Managing Cracked Teeth with Root Extension: A Prospective Preliminary Study Using Biodentine™ Material.

Purpose: The authors of this study proposed an innovative approach involving the use of Biodentine™ material as an intraorifice barrier in cracked teeth with root extension to promote internal crack sealing, preventing the possibility of microinfiltration and apical crack propagation. Materials and Methods: The dental records of 11 patients with 12 posterior cracked teeth with root extension were included with a precise protocol performed by a senior endodontist. The treatment protocol included pulp diagnosis, crack identification using a dental operating microscope (DOM), endodontic treatment, placing a Biodentine™ as an intraorifice barrier, and immediate full-coverage restoration. The effectiveness of the treatment was assessed at two intervals, 6 months, and 1-3 years posttreatment, evaluating clinical, radiographic, and tomographic aspects. The treatment was deemed successful if there were no indications of radiolucency, sinus tracts, edema, or periodontal pockets associated with the crack line. Results: The study observed remarkably positive outcomes during the follow-up period, which spanned from 1 to 3 years. All the cracked teeth (100%) remained asymptomatic, meaning they were free of pain or discomfort. Furthermore, these teeth were in occlusal function. Both radiographic and tomographic assessments revealed the absence of bone loss along the crack line. This outcome signifies that the treatment effectively prevented further deterioration of the surrounding bone. Conclusions: Integrating advanced biomaterials and conservative restorative techniques has paved the way for innovative approaches in dental care. This protocol suggests a proactive step for managing cracked teeth with root extension. It addresses both biological aspects by sealing internal cracks and mechanical aspects by preventing crack progression, thereby improving these teeth' prognosis and long-term survival.

The Correlation of Crack Lines and Definitive Restorations with the Survival and Success Rates of Cracked Teeth: A Long-term Retrospective Clinical Study.

INTRODUCTION: Cracked teeth frequently require protective adhesive restorations. This long-term, longitudinal retrospective clinical study aimed to evaluate the factors influencing the success and survival rates of cracked teeth with crack lines (CLs) in different directions when restored early with onlays or full-coverage crowns. METHODS: The dental records of 71 patients with a total of 86 cracked teeth with different pulpal and periapical diagnoses and with follow-ups spanning over 1-11 years were included. Data regarding the demographics; clinical symptoms and signs; bruxism; occlusal interferences; eating habits; pulpal and periapical diagnoses; number, direction, location, and extent of CLs; probing depth; and coronary condition before and after the placement of definitive restorations were collected. Univariate associations between tooth survival and explanatory variables were assessed. The long-term survival rate was estimated using Kaplan-Meier analysis and the log-rank test. A multivariate analysis was performed using Cox regression analysis. RESULTS: The overall success rate was 93.0%, and the overall survival estimates of cracked teeth restored early were 98.6%, 94.9%, and 55.9% at the 1-, 5-, and 11-year follow-ups, respectively. The direction of the CLs did not influence the survival of the tooth. No significant association was observed between the type of tooth, probing depth, root canal treatment, and tooth loss (P > .05). The multivariate analysis showed that previously treated cracked teeth (P < .05), the provision of onlay restorations (P < .05), and the placement of posts (P < .05) had higher correlations with tooth loss. Additionally, the placement of full-coverage crowns resulted in lower tooth loss compared with the placement of onlays (P < .05). CONCLUSIONS: Previous endodontic treatment in teeth that subsequently develop CLs has a negative impact on the survival rate of the teeth. Moreover, early placement of full-coverage crowns should be implemented for cracked teeth regardless of the direction or the number of CLs because it is associated with a higher cracked tooth survival rate.

Clinical Approach to Pulp Canal Obliteration: A Case Series.

This article describes four cases with safe and feasible clinical treatment strategies for anterior teeth with pulp canal obliteration (PCO) using cone-beam computed tomography (CBCT), digital radiography (DR), dental operating microscopy (DOM) and ultrasonic tips (US). Four anterior teeth with PCO were chosen. DR was taken with different angulations and analyzed with different filters. Subsequently, the access cavity was performed with the aid of DOM. If the canal was not identified, CBCT was requested. Sagittal and axial slices guided the direction of the ultrasonic tips. After identification of the canal, it was then negotiated and instrumented with the rotary instruments. All four canals were successfully identified, with no complications. In case 1, the canal was identified using DR, DOM and US tips. In cases 2, 3 and 4, the canals were identified with DR, DOM, US tips and CBCT. Complete root canal obliteration identified in radiography did not necessarily mean that pulp tissue was not visible clinically, either. The clinical evaluation of the access cavity with the aid of MO was crucial. If the canal was not identified, CBCT was mandatory in order to show more detailed view of the precise position of the canals, their directions, degrees of obstruction and dimensions. It served as a guide for the direction of the ultrasonic tips to keep them within the pulp chamber safely, with a low risk of iatrogenic injury.