RESUMO
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.
RESUMO
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)