Clinical outcomes of cracked tooth syndrome after 3 years of treatment: a case series / Desfechos clínicos da síndrome do dente trincado após 3 anos de tratamento: uma série de caso

Background: Diagnosis of cracked tooth syndrome (CTS) requires clinical experience and scientific knowledge. Even providing an effective resolution of the symptoms, clinicians must inform their patients that cracks may progress and induce tooth separation. Thus, follow-up is essential. Case-report: This study describes the treatment of patients with cracked tooth syndrome through a series of three cases. It also includes their long-term follow-ups over three years, through clinical probing and radiography. The findings highlight the importance of periodic check-ups to manage potential complications. Regular follow-ups can help control undesirable responses that may cause pain or make future treatments unfeasible. On all the scenarios presented, an endodontic treatment was needed. On the first successful case the radiolucent lesion regressed with no discomfort or pain. The second case was an unsuccessful one. The patient returned to the dental office after 3 years when probing revealed a 10-mm pocket at the distal aspect of the tooth. The radiography showed distal bone loss. The tooth was extracted to prevent bone loss from progressing. The third report documented the treatment of a patient who declined follow-up care and only returned after 3 years. At that point, a severe mobility was apparent. The radiography revealed a large periapical radiolucency with extensive bone loss, and the tooth extraction became necessary. Conclusion: These cases underscore the importance of informing patients about the potential for crack progression and tooth separation and emphasizes the crucial role of regular follow-up care, as well as discussing the possibilities of restorative treatment (au)

Contexto: O diagnóstico da síndrome do dente trincado (SDT) requer experiência clínica e conhecimento científico. Mesmo com a resolução dos sintomas, os clínicos devem informar seus pacientes que as trincas podem progredir e induzir a fratura dos dentes. Assim, o acompanhamento é essencial. Relato do caso: Este estudo descreve o tratamento de pacientes com síndrome do dente trincado através de uma série de três casos e acompanhamento a longo prazo, durante três anos, por meio de sondagem clínica e radiografia (RX). Os resultados destacam a importância dos controles periódicos para gerir potenciais complicações, o que pode ajudar a controlar respostas indesejáveis dolorosas ou inviabilização de tratamentos futuros. Em todos os cenários, foi necessário tratamento endodôntico. No primeiro caso bem-sucedido, a lesão radiolúcida regrediu sem qualquer desconforto ou dor. O segundo caso foi de insucesso. O paciente voltou ao consultório dentário após 3 anos, quando a sondagem revelou uma bolsa de 10 mm na distal do dente, com perda óssea detectada no RX, sendo indicada a extração. O terceiro relatório documentou o tratamento de um paciente que recusou o acompanhamento e só regressou após 3 anos. Nessa altura, era notável uma intensa mobilidade. O RX revelou uma grande radiolucência periapical com extensa perda óssea, sendo necessária a extração do dente. Conclusão: Estes casos destacam a importância de informar os pacientes sobre o potencial de progressão da fissura e separação do dente e enfatiza o papel crucial do acompanhamento regular, além de discutir as possibilidades de tratamento restaurador (AU)

Optimization of Results for Cracked Teeth Using CAD-CAM System: A Case Series.

Different restorative techniques have been proposed for the treatment of posterior teeth affected by cracked tooth syndrome (CTS). However, the literature is scarce in protocols of how to solve CTS using ceramic restorations made by computer aided design-computer aided manufacturing (CAD-CAM) system. CAD-CAM provides a fast and efficient restorative treatment usually in a single visit, reducing the risk of contamination and micro-infiltration of the cracked line. The objective of this work was to describe 3 clinical cases of cracked teeth, which presented vertical fracture lines in different directions and extension through the pulp, restored by CAD-CAM system, with 5-year follow-up. Patients with short-term spontaneous masticatory pain, cold sensibility and restored teeth without cuspal coverage were selected. Digital radiographs (DR) were taken to confirm the pulp and periapical status. Periodontal probing depth, sensitivity, percussion, and occlusion tests were performed. The fracture lines with their direction and extension were identified under dental optical microscope (DOM). The treatment plan was performed in two stages: immediate treatment to stabilize the tooth and minimize pain, and final restorative treatment by CAD-CAM system to stabilize the crack. Patients were between the ages of 37 and 45 years. Most of the studied teeth presented extensive restorations without cuspal coverage. The presence of occlusal interference, in lateral movement, was a constant finding. Endodontic treatment was performed in cases of irreversible pulpitis or pulpal necrosis. In all three cases, cavity preparation was performed for full coverage restorations, as the fracture lines extended in several directions, requiring a re-enforcement of the cervical region of the teeth in question. The survival rate of the reported cases was 100% with 5-year clinical and radiographic follow-up, suggesting that CAD-CAM system may be a promising alternative treatment in the management of CTS, improving tooth longevity.

