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European Endodontic Journal Jan 2023This study aimed to evaluate the survival from fractures and risk factors of VPT-treated permanent molars restored with direct resin composites in young patients.
Tooth Fracture and Associated Risk Factors in Permanent Molars Treated with Vital Pulp Therapy and Restored with Direct Resin Composites: A Retrospective Survival Analysis in Young Patients.
OBJECTIVE
This study aimed to evaluate the survival from fractures and risk factors of VPT-treated permanent molars restored with direct resin composites in young patients.
METHODS
The dental records of patients aged 6 to 18 years with VPT-treated permanent molars restored with resin composites were retrospectively evaluated for the presence of fractures on these teeth. Kaplan-Meier methods were used to estimate the survival probabilities. The potential risk factors were assessed using the multivariable Cox proportional hazard model.
RESULTS
A total of 234 treated molars from 189 patients were included. An overall average follow-up time was 33.34+-20.54 months (ranging from 6 to 83 months). At the end of the study, 21.8% of molars had fractures with the majority of them (92.2%) were restorable. Radiographically, only 3.9% of the fractured molars had periapical lesions and considered VPT failures. The percentages of the fracture types are as follows: 54.9% natural tooth structure fracture, 27.5% restoration fracture, and 17.6% combination fracture. The most common fracture location among the 37 molars with natural tooth fracture (either alone or in combination with restoration fracture) was at the marginal ridge (59.5%), followed by the marginal ridge extending to cusp (21.6%), and the cusp itself (18.9%). The cumulative survival probabilities of these teeth decreased over time, reaching 66.02% (95% CI: 55.89-74.36) after 5 years. VPT-treated molars in the mandible had a 2.1 times higher risk of fracture than those in the maxilla. Furthermore, the molars treated with partial and coronal pulpotomy had 2.4 times and 4.6 times higher risks of fracture when compared to those with indirect pulp capping, respectively.
CONCLUSION
In VPT-treated permanent molars in young patients, more fractures were seen in mandibular teeth and in teeth with pulp roof removal (partial and coronal pulpotomy). Clinicians should plan for proper restoration on these teeth. (EEJ-2022-08-097).
Topics: Humans; Retrospective Studies; Molar; Composite Resins; Tooth Fractures; Survival Analysis; Risk Factors
PubMed: 36748448
DOI: 10.14744/eej.2022.18894 -
Oral and Maxillofacial Surgery Mar 2022Dental injuries (DIs) are associated with facial fractures, particularly mandibular fractures. As paediatric mandibular fractures have special features, we sought to...
PURPOSE
Dental injuries (DIs) are associated with facial fractures, particularly mandibular fractures. As paediatric mandibular fractures have special features, we sought to clarify the occurrence and types of DIs among this patient group. We assessed how age, injury type, and fracture location affects the occurrence of DIs and thereby defined which patients are most susceptible.
METHODS
This retrospective study included patients < 18 years with a recent mandibular fracture. Predictor variables were gender, age group, mechanism of injury, type of mandibular fracture, and other associated facial fracture(s). Types and locations of DIs and tooth loss due to injury were also reported.
RESULTS
DIs were detected in 34.7% (n = 41) out of 118 patients. Patients with tooth injury had on average 3.5 injured teeth. A total of 16.2% of injured teeth were lost, typically at the time of the injury. Loss of at least one tooth was seen in approximately 10% of patients. Avulsion was the most common cause of tooth loss (52.2%). Non-complicated crown fracture (50.7%) was the most common DI type. Statistically significant associations between studied variables and DIs were not detected.
CONCLUSION
DIs are common and often multiple in paediatric mandibular fracture patients regardless of background factors. DIs often lead to tooth loss. Prompt replantation of an avulsed tooth, early detection of DIs, and prevention of tooth loss whenever possible are important to avoid permanent tooth defects.
Topics: Child; Humans; Mandibular Fractures; Retrospective Studies; Tooth Avulsion; Tooth Crown; Tooth Fractures; Tooth Injuries
PubMed: 33913044
DOI: 10.1007/s10006-021-00966-8 -
Advances in Dental Research Nov 2013Direct placement restorative materials must interface with tooth structures that are often compromised by caries or trauma. The material must seal the interface while...
Direct placement restorative materials must interface with tooth structures that are often compromised by caries or trauma. The material must seal the interface while providing sufficient strength and wear resistance to assure function of the tooth for, ideally, the lifetime of the patient. Needed are direct restorative materials that are less technique-sensitive than current resin-based composite systems while having improved properties. The ideal material could be successfully used in areas of the world with limited infrastructure. Advances in our understanding of the interface between the restoration adhesive system and the stages of carious dentin can be used to promote remineralization. Application of fracture mechanics to adhesion at the tooth-restoration interface can provide insights for improvement. Research in polymer systems suggests alternatives to current composite resin matrix systems to overcome technique sensitivity, while advances in nano- and mesoparticle reinforcement and alignment in composite systems can increase material strength, toughness, and wear resistance, foreshadowing dental application.
