-
Journal of the Formosan Medical... Apr 2018Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose,... (Review)
Review
Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction.
Topics: Aged; Aged, 80 and over; Dental Cementum; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Root Canal Therapy; Tooth Fractures; Tooth Root
PubMed: 28969877
DOI: 10.1016/j.jfma.2017.09.001 -
Journal of Endodontics Jun 2019Magnetic resonance imaging (MRI) has the potential to aid in determining the presence and extent of cracks/fractures in teeth because of better contrast without ionizing...
INTRODUCTION
Magnetic resonance imaging (MRI) has the potential to aid in determining the presence and extent of cracks/fractures in teeth because of better contrast without ionizing radiation. The objectives were to develop MRI criteria for root crack/fracture identification and to establish reliability and accuracy in their detection.
METHODS
MRI-based criteria for crack/fracture appearance was developed by an MRI physicist and a panel of 6 dentists. Twenty-nine human adult teeth previously extracted after a clinical diagnosis of a root crack/fracture were frequency matched to 29 controls. Samples were scanned using an in vivo MRI protocol and the reference standard (ie, ex vivo limited field of view cone-beam computed tomographic [CBCT] imaging). A blinded, 4-member panel evaluated the images with a proportion randomly retested to establish intrarater reliability. Overall observer agreement, sensitivity, and specificity were computed for each imaging modality.
RESULTS
Subjectively, MRI has increased crack/fracture contrast and is less prone to artifacts from radiodense materials relative to CBCT imaging. Intrarater reliability for MRI was fair to excellent (κ = 0.38-1.00), and for CBCT imaging, it was moderate to excellent (κ = 0.66-1.00). Sensitivity for MRI was 0.59 (95% confidence interval [CI], 0.39-0.76; P = .46), and for CBCT imaging, it was 0.59 (95% CI, 0.59-0.76; P = .46). Specificity for MRI was 0.83 (95% CI, 0.64-0.94; P < .01), and for CBCT imaging, it was 0.90 (95% CI, 0.73-0.98; P < .01).
CONCLUSIONS
Despite advantages of increased contrast and the absence of artifacts from radiodense materials in MRI, comparable measures of sensitivity and specificity (to limited field of view CBCT imaging) suggest MRI quality improvements are needed, specifically in image acquisition and postprocessing parameters. Given the early stage of technology development, there may be a use for MRI in detecting cracks/fractures in teeth.
Topics: Adult; Cone-Beam Computed Tomography; Humans; Magnetic Resonance Imaging; Reproducibility of Results; Sensitivity and Specificity; Tooth Fractures; Tooth Root
PubMed: 31056300
DOI: 10.1016/j.joen.2019.03.008 -
Journal of the Mechanical Behavior of... Dec 2023This study investigated the impact of preparation design and material types on fracture strength in maxillary premolars endocrowns after thermodynamic aging.
PURPOSE
This study investigated the impact of preparation design and material types on fracture strength in maxillary premolars endocrowns after thermodynamic aging.
MATERIALS AND METHODS
Eighty two-rooted maxillary premolar crowns underwent endodontic treatment (N = 80, n = 10). The teeth were categorized into ten groups (4-mm deep with no intracanal extension lithium disilicate glass ceramic & multilayer zirconia endocrowns (LE0 & ZE0); 4-mm deep with 4-mm intracanal extension in one canal (LE1 & ZE1); 4-mm deep with 2-mm intracanal extensions in both canals (LE2 & ZE2); flat overlays with no endocore (LO & ZO); glass fiber reinforced post & core and crown (LC & ZC)). After cementation, all specimens were subjected to 1500 thermocycles and 1,200,000 chewing cycles with an axial occlusal load of 49 N. A static loading test was performed at a non-axial 45° loading using a universal testing machine and failure modes (Type I: restoration debonding; Type II: restoration fracture; Type III: restoration/tooth complex fracture above bone level; Type IV: restoration/tooth complex fracture below bone level) were evaluated using a stereoscope. Data were ananalzed using 2-way ANOVA and Tukey's tests (alpha = 0.05).
