Prognostic factors associated with pulp status in patients with cracked teeth treated with occlusal veneer: A 6- through 24-month prospective clinical study.

BACKGROUND: The authors evaluated the prognostic factors associated with pulp status in patients with cracked teeth (CT) treated with occlusal veneer. METHODS: An analysis of 80 CT (71 patients) with 1 or more crack lines (CLs) and normal pulp vitality or reversible pulpitis was performed. All patients received occlusal veneer and their demographic and clinical data were recorded. Pulp status and clinical features were recorded at 1 week and posttreatment at 1, 2, 3, 6, 12, 18, and 24 months. RESULTS: Maxillary first molars were commonly involved (30 [38%]). The number of CLs on the finish line ranged from 1 through 7 and most had 3 CLs (24 [30%]). The number of CLs through preparation on the finish line ranged from 0 through 4, and 2 CLs (42 [53%]) were the most prevalent. During follow-up, 5 of 80 CT progressed to pulp disease, resulting in a success rate of 93.8%. Results of the Cox model and Kaplan-Meier analysis showed that probing depth greater than 6 mm, widening periodontal ligament of apical area, more than 4 CLs on finish line, and more than 2 CLs through preparation on the finish line were risk factors associated with pulp status (P < .05). CONCLUSIONS: Occlusal veneer can protect CT without preventive root canal therapy. PRACTICAL IMPLICATIONS: The success rate and risk factors of pulp disease in CT restored with occlusal veneer are reported.

Treatment of cracked teeth: A comprehensive narrative review.

OBJECTIVES: The term "cracked tooth" is used to describe an incomplete fracture initiated from the crown and progressing towards a subgingival direction. Despite the high prevalence of cracked teeth and their frequent association with symptoms and pulpal or periapical pathoses, there is still no consensus in the literature with regard to their restorative and endodontic management. Therefore, the aim of this narrative review was to evaluate the most relevant research and provide an up-to-date comprehensive overview regarding the treatment of cracked teeth. MATERIALS AND METHODS: An electronic literature search was carried out in MEDLINE (via Ovid), Embase (via Ovid), Scopus, and Web of Science as well as several "Grey literature" sources up to February 22nd 2022 using a combination of pre-specified 'free-text' terms (keywords) and "subject headings." The search process was supplemented by handsearching in relevant dental journals and reference lists. This narrative review focused on clinical follow-up studies (observational or interventional studies, case series/reports), laboratory studies and systematic reviews written in English language that reported data on treatment of permanent cracked teeth. The selection of relevant studies was carried out by two reviewers (AK and DG) working independently in two consecutive stages: title/abstract screening and full-text retrieval. Any discrepancies in the study selection were resolved by discussion between the reviewers. RESULTS: In total, 64 articles were selected for inclusion in this narrative review. CONCLUSIONS: Cracked teeth with normal pulp or reversible pulpitis have exhibited high pulp and tooth survival rates by the provision of direct or indirect composite restorations. Besides, recent data favour monitoring, especially in the absence of symptoms or compromised tooth structure. When endodontic intervention is required, current evidence suggests that along with appropriate restorative management, outcomes of cracked teeth may be comparable to those of non-cracked root filled teeth.

Onset and resolution of pain among treated and untreated posterior teeth with a visible crack: Three-year findings from the national dental practice-based research network.

OBJECTIVE: Cracked teeth may be associated with pain, especially biting pain, and to a lesser degree cold and spontaneous pain.  Described are how commonly these pains remain constant, develop, or resolve over time, none of which have been well-described, especially among untreated cracked teeth. METHODS: Cracked teeth from the Cracked Tooth Registry (CTR) study were followed for 3 years.  Assessments of cold, biting, and spontaneous pain and treatments performed were completed at enrollment (Y0) and at each annual recall visit. RESULTS: 209 practitioners enrolled 2,858 patients, each with a visible crack on a posterior tooth; 2601 (91%) patients attended at least one recall visit. Overall, 960 (37%) were treated, primarily with crowns. Among both treated and untreated cracked teeth with biting pain or spontaneous pain at Y0, the vast majority (92-99%) had their pain resolved by the time of a recall visit and 85-93% remained pain-free after initial resolution. The observations for cold pain were similar: 68% (untreated) and 78% (treated) became free of cold pain at some point during follow-up, and 84% of these stayed free of cold pain after initial resolution. Few teeth developed biting or spontaneous pain (4-8%) and 44-67% of these had pain resolution during the follow-up period. CONCLUSION: In this study, treatment resolved a preponderance of pain associated with a cracked tooth.  Pain was also resolved for most untreated cracked teeth, especially biting pain, and to a lesser degree spontaneous and cold pain, although not to the same degree as with the treated cracked teeth.