Diagnóstico, plan de tratamiento y restauración de un diente con el síndrome del diente fisurado: reporte de caso y seguimiento de siete años / Diagnosis, planning, and restoring treatment of cracked syndrome tooth: case report - 7-year follow-up

Se describe y reporta el diagnóstico, tipo de tratamiento y seguimiento de un caso con el síndrome del diente fisurado. Una paciente de 26 años acusaba sensibilidad a los cambios térmicos y a la oclusión en el lado izquierdo de la mandíbula. Al examen clínico se observó dos grietas o fisuras pigmentadas en las superficies bucales y linguales de la pieza 36. La colocación de una restauración directa con resina compuesta resolvió los síntomas y alivió por completo el dolor. Dicha situación persistió incluso en el control realizado 7 años después. El diagnóstico y tratamiento para el caso descrito dio como resultado un completo alivio y mantenimiento de la situación alcanzada siete años después.

This case report describes a cracked tooth syndrome and reports on its diagnosis, type of treatment and monitoring. A 26-year-old female patient complained of thermal and chewing sensitivity in the left side of her mandible. Clinical examination revealed two pigmented cracks on the buccal and lingual surfaces of tooth 36. The choice of a direct restorative treatment with composite resin led to the resolution of symptoms and complete relief of pain, which persisted in a 7-year monitoring period. The diagnosis and treatment of the case described here resulted in complete pain relief and maintenance of normal conditions seven years later.

Actualización de aspectos relacionados con el Síndrome del Diente Fisurado / Upgrade of aspects related to the cracked tooth syndrome

Introducción: hace más de 30 años se describió una condición caracterizada por la presencia de una fisura dentaria o fractura dentaria incompleta, actualmente una marcada incidencia ha ocasionado que exista cierta confusión entre los clínicos. Esta entidad se conoce como Síndrome del Diente Fisurado. Objetivo: actualizar acerca de un grupo de aspectos relacionados con el Síndrome del Diente Fisurado. Material y Métodos: le realizó una revisión bibliográfica teniendo en cuenta la literatura científica y clásica de los últimos 5 años a la fecha, en idioma español e inglés, utilizando las bases de datos Ebesco, Scielo y Lis, de lo cual se obtuvieron más de 140 artículos de 22 países, que fueron decantados a 26 de acuerdo con la actualidad y ajuste real a los criterios académicos y prácticos de la Escuela Estomatológica Cubana. Desarrollo: la dificultad del diagnóstico del Síndrome del Diente Fisurado, el aumento en su incidencia, los nuevos conocimientos acerca de su etiología y los recientes avances en cuanto a los elementos diagnósticos y tratamientos han hecho que se mantenga como un tema importante dentro de la literatura especializada contemporánea. En este trabajo se exponen las tendencias diagnósticas y terapéuticas más novedosas de modo que cada clínico pueda formar su propio criterio. Conclusiones: el Síndrome del Diente Fisurado es una de las primeras causas de extracción dentaria debido a los problemas para su identificación. Es quizás el problema bucal peor diagnosticado y el más confundido con otras entidades de tipo pulpar, periodontal o dolor buco-facial(AU)

Introduction: since more than thirty years ago was discovered a condition characterized by the presence of a dental fissure or dental incomplete fracture; actually a remarkable incidence has carried out the existence of certain confusion among the clinics. This entity is known as syndrome of fissured teeth. Objective: to update about a group of aspects relating to thecracked tooth syndrome. Material and Methods: was carried out a bibliographical revision taking into account the scientific and classic literature from the last five years up to day, both Spanish and English language, using databases Ebesco, Scielo and Lis obtaining more than 140 articles from 22 countries, which were rejected 26because were not update and were not adjusted to real academicand practical approaches criterion of the Cuban Stomatology School. Development: the difficulty of the diagnostic of the Cracked tooth syndrome, the increasing incidence, the new knowledge regarding its etiology and the recent advances concerning to the diagnostic elements and treatment had made its maintenance as an important topic inside the contemporaneous specialized literature. In this work are exposed the diagnostic and therapeutic tendencies more actualized in the way that each clinician may have its own criteria. Conclusion: the cracked tooth syndrome is one of the more common causes of dental extraction due to the problems for its identification. It´s, maybe, the mouth problem worst diagnosed and for that the most confused with other pulped type entities, periodontal or Mouth-facial Paine(AU)