at 5 years was found, while among the DRCT group, a 58% survival rate was found. Conclusion Composite resin restorations resulted in tooth survival in >50% of patients; 85.4% of PRCT and 61.5% of DRCT were functional after 5 years of follow‐up.

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Section: Discussionmentioning

confidence: 99%

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

Malentacca¹,

Zaccheo²,

Scialanca³

et al. 2021

Int Endodontic J

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“…A relação entre a presença de uma fissura e sua tendência de se estender a uma divisão fatal ainda não é claramente compreendido. No entanto, pode ser presumir que a presença de uma linha de fissura aumenta o risco (Olivieri, et al, 2020).…”

Section: Discussionunclassified

“…A presença de bolsa periodontal associada tem efeito significativo na sobrevida de dentes trincados tratados endodonticamente, aumentando as chances de extração em 11%. (Olivieri, et al, 2020). Em uma pesquisa recente com 3.500 endodontistas nos Estados Unidos, a presença de uma bolsa periodontal de 6 mm de profundidade associada resultou em ser o fator mais crucial na decisão de tratar ou extrair um dente rachado com envolvimento pulpar.…”

Section: Discussionunclassified

“…A probabilidade destes fatores, como os intraoperatórios (obturação e restauração coronária satisfatória), afetarem o prognóstico do tratamento é relativamente alta (Ng, et al, 2007). É possível que alguns desses fatores possam afetar a sobrevivência dos dentes mais do que a própria presença de uma rachadura (Olivieri, et al, 2020). Neste relato de caso, o achado da trinca nas imagens de micro-CT e a má adaptação do cone de guta-percha no terço apical, explica a recontaminação do sistema de canais radiculares pela solução de continuidade do sulco gengival com o canal radicular através da rachadura que caminhou da coroa a superfície radicular.…”

Section: Discussionunclassified

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Análise em micro-CT de dente rachado em segundo molar mandibular com anatomia em C após trauma oclusal: Relato de caso

Velozo

Dantas

Sousa

et al. 2021

RSD

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O objetivo do presente estudo foi analisar em micro-CT dente extraído por cracked tooth. Uma mulher de 38 anos, branca, com queixa de occasional discomfort ao morder caroço de milho de pipoca, procurou a urgência. Após exame clínico intra-oral e radiográfico, o segundo molar mandibular direito (dente 47) foi diagnosticado com polpa viva e fratura das cúspides linguais, e após remoção de restauração de amálgama constatou-se incomplete fracture initiated from the crown na crista proximal distal. O plano de tratamento iniciou-se com reabilitação protética através de coroa total. Três meses depois sintomas de pulpite irreversível sintomática. A cavidade pulpar foi acessada através da coroa protética e o dente foi tratado endodonticamente. Dois anos depois o paciente apresentou fístula próxima a sulco gengival e sondagem periodontal de 12mm no centro da superfície distal. Ao exame tomográfico de feixe cônico observa-se extensa perda óssea atingindo o canal mandibular. O plano de tratamento foi a exodontia do elemento dentário. O dente extraído foi então submetido ao escaneamento no micro-CT. Na análise das imagens do micro-CT do dente extraído, constatou-se dente rachado constatou-se, estendendo-se da coroa até a raiz proximal (face distal). Foi verificado também má adaptação do cone de guta-percha no terço apical do tratamento endodôntico realizado. Através deste relato, podemos inferir que, o diagnóstico de dente rachado é um desafio na prática clínica, e a propagação corono-radicular da rachadura está associada a infiltração microbiana e consequente risco de perda do elemento dental.

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“…The presence of a periodontal pocket associated with a fissure results in an increased risk of losing the tooth [40,18] . In addition to endodontic treatment, barriers have been suggested to prevent leakage, placed apically to the extent of the fissure, complete occlusal reduction, post-operative instructions and rapid placement of a full-coverage restoration [41] . In actuality, there is still no specific treatment for cracked teeth.…”

Section: Treatment Of Cracked Teethmentioning

confidence: 99%

Cracked tooth syndrome, an update

Gonzalez-Guajardo¹,

Ramirez-Herrera²,

Mas-Enriquez³

et al. 2021

Int. J. Appl. Dent. Sci.

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Introduction: Cracked tooth syndrome is defined as an incomplete fracture initiated from the crown and extending cervically, and sometimes gingivally, and is usually directed mesiodistally. Objective: To analyze the literature about cracked tooth syndrome, its etiology, prevalence, pulp involvement and treatment. Methodology: Using the keywords "cracked tooth syndrome", "etiology", "prevalence", "pulp involvement" and "treatment", the MEDLINE/PubMed and ScienceDirect databases were searched, with emphasis on the last 5 years. It was evaluated with the PRISMA and AMSTAR-2 guidelines. Results: There are many causes for cracks, the main one being malocclusion. Another is due to restorations, pieces to which amalgam was placed due to the extension of the cavity for the retentions. The second lower molar presents more frequently fissures due to premature contact. Cracked teeth are a challenge for the dentist in the diagnosis since the discomfort is presented with different stimuli. Depending on the extent of the fissure, the treatment is decided, always keeping in mind that the prognosis is reserved. Conclusions: Cracked tooth syndrome will always be a challenge for the dentist at the time of diagnosis and treatment. There is no specific treatment, depending on the extent of the fissure is to decide the treatment to be performed.

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

Cited by 35 publications

References 38 publications

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

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

Análise em micro-CT de dente rachado em segundo molar mandibular com anatomia em C após trauma oclusal: Relato de caso

Cracked tooth syndrome, an update

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