Incidence of Pulpal Complications after Diagnosis of Vital Cracked Teeth.

INTRODUCTION: This retrospective cohort study aimed to observe the incidence of pulpitis and necrosis in teeth with cracks that were not endodontically treated. METHODS: One hundred eighty-four patients with 199 cracked teeth that were diagnosed with reversible pulpitis and were treated from January 2010 to December 2013 at National Dental Centre, Singapore, were recruited. Cracked teeth were identified by inspection, transillumination, and positive bite tests. A diagnosis of reversible pulpitis was made if the tooth had no history of spontaneous pain, was positive but non-lingering to cold, and there was an absence of any periapical pathosis. Upon diagnosis, orthodontic bands were cemented, and these teeth were referred for crowns. Patients were recalled back at least 3 years after diagnosis, except for those patients whose cracked teeth had undergone endodontic treatment or were extracted. RESULTS: Fifty-eight out of 199 (29.1%) teeth had pulpal complications. Thirty-eight of 58 (65.5%) were diagnosed as irreversible pulpitis after approximately 1.2 years (437 days), and 20 of 58 (34.5%) were diagnosed with necrotic pulp after approximately 2 years (755.5 days). The absence of a full-coverage crown increased the risks of pulp complications (odds ratio = 8.74, P = .000), and males had an increased incidence of pulp complications compared with females (odds ratio = 1.96, P = .056). CONCLUSIONS: Seventy-one percent (141/199) of cracked teeth with reversible pulpitis remained healthy after 3 years. It is essential to brace the cracked tooth to minimize cusp flexion and provide full coverage of the crack from the oral environment. When treated early, these teeth may still reasonably survive for at least 3 years.

Associations of types of pain with crack-level, tooth-level and patient-level characteristics in posterior teeth with visible cracks: Findings from the National Dental Practice-Based Research Network.

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); 2858 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 < .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.

Different treatment protocols for different pulpal and periapical diagnoses of 72 cracked teeth.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Chronic orofacial pain (OFP) of different origin. A case report]. / Chronischer Gesichtsschmerz unterschiedlicher Genese. Ein Fallbericht.

INTRODUCTION: Therapy of chronic orofacial pain (OFP) is often a challenge since OFP can be triggered by numerous medical conditions. Pulpitis is frequently related to acute OFP, only in rare cases pulpitis elicits chronic OFP e. g. due to a cracked tooth. Hypertrophy of masticatory muscles can also cause pain. While this pathosis is easily diagnosed, hypertrophy of masticatory muscles is challenging to treat. METHODS: The presented case demonstrates a combination of a cracked tooth and a symtomatic hypertrophy of the masseteric muscle in a 19-year old patient. The patient suffered from diffuse chronic OFP for more than four month. After diagnosis an interdisciplinary step-by-step treatment plan was realized with re-evaluation and adjustment. RESULTS: After physiotherapy and medicamentous pain control intramuscular injection of Botolinum toxin type-A was performed with remission of the muscle hypertrophy but only partial success regarding pain control. After root canal treatment of a cracked tooth the patient was free of symptoms. CONCLUSION: The high degree of specialization in dental medicine requires a multidisciplinary approach for OFP not thoroughly responding to therapy. Stepwise diagnostics and treatments are recommended to clarify the pathology and to address multiple causes of disease.

Recognition and management of odontogenic referred pain.

There are times when referred pain makes it difficult to locate the source of odontogenic pain. In those situations, additional evaluation or referral is needed to determine the cause of the chief complaint. This article presents two cases that illustrate the difficulty and frustrations of referred pain for both patients and dentists. After a thorough evaluation and diagnosis, the true sources of the patients' chief complaints were identified and treated, leading to complete resolution of their symptoms. These cases emphasize the importance of listening to the patient, obtaining a detailed dental history, collecting comprehensive diagnostic data, and developing an accurate diagnosis before initiating treatment. When a definitive diagnosis cannot be determined, referral may be necessary to provide the best treatment possible.

Cracked tooth syndrome: characteristics and distribution among adults in a Nigerian teaching hospital.