RESULTS
The endocrowns manufactured from multilayered zirconia and pressed lithium disilicate glass ceramic exhibited a fracture load ranging between 1334 ± 332 N and 756 ± 150 N, with ZC presenting the highest and LE2 the lowest values. The differences were not statistically significant (p > 0.05).
CONCLUSION
All endocrowns tested in this study performed similar considering the different designs and materials tested. The distribution of fracture modes did not differ significantly depending on the design of the restoration and the type of material used.
Topics: Humans; Flexural Strength; Materials Testing; Computer-Aided Design; Zirconium; Ceramics; Dental Porcelain; Tooth Fractures; Dental Stress Analysis; Dental Restoration Failure
PubMed: 37839334
DOI: 10.1016/j.jmbbm.2023.106184 -
Journal of the American Dental... Feb 2021The authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-,...
BACKGROUND
The authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-, and crack-level characteristics with these outcomes.
METHODS
Two-hundred-and-nine National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2,601 participants with a cracked vital posterior tooth that had been examined for at least 1 recall visit over 3 years. Data were collected at the patient, tooth, and crack levels at baseline, annual follow-up visits, and any interim visits. Associations between these characteristics and the subsequent same-tooth fractures and crack progression were quantified.
RESULTS
Of the 2,601 teeth with a crack or cracks at baseline, 78 (3.0%; 95% confidence interval, 2.4% to 3.7%) subsequently developed a fracture. Of the 1,889 patients untreated before year 1, 232 (12.3%; 95% confidence interval, 10.9% to 13.8%) had some type of crack progression. Baseline tooth-level characteristics associated with tooth fracture were the tooth was maxillary and had a wear facet through enamel and a crack was detectable with an explorer, on the facial surface, and in a horizontal direction. Crack progression was associated with males and teeth with multiple cracks at baseline; teeth with a baseline facial crack were less likely to show crack progression. There was no commonality between characteristics associated with tooth fracture and those associated with crack progression.
CONCLUSIONS
Development of tooth fractures and crack progression over 3 years were rare occurrences. Specific characteristics were associated with the development of tooth fracture and crack progression, although none were common to both.
PRACTICAL IMPLICATIONS
This information can aid dentists in assessing factors that place posterior cracked teeth at risk of experiencing adverse outcomes.
Topics: Cracked Tooth Syndrome; Dental Enamel; Humans; Male; Tooth; Tooth Fractures
PubMed: 33358237
DOI: 10.1016/j.adaj.2020.09.023 -
Dental Traumatology : Official... Oct 2022Traumatic dental injuries (TDIs) in the primary dentition may result in tooth discolouration and fractures. The aim of this child-centred study was to explore the...
BACKGROUND/AIM
Traumatic dental injuries (TDIs) in the primary dentition may result in tooth discolouration and fractures. The aim of this child-centred study was to explore the differences between preschool children's eye movement patterns and visual attention to typical outcomes following TDIs to primary teeth.
MATERIALS AND METHODS
An eye-tracker recorded 155 healthy preschool children's eye movements when they viewed clinical images of healthy teeth, tooth fractures and discolourations. The visual search pattern was analysed using the eye movement analysis with the Hidden Markov Models (EMHMM) approach and preference for the various regions of interest (ROIs).
RESULTS
Two different eye movement patterns (distributed and selective) were identified (p < .05). Children with the distributed pattern shifted their fixations between the presented images, while those with the selective pattern remained focused on the same image they first saw.
CONCLUSIONS
Preschool children noticed teeth. However, most of them did not have an attentional bias, implying that they did not interpret these TDI outcomes negatively. Only a few children avoided looking at images with TDIs indicating a potential negative impact. The EMHMM approach is appropriate for assessing inter-individual differences in children's visual attention to TDI outcomes.
Topics: Child, Preschool; Eye-Tracking Technology; Humans; Tooth Fractures; Tooth Injuries; Tooth, Deciduous
PubMed: 35460595
DOI: 10.1111/edt.12751 -
The Journal of ECT Sep 2020One adverse effect of electroconvulsive therapy (ECT) is dental fracture; thus, a bite guard and muscle relaxants are used to prevent it. Earlier research reported...