Topics: Dental Materials; Dental Restoration, Permanent; Humans; Microscopy, Electron, Scanning; Nanocomposites; Tooth Fractures; Tooth Remineralization
PubMed: 24129814
DOI: 10.1177/0022034513502207 -
Dental Materials Journal May 2021The aim is to evaluate the influence of remaining tooth substance and post-endodontic restoration on fracture strength of endodontically treated maxillary incisors. 150...
The aim is to evaluate the influence of remaining tooth substance and post-endodontic restoration on fracture strength of endodontically treated maxillary incisors. 150 maxillary central incisors were divided into three groups, Group 0, intact teeth; Group 1, removal of distal wall; Group 2, removal of mesial and distal walls, and further into two subgroups A,A,A and B,B,B according to post-endodontic restoration (post/no-post), then loaded to fracture. Interactions among variables and intergroup significance were tested with two-way ANOVA and Kruskal Wallis's tests (p≤0.05). Tukey's test was applied for multiple comparisons. Statistically significant differences were found between groups B-A, and B-A, but they were not found between B-A. Intragroup analysis showed statistically significant differences in both groups post/no-post with decreasing dental substance. Fiber post placement causes an increase in fracture strength and a reduction of irreparable fractures in endodontically treated maxillary central incisors that lost at least one wall.
Topics: Composite Resins; Dental Restoration Failure; Dental Stress Analysis; Flexural Strength; Humans; Incisor; Post and Core Technique; Tooth Fractures; Tooth, Nonvital
PubMed: 33612564
DOI: 10.4012/dmj.2020-220 -
BMC Oral Health Feb 2021Tooth fractures can occur after temporary inter-appointment endodontic filling, resulting in not preserving and thus extraction of the affected tooth. The purpose of...
BACKGROUND
Tooth fractures can occur after temporary inter-appointment endodontic filling, resulting in not preserving and thus extraction of the affected tooth. The purpose of this investigation was therefore to evaluate the tooth substance fracture potential given by the expansion of endodontic temporary filling materials.
METHODS
Tooth and access cavities were prepared in 80 mandibular molars. Four groups of 20 teeth each (Cavit, Cavit W and Coltosol F and control) were included. To simulate a clinical situation, the teeth were endodontically pre-treated and a calcium hydroxide dressing was placed. The cavities were filled with the corresponding temporary filling material, with exception of the control group, and kept submerged in distilled water for 15 days. The teeth were examined every 24 h by two calibrated observers under a stereomicroscope (7.5×), fractures of the temporary filling material and tooth structure were photo-documented, and the results statistically analyzed. Kaplan-Meier survival analysis were calculated to illustrate (survival = no fracture) probabilities to evaluate the time when the temporary filling material, tooth structure or both together occurred. Log-rank test was performed in order to assess significant differences between the materials and the subgroups used.
RESULTS
Fractures were observed only in the Coltosol F group (p < 0.01), at the end of the observation period, a total of 13 teeth (65%) showed temporary filling material and eight teeth (40%) showed tooth structure fractures. No fractures in the pulp chamber area were observed at the end of the observation period in any group.
CONCLUSIONS
Within the limitations of the current in vitro study, the results obtained suggest that tooth structure fractures caused by a temporary filling material can occur during endodontic treatment, thus compromising the success of the treatment.
Topics: Calcium Sulfate; Dental Cements; Dental Restoration, Temporary; Humans; Polyvinyls; Root Canal Filling Materials; Tooth Fractures; Zinc Oxide; Zinc Sulfate
PubMed: 33593339
DOI: 10.1186/s12903-021-01431-4 -
Medical Principles and Practice :... 2015A review is presented of the mechanical damage suffered by tooth crowns. This has been the subject of much recent research, resulting in a need to revise some of the... (Review)
Review
A review is presented of the mechanical damage suffered by tooth crowns. This has been the subject of much recent research, resulting in a need to revise some of the thinking about the mechanisms involved. Damage is classified here by scale into macro-, meso- and microfracture. The focus is on the outer enamel coat because this is the contact tissue and where most fractures start. Enamel properties appear to be tailored to maximize hardness, but also to prevent fracture. The latter is achieved by the deployment of developmental flaws called enamel tufts. Macrofractures usually appear to initiate as extensions of tufts on the undersurface of the enamel adjacent to the enamel-dentine junction and extend from there into the enamel. Cracks that pass from the tooth surface tend to be deflected by an enamel region of high toughness; if they find the surface again, a chip (mesofracture) is produced. The real protection of the enamel-dentine junction here is the layer of decussating inner enamel. Finally, a novel analysis of mechanical wear (microfracture) suggests that the local toughness of the enamel is very important to its ability to resist tissue loss. Enamel and dentine have contrasting behaviours. Seen on a large scale, dentine is isotropic (behaving similarly in all directions) while enamel is anisotropic, but vice versa on a very small scale. These patterns have implications for anyone studying the fracture behaviour of teeth.