This study highlighted the characteristics and distribution of cracked tooth syndrome (CTS) and the associated factors in adult attendees in the University of Nigeria Teaching Hospital. Three hundred seventy patients aged 18 years to 77 years with CTS-like conditions were included and studied over 12 months. The following information was recorded: suspected tooth and the dental arch, restorative status of the tooth, age and sex of the patient, results of bite test and transillumination, and the pulpal and periapical status of the tooth. CTS was seen most often in the 41 to 50 years age band (36.4%), in molars (63.6%), and in the maxillary arch (51.5%). Also, it was more frequent in men (55.8%). About 82% of CTS occurred in amalgam-restored teeth. All cases had a positive response to the bite test and a normal response to the electric pulp test. Only 10% gave a positive history of masticatory accident as against none with history of bruxism habits. It was concluded that patients with unexplained pain in a vital, amalgam-restored tooth (especially in maxillary molars), with or without a history of a masticatory accident, may have a cracked or fractured tooth.

Predictable management of cracked teeth with reversible pulpitis.

BACKGROUND: The aims of this study were to assess symptoms and signs caused by cracks in teeth and to assess a conservative management protocol. METHODS: The symptoms and signs of 100 consecutive teeth that had reversible pulpitis associated with cracks were compared to findings from other reports. Teeth were managed with a conservative protocol which involved removal of cracks, caries and restorations, followed by placement of a sedative lining and interim restoration unless there were pulp exposures or insufficient tooth structure remaining. Teeth were monitored for pulp healing after three months and for up to five years. RESULTS: Eighty teeth did not require endodontic treatment. One tooth had an uncertain pulp status at review appointments. Fifteen teeth required endodontic treatment at the initial appointment because of carious pulp exposures (4 teeth), cracks extending into the pulp (2), and posts required (9). Four other teeth required endodontic treatment later following conservative pulp treatment due to continued pulpitis under the temporary restoration (1), pulpitis after core restoration (2), and pulp necrosis diagnosed at the review (1). CONCLUSIONS: Provided there is an accurate diagnosis of the pulp status and its cause, teeth with reversible pulpitis due to cracks can be treated conservatively without endodontic treatment in about 80 per cent of cases.

Influence of cracks on leakage and obturation efficiency of root-end filling materials after ultrasonic preparation: an in vitro evaluation.

OBJECTIVES: To evaluate (1) the apical seal of root-end cavities using mineral trioxide aggregate (MTA) and glass-ionomer cement in teeth with and without cracks after ultrasonic root-end preparation and (2) the obturation efficiency of the materials in the root-end cavities. METHOD AND MATERIALS: Sixty teeth with root-end cavities were divided into 3 groups: teeth without cracks (-) (group A) and teeth with cracks (+) (group B). The third group (4 teeth) served as a control. Groups A and B were each divided into 2 subgroups: Groups 1A and 1B were filled with Fuji IX capsules (GC) after treatment with cavity conditioner; groups 2A and 2B were filled with white MTA (Dentsply). The teeth were immersed in india ink and cleared. Apical leakage was measured from the resection surface to the maximal point of ink infiltration. Obturation efficiency was scored as good (acceptable), irregular (acceptable), or poor (unacceptable). Statistical analysis was performed using nonparametric and Fisher exact tests. RESULTS: Apical leakage could be arranged in the following order: Fuji IX+ > MTA+ > Fuji IX- > MTA-. Significant differences between Fuji IX- and Fuji IX+ (P < .001) and between MTA- and MTA+ (P < .001) were demonstrated. Fuji IX showed significantly more unacceptable fillings than did MTA (P < .005). No correlation between obturation efficiency and apical leakage was demonstrated (P > .05). CONCLUSION: The presence of cracks originating from the root canal negatively influences the seal of root-end filling materials and is probably of major clinical importance. MTA and Fuji IX showed equal sealing capacity, but MTA showed better obturation efficiency in the root-end cavity than Fuji IX.

Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration.

The purpose of this study was to investigate long-term clinical effectiveness of treating painful cracked teeth with a direct bonded composite resin restoration. The hypothesis tested was that cracked teeth treated with or without cuspal coverage showed the same performance. Forty-one patients attended a dental practice with a painful cracked tooth that was restored with a direct composite resin restoration. Twenty teeth were restored without and 21 with cuspal coverage. After 7 years, 40 teeth could be evaluated. Three teeth without cuspal coverage needed an endodontic treatment, of which 2 failed as a result of fracture. No significant differences were found for tooth or pulp survival. Three more repairable restoration failures were recorded. Mean annual failure rate of restorations without cuspal coverage was 6%; no failures in restorations with cuspal coverage occurred (P = .009). A direct bonded composite resin restoration can be a successful treatment for a cracked tooth.

A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis.

