Repair of teeth with cracks in crowns and roots: An observational clinical study

Abstract

Aim This retrospective observational study investigated the survival rate of teeth with radicular cracks that were restored using composite materials. Methodology The study was approved by the Ethical Committee of Sistema Sanitario Nazionale (prot. N°2370CELazio1), Clinicaltrials.gov identifier: NCT04430205. Between 1991 and 2019, 87 teeth with radicular cracks (87 patients [46 men, 41 women, mean age 50.2 years]) were treated with adhesive composite restