Dentin thickness as a risk factor for vertical root fracture in endodontically treated teeth: a case-control study

Silva, Lorena Rosa; Lima, Kaique Leite de; Santos, Ananda Amaral; Leles, Cláudio Rodrigues; Estrela, Carlos; Silva, Brunno Santos de Freitas; Yamamoto‐Silva, Fernanda Paula

doi:10.1007/s00784-020-03406-1

Cited by 30 publications

(22 citation statements)

References 33 publications

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“…This can occur due to excessive instrumentation, excessive dentin removal and remaining dentin thickness, excessive irrigation and/or force during lateral condensation. Other causes could include retreatment, overfilled roots, microstructural changes in dentin over a long period, reduced proprioception and fracture resistance of the filled tooth [ 13 ]. Since the symptoms associated with a vertical fracture occurred before endodontic treatment, a fracture in the context of treatment was excluded.…”

Section: Discussionmentioning

confidence: 99%

Apical periodontitis after intense bruxism

et al. 2022

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Background Bruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism. Case presentation This article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed. Conclusions Incomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.

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Section: Discussionmentioning

confidence: 99%

Apical periodontitis after intense bruxism

et al. 2022

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“…Additionally, excessive removal of cervical dentin (danger zone) increases the risk of substantial damage which detrimentally affects tooth fracture resistance [30]. Furthermore, dentin thickness of less than 1.3 mm is associated with a greater likelihood of vertical root fracture of endodontically treated teeth [31]. In recent literature, cone beam computed tomography and 3D-printed guiding templates have enabled the location of calcified canals, facilitating endodontic treatment of those teeth and preserving hard tissue during access cavity preparation [32].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it can be assumed that formation of microcracks is not directly related to post removal procedure. Even if dentin removal, especially in the cervical region, increases the fracture susceptibility of endodontically treated teeth [31], formation of microcracks obviously does not depend on substance loss alone. As tooth fracture is a multifactorial occurrence, there are additional reasons apart from dentin removal, leading to microcrack formation and finally resulting in a decreased fracture resistance.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of different fiber post removal techniques and their influence on dentinal microcrack formation

et al. 2021

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Objectives The aim of this study was to evaluate the effectiveness of different fiber post removal techniques and to correlate dentinal loss with microcrack formation. Materials and methods Forty-five extracted single-rooted teeth were root canal treated and fiber posts were adhesively luted. Specimens were divided into three groups (n = 15) according to the removal technique: long-shaft round bur (EndoTracer #08, Komet, Lemgo, Germany), SonicFlex Endo (KaVo, Biberach, Germany), DT Post Removal Kit (VDW, Munich, Germany). Roots were scanned before post cementation and after post removal using micro-computed tomography. Dentin loss, residual luting material, working time, and the induction of microcracks were assessed. Statistical analysis was performed by using multiple contrast tests (max-t tests, α = 0.05). Correlations between parameters dentin loss/new microcracks and dentin loss/residual material were calculated using Kendall’s tau. Results Post removal with SonicFlex Endo resulted in the highest amount of removed dentin with significant differences to the round bur and the DT Post Removal Kit. No technique was found to completely remove the post and luting material. All techniques induced microcracks with the DT Post Removal Kit presenting the highest number of new defects. No correlation between dentin loss and new microcracks was observed. Deviations from the original root canal occurred in all groups, but no perforation was observed. Conclusions All techniques resulted in dentin loss, residual luting material, and the formation of microcracks. However, no correlation between dentin loss and the induction of microcracks was observed. Clinical relevance As all techniques resulted in microcrack formation and dentin loss, this study emphasizes the risk of iatrogenic damage due to post removal procedures.

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“…Regarding to, the wear generated during the orthograde re-treatment was considered a primary risk factor ( 4 ), as it affected the dental structure between 1 and 5 years. In orthograde re-treatment, the removal of all filling material from the root canals is essential to ensure disinfection; however, this process involves additional mechanical manipulation of the root walls, generating more considerable wear on the tooth structure ( 8 ). Shemesh et al .…”

Section: Discussionmentioning

confidence: 99%

“…The loss of the protective effect of the pulp tissue during chewing adds to the microstructural changes in the dentin that promote instrumentation; the chemical conditioning ( 8 ) and excessive forces during filling ( 9 ) are plausible factors that contribute to the failure of the dental structure, especially over time. Therefore, if 66% of VRFs were diagnosed between 2 to 5 years from the completion of root canal treatment ( 9 ), the structural changes that the treated root dentin undergoes are considered time-dependent, and the multifactorial nature of the vertical fracture does not allow the identification of a single risk factor ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Vertical root fractures: A time-dependent clinical condition. A case-control study in two colombian populations

et al. 2021

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Background This nested case-control study can be viewed as an efficient way to sample subjects from a large cohort study case-control study aimed to analyze the effect of different clinical factors on the appearance of vertical root fractures in endodontically-treated teeth (ETT) over time. Material and Methods By matching 90 cases and 270 controls nested in a cohort of 450 patients. Incident “cases” included those ETT in which a confirmed VRF. The “controls” were ETT with clinical and radiographic evidence of normality. When an “incident case” was detected, three random “controls” according to the evaluation time registered in years were selected. Time interval corresponded to the exposure time from the end of the endodontic treatment until the tooth was included in the study. Demographic and clinical parameters included: age, gender, type, and location of the tooth, type of endodontic treatment, number of appointments necessary to complete the endodontic treatment, use of intra-canal medication, the apical extension of the filling, type of coronal restoration, the role of the tooth in the rehabilitation treatment, presence of intra-radicular posts, and presence of an adjacent implant, were analyzed over time. Statistical analysis: univariate descriptive analysis, Pearson’s χ2 test, and a logistic regression model adjusted for the most significant variables with a 95% confidence interval. Results The prevalence of vertical root fractures was 16.42%. The multivariate analysis confirmed that re-treatment (OR:12.19; OR:4.28; P <0.05) lasting five to ten years and intra-canal medication (OR:6.16; P =0.004) for more than eleven years significantly more associated with the risk of vertical root fracture. For teeth with intra-canal post or direct coronal restorations, the risk of vertical root fracture was three times lower. Conclusions Endodontic re-treatment and the use of intracanal medication such as calcium hydroxide should be considered primary and secondary risk factors, respectively, according to the appearance of VRF over time. Key words: Apical surgery, endodontic re-treatment, endodontically-treated teeth, risk factors, vertical root fracture.

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Dentin thickness as a risk factor for vertical root fracture in endodontically treated teeth: a case-control study

Cited by 30 publications

References 33 publications

Apical periodontitis after intense bruxism

Apical periodontitis after intense bruxism

Effectiveness of different fiber post removal techniques and their influence on dentinal microcrack formation

Vertical root fractures: A time-dependent clinical condition. A case-control study in two colombian populations

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