The purpose of this investigation was to report on the clinical outcomes of cracked teeth diagnosed with reversible pulpitis (RP). Eight thousand one hundred seventy-five patients referred for evaluation and treatment during a 6-year period had medical and dental histories, radiographs, pulpal and periapical diagnosis, periodontal probings, direct identification of crack(s) with transillumination, and biting responses on various cusps recorded. All data were stored daily in a database. All cases were treatment planned according to the pulpal and periapical diagnosis. Cases with RP were treatment planned for crowns only, regardless of periapical diagnosis. All patients were recalled at 1 year unless root canal treatment was needed before the anniversary. Results indicated that cracks were identified in 9.7% (796 of 8175) of all teeth evaluated during this time period. Of 127 patients specifically diagnosed with RP, 27 converted to irreversible pulpitis (N = 21) in 58 days or to necrotic pulp (N = 6) in 149 days. To date, none of the original remaining 100 cases of RP have required root canal treatment. The outcomes of this study suggest that if a marginal ridge crack is identified early enough in teeth with a diagnosis of RP and a crown is placed, root canal treatment will be necessary in about 20% of these cases within a 6-month period.

Decision making for the patient who presents with acute dental pain.

Patients who require dental emergency care for pain or trauma may not be able to see a dental practitioner for treatment. The patients often seek care in alternative medical facilities when the symptoms are too severe to be managed by over-the-counter medications. Nurses, physicians, and allied medical staff may be required to triage these patients and provide palliative treatment until the patient is able to seek definitive dental treatment. By using criteria to assess the etiology of the dental pain and implementing possible alternative treatments, these patients can receive palliative care until dental treatment becomes accessible. With the potential for development of resistant forms of microorganisms, the indiscriminate use of antibiotics for dental pain is to be avoided. Occasionally, dental patients presenting to medical settings exhibit symptoms and signs of dental-related problems that are potentially life threatening. Identification of signs of impending life-threatening complications is of paramount importance, since prompt treatment will significantly affect the prognosis.

The effectiveness of bonded composite restorations in the treatment of painful, cracked teeth: six-month clinical evaluation.

This study investigated the clinical efficacy of a bonded resin composite restoration with and without cuspal coverage for the treatment of painful, cracked teeth. Patients in a private dental practice who presented with complaints were selected. Inclusion criteria were sensitivity to cold, biting and a clinically-visible crack after removal of the existing restoration. All 40 teeth were restored with a three-step total etch system (Phosphoric acid/Clearfil SA primer/PhotoBond), 20 with cuspal coverage and 20 without. Patients were interviewed at one week, five weeks and six months regarding the presence of pain. In addition, the teeth were clinically examined after six months to reveal any sensitivity. At one week, patients reported that 12 teeth (30%) were free of pain and 28 teeth (70%) still had symptoms. At five weeks, patients reported that 25 teeth (62.5%) were free of pain and 13 teeth (32.5%) still had symptoms. Two teeth (5%) needed endodontic treatment after two and five weeks. At six months, patients reported that 30 teeth (75%) were functioning without any complaints. Upon clinical examination, only 20 teeth (50%) were free of symptoms. No statistically significant difference between the results of the teeth treated with and without cuspal coverage could be shown (Fischer's exact test at p<0.05).

Diangóstico diferencial del dolor orofacial I. Asociado a estructura intracraneanas, extracraneanas y desórdenes sicogénicos / Differential diagnosis of orofacial pain I. Associated with intracranial, extracranial structures and psychogenic disorders

El dolor orofacial (DOF) es un problema común en el población y representa una condición potencialmente deteriorante y debilitante. Un diagnóstico correcto es la base principal para un manejo adecuado; en pacientes con DOF esta tarea puede ser pequeña y simple, o bien convertirse en una experiencia complicada y frustrante para ambos, clínico y pacinetes. Sin embargo, el conocimiento por parte del clínico de todas las posibles condiciones de dolor que pueden afectar la región orofacial facilitará el proceso diagnóstico. Es importante destacar que es muuy difícil diagnosticar algo que no se conoce y aunque "las cosas comunes ocurren comúnmente" no es extraño encontrar pacientes con patologías "raras", de poca ocurrencia, que el clínico ha olvidado o no conoce. El hecho de que el clínico no considere todos estos aspectos durante la evaluación clínica puede llevarlo fácilmente a confundirse, lo que finalmente terminará en un diagnóstico incorrecto, mal manejo clínico y posiblemente consecuencias devastadoras para los pacientes. Esta es una serie de tres artículos que tienen como propósito presentar una revisión de la literatura de las condiciones que se han considerado para establecer el diagnóstico diferencial del dolor orofacial. Los dolores asociados a las estructuras intracraneales (cefaleas por tumores cerebrales), extracraneales (dientes, ojos, senos paranasales, entre otros) y el dolor sicogénico serán discutidos en este primer artículo

Efficacy of bonded and nonbonded amalgam in the treatment of teeth with incomplete fractures.

