Seven-year Clinical Evaluation of Painful Cracked Teeth Restored with a Direct Composite Restoration

Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome

“…39 The above was refl ected in two clinical studies by Opdam et al 25,26 In both studies, following the removal of the existing amalgam restoration, the cusps of affected teeth (as opposed to the entire occlusal surface) were reduced by 0.5-1.0 mm coronally from the onset of the micro-crack and the resulting cavity outline fi nished with a bevelled margin (before the application of direct composite resin).…”

“…26 At the end of the observation period, a survival rate of 100% was elucidated; all 21 cases reported the elimination of symptoms of thermal sensitivity and pain on biting when asked verbally. Similar results were published by Homewood.…”

“…The authors concluded that direct composite resin restorations without cuspal coverage can be effective in treating cases of CTS (75% of cases reported alleviation of symptoms when verbally questioned). Opdam et al 26 have also published a report in 2008, documenting the results of a seven year evaluation of the effi cacy of direct composite resin when used to restore painful cracked teeth (previously containing amalgam restorations). The results of the latter study displayed an annual failure rate of 6%.…”

“…26 The latter effect may be exaggerated in cases of CTS by two factors; fi rstly, CTS is often seem among patients who display parafunctional grinding habits who would be more likely to apply higher loads to the restored tooth, and secondly due to the presence of a pre-existing fracture, cuspal fl exibility would have already been increased when compared to a healthy un-fractured, sound tooth, placing further greater strain on a progressively weakening adhesive layer. (cermets), however, have been reported to restore prepared teeth to a strength equivalent to that of sound teeth or those restored with resin composite.…”

“…According to a leading authority, cracked teeth should be considered to be at an increased risk of pulpal complications (in particular, where there has been thermal sensitivity); 26 the preparation of such teeth to receive indirect restorations would not only result in the loss of more sound tooth tissue but necessitate the use of a provisional restoration. Both the latter factors will increase the risk of pulpal complications.…”