OBJECTIVES
One adverse effect of electroconvulsive therapy (ECT) is dental fracture; thus, a bite guard and muscle relaxants are used to prevent it. Earlier research reported varying rates of dental fracture, but there is no large-scale study on the incidence of dental fracture during ECT. This study aimed to examine the incidence of dental fracture during ECT and to investigate whether the incidence differs between different sexes, age groups, diagnosis groups, electrode placements, or number of treatment sessions.
METHODS
This register-based study used data from the Swedish national quality register for ECT. All hospitals offering ECT report to this register, and the coverage ratio is about 90%. All registered patients who started an ECT series between January 2012 and January 2019 were included in this study, with the data representing 16,681 individuals, 38,862 series, and 254,906 sessions.
RESULTS
Forty-six dental fractures were identified, giving an incidence of dental fracture of 0.2% per series, 0.02% per session, and 0.3% per individual. We did not find any significant associations between dental fracture rates and male or female populations, age, or different diagnosis groups, nor was there any significant difference between dental fracture rates and electrode placement. The mean number of treatments was significantly higher in the dental fracture group than in patients without dental fracture.
CONCLUSIONS
There is a minimal risk of dental fracture during ECT. Our findings, together with those of other studies, provide further motivation for the use of a bite guard and muscle relaxant.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Electroconvulsive Therapy; Female; Humans; Incidence; Male; Middle Aged; Registries; Sweden; Tooth Fractures
PubMed: 31972668
DOI: 10.1097/YCT.0000000000000652 -
International Journal of Environmental... Nov 2020This study aimed to determine the injury prevention-, safety education-, and violence-related factors pertaining to tooth fracture experience (TFE) in Korean...
This study aimed to determine the injury prevention-, safety education-, and violence-related factors pertaining to tooth fracture experience (TFE) in Korean adolescents. We used data from the 14th Korea Youth Risk Behavior Survey (KYRBS) in 2018. The 60,040 participants were selected using a complex sampling design from middle and high schools. The participants completed a self-administered questionnaire. The explanatory variables, including school safety education and violence, were assessed in relation to prevention of traumatic injuries. Complex-samples multivariable logistic regression models were applied to explain the factors related to TFE over the past 12 months. The overall prevalence of TFE was 11.4%. Risk factors related to tooth fractures were not wearing a seatbelt on an express bus, not wearing helmets while riding motorcycles and bicycles, clinical treatment due to injuries at school, injuries associated with earphone/smartphones use, and lack of school safety education such as danger evacuation training. The top risk factor was injuries associated with earphone/smartphone usage, followed by lack of familiarity with school safety education. Thus, to prevent tooth fractures among adolescents, schools should strengthen their safety education, including education regarding mobile device usage, and wearing a seatbelt and wearing a helmet. Care should be taken to manage facilities around the school and to prevent injury related to tooth fracture. Further studies on various risk factors related to tooth fractures are warranted.
Topics: Adolescent; Head Protective Devices; Health Education; Humans; Motorcycles; Republic of Korea; Tooth Fractures; Violence
PubMed: 33218100
DOI: 10.3390/ijerph17228556 -
Journal of the Formosan Medical... Sep 2022Horizontal root fractures (HRF) were observed mostly in the anterior teeth of young adults due to dental injury. However, HRFs in posterior teeth (PHRF) without dental... (Review)
Review
Horizontal root fractures (HRF) were observed mostly in the anterior teeth of young adults due to dental injury. However, HRFs in posterior teeth (PHRF) without dental trauma cannot be neglected. The etiology and risk factors of PHRF were unclear. Lower premolars and palatal root of maxillary molars were particularly affected, indicating the specificity of this diseased entity. PHRF were mainly reported in Asian population, suggesting possible racial difference. Whereas most PHRF teeth showed symptoms mimicking endodontic and periodontal lesions, some affected teeth were asymptomatic. Periodontal pocket, soft tissue swelling, chronic pain or discomfort during mastication were commonly noted. Diagnosis of PHRF depended on thorough clinical examination, radiographic images or exploratory surgery. Intracanal bleeding and electronic apex locator confirmation during endodontic treatment were also useful for diagnosis. Flexible splinting, endodontic/periodontal treatment or root amputation were treatment strategies to preserve the fractured teeth. The aim of this narrative review is to summarize the demography, tooth and root distribution, diagnostic methods, etiology and possible related factors, clinical features, radiographic characteristics, and the treatment schemes of PHRF without dental trauma. A better understanding and identification of this particular root fracture could be achieved. The diagnostic tools and practical management are useful for clinical guides.