BACKGROUND: This clinical study compared the efficacy of adhesive-retained vs. pin-retained complex amalgam restorations in the treatment of molars with incomplete fractures. Both relief of chewing pain and cold sensitivity were evaluated at two weeks, three months and one year. METHODS: The authors treated 38 patients with a chief complaint of chewing sensitivity on vital molar teeth (40 teeth in the study). A random-number generator determined the treatment method for each tooth. Twenty teeth received bonded amalgam restorations. Twenty teeth received amalgapins or threaded pins to retain the amalgam. Teeth were evaluated for postoperative chewing sensitivity. A visual analog pain scale was used to evaluate cold response to a skin-refrigerant-soaked cotton pellet at each visit. After 12 months, all 40 teeth were available for evaluation. RESULTS: Chewing pain was completely eliminated in all but one tooth. A Student's t-test found no significant difference (P > .05) in preoperative cold sensitivity between the bonded and nonbonded groups. A paired t-test comparison indicated that the teeth in the bonded group were significantly less sensitive to cold after three months and 12 months than they were at the time of the baseline measurements (P < .0001). A paired t-test indicated no significant difference between preoperative and postoperative cold sensitivity scores for teeth in the nonbonded group (P > .05). CONCLUSIONS: Both adhesively bonded and mechanically retained complex amalgam restorations were successful in resolving chewing sensitivity in cracked molars. For 39 of 40 teeth, chewing sensitivity did not return during the one-year follow-up period. At three months and 12 months, cold sensitivity was reduced in the bonded restorations. At all three time periods, cold sensitivity remained similar to baseline levels for the mechanically retained restorations. CLINICAL IMPLICATIONS: Incomplete tooth fracture in molars can be successfully treated by covering fractured cusps with amalgam restorations. This study excluded teeth with prolonged sensitivity to a cold stimulus or those with periodontal evidence of root fracture. With these exclusions, elimination of chewing sensitivity was predictable. Teeth restored with bonded restorations experienced a decrease in sensitivity to a cold stimulus at three months and at 12 months, but not at two weeks. The cold sensitivity of teeth restored with nonbonded restorations was similar at baseline, two weeks, three months and one year.

Bacterial contamination of cracks in symptomatic vital teeth.

As part of an ongoing study on the initiation of cracks in teeth, 20 teeth exhibiting symptoms consistent with the presence of dentinal cracks were examined. The presence of a cracked cusp was confirmed by the selective application of pressure either with a mirror handle or Fracfinder (Svenoka, Dental Instruments, Vasby, Sweden). Cracked cusps were fractured from the teeth after the removal of all existing restorations and were immediately placed into ten percent formalin. Subsequently, specimens were dehydrated, sputter-coated and examined under the scanning electron microscope (SEM). All the cracked cusps exhibited complete fracture of the dentine to the level of the dentino-enamel junction. No partial fractures were seen. Numerous bacteria of many morphological forms were present on the dentinal surfaces, of all fractured cusps, in all teeth. Cocci, bacilli and filamentous forms were consistently found. Many bacteria were in the process of division. While bacterial contamination of dentinal cracks has been described in histological studies, the nature and distribution of these bacterial and fungal forms has not been shown previously in any detail. Prior SEM studies investigating the nature and mechanisms of fracture have not revealed bacterial contamination of the fractured surface. This paper draws attention to the fact that all symptomatic cracks in teeth appear to 1. extend right through the dentine to the dentino-enamel junction, and 2. appear to be extensively contaminated by bacteria.

Síndrome do dente trincado / Cracked tooth syndrome

A síndrome do dente trincado ocorre com grande freqüência. Seu tratamento pode ser complexo e seu diagnóstico é difícil. Em exame radiográfico raramente a presença de fratura pode ser observada. Vários outros termos têm sido usados como sinônimos, como fratura incompleta e fratura de esmalte. Geralmente a presença de dor tem sido usado como indicativo da fratura. Muitos fatores contribuem para fratura incompleta de um dente como a mal oclusão, os grandes preparos cavitários e o traumatismo oclusal. Existem diversas formas de tratamento sugeridas na literatura como, por exemplo: o ajuste oclusal localizado, a restauração adesiva em compósitos e em amálgama, o uso de bandas ortodônticas, os onlays, e os adesivos