Topics: Bicuspid; Biomechanical Phenomena; Cuspid; Dental Enamel; Dental Stress Analysis; Fractures, Stress; Humans; Incisor; Molar; Stress, Mechanical; Surface Properties; Tooth; Tooth Fractures; Tooth Wear
PubMed: 25427777
DOI: 10.1159/000367976 -
ELife Sep 2019Exceptionally high rates of tooth fracture in large Pleistocene carnivorans imply intensified interspecific competition, given that tooth fracture rises with increased...
Exceptionally high rates of tooth fracture in large Pleistocene carnivorans imply intensified interspecific competition, given that tooth fracture rises with increased bone consumption, a behavior that likely occurs when prey are difficult to acquire. To assess the link between prey availability and dental attrition, we documented dental fracture rates over decades among three well-studied populations of extant gray wolves that differed in prey:predator ratio and levels of carcass utilization. When prey:predator ratios declined, kills were more fully consumed, and rates of tooth fracture more than doubled. This supports tooth fracture frequency as a relative measure of the difficulty of acquiring prey, and reveals a rapid response to diminished food levels in large carnivores despite risks of infection and reduced fitness due to dental injuries. More broadly, large carnivore tooth fracture frequency likely reflects energetic stress, an aspect of predator success that is challenging to quantify in wild populations.
Topics: Animal Diseases; Animals; Feeding Behavior; Fossils; Tooth Fractures; Wolves
PubMed: 31549963
DOI: 10.7554/eLife.48628 -
Journal of Dentistry Nov 2023To 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. (Review)
Review
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.
Topics: Humans; Cracked Tooth Syndrome; Tooth, Nonvital
PubMed: 37713950
DOI: 10.1016/j.jdent.2023.104683 -
Dental Materials Journal Apr 2022The objective of this study was to determine the influence of height and thickness of the one wall remaining coronal tooth structure on the fracture resistance of an...
The objective of this study was to determine the influence of height and thickness of the one wall remaining coronal tooth structure on the fracture resistance of an endodontically treated root with resin abutment build-up using resin composite and fiber-reinforced resin composite post. Static and dynamic fracture tests were performed by placing the remaining tooth wall on the tensile side and applying loads at an angle of 30° from the tooth axis. Superior static fracture resistance was observed when the wall remaining on the tooth had a height and thickness greater than 1.0 mm. The dynamic fatigue test showed high loading capacity or fracture resistance in specimens with large height and thickness. The dynamic fatigue test showed the influence of the remaining tooth structure on fracture resistance clearly. In conclusion, the static and dynamic fracture resistances increased with the height and thickness of the one wall remaining tooth structure.
Topics: Composite Resins; Dental Restoration Failure; Dental Stress Analysis; Humans; Post and Core Technique; Tooth Fractures; Tooth, Nonvital
PubMed: 34759127
DOI: 10.4012/dmj.2021-145 -
Fa Yi Xue Za Zhi Feb 2020Objective To discuss the types, number and diagnostic methods of traumatic tooth fracture in order to provide reference for forensic clinical identification. Methods The...
Objective To discuss the types, number and diagnostic methods of traumatic tooth fracture in order to provide reference for forensic clinical identification. Methods The 41 cases accepted by Judicial Appraisal Center of Gansu University of Political Science and Law from January 2015 to December 2017, were analyzed by descriptive statistics according to information such as the basic situation, injury manner, type and number of tooth fracture, diagnostic method and expert opinion. Results The 41 cases included 31 males and 10 females. Tooth fracture occurred mainly on the maxillary anterior teeth. The main injury manner of traumatic tooth fracture was collision injury. CT scan improved the accuracy of diagnosis. Conclusion There are gender differences in tooth fracture cases. The part of fracture is related to tooth anatomical characteristics. CT scan can be a priority in tooth fracture diagnosis. Forensic analysis of traumatic tooth fracture should comprehensively consider the types and number of tooth fracture, and define the relationship between tooth fracture and the injury.
Topics: Expert Testimony; Female; Forensic Medicine; Humans; Male; Sex Factors; Tomography, X-Ray Computed; Tooth Fractures
PubMed: 32250081
DOI: 10.12116/j.issn.1004-5619.2020.01.013