Topics: Bicuspid; Humans; Molar; Periodontal Pocket; Root Canal Therapy; Tooth Fractures; Tooth Root; Young Adult
PubMed: 35428526
DOI: 10.1016/j.jfma.2022.03.019 -
BioMed Research International 2021The oral health care of autistic children is elaborated; they often fail to define dental problems, and a family-centered approach can be useful to improve and intercept...
BACKGROUND
The oral health care of autistic children is elaborated; they often fail to define dental problems, and a family-centered approach can be useful to improve and intercept these disorders.
AIM
To assess the oral status of autistic children, comparing it with no autistic patients.
MATERIALS AND METHODS
A retrospective study analyzed the oral health status of 70 children, 35 with autism and 35 without the disorder. Conditions assessed were dental trauma type, periodontal tissue injuries, soft tissue lip injuries, different treatments carried out, associated soft tissue findings and disorders, and the long-term management. All patients (≤15 years of age) were chosen consecutively.
RESULTS
Females (57%) suffered more traumatic injuries than males (43%) in the autistic group, whereas males affected by dental trauma (54%) are predominant in the control group. The enamel fracture was the main finding among the dental trauma types in both groups followed by enamel/dentin/pulp fracture (31%), root fracture (11%), and avulsions (3%) in the autistic group and by avulsions (20%), root fracture (11%), and enamel/dentin/pulp fracture (6%) in the control group. The comparison of all variables of the two groups showed a statistically significant difference ( < 0.012). The lower lip was statistically more injured than the upper lip ( < 0.005).
CONCLUSIONS
The composite restorative technique was the most common approach carried out; the long-term evaluation, when possible, was predominantly managed through root canal therapy in the control group (81%), and root canal therapy (50%) and tooth extraction (50%) in the sample group.
Topics: Adolescent; Age Factors; Autistic Disorder; Child; Dental Care; Dental Care for Children; Dentin; Female; Humans; Male; Periodontium; Retrospective Studies; Root Canal Therapy; Sex Factors; Tooth Fractures
PubMed: 34540992
DOI: 10.1155/2021/3125251 -
The Journal of Clinical Pediatric... Sep 2022Restoration of traumatized incisors by reattachment of the original tooth fragment appears to be the most conservative treatment approach. But the measurement of forces...
OBJECTIVE
Restoration of traumatized incisors by reattachment of the original tooth fragment appears to be the most conservative treatment approach. But the measurement of forces acting on natural tooth in-vivo poses many challenges. The advent of finite element analysis (FEA) has made it possible to demonstrate the propagation of stress through each part of a tooth and its restoration. The objective of this study was to evaluate and compare the fracture resistance of reattached human tooth fragment with different types of retentive preparation techniques using finite element analysis.
STUDY DESIGN
An intact maxillary central incisor was obtained, scanned by laser and its Computer Assisted Device (CAD) model was generated and then converted to Finite Element Model(FEM). Mechanical properties of tooth specimen and materials were added on the generated mesh. These reattached fragments were then fractured with a force applied at 30°, 45°, 70° and 90° to the long axis of tooth. FEA Calculation was run with the setup.
RESULTS
The highest fracture strength recovery was found with internal dentinal groove (64.97%) followed by labial double chamfer with lingual over-contour (54.49%), subsequently by labial and lingual double chamfer (51.31%) and least was with simple reattachment (28.27%).
CONCLUSIONS
Fracture resistance varied with different retentive techniques and greatest strength was offered by internal dentinal groove preparation.
Topics: Humans; Finite Element Analysis; Tooth Fractures; Dental Restoration, Permanent; Dental Stress Analysis; Incisor; Tooth Crown; Composite Resins
PubMed: 36624918
DOI: 10.22514/jocpd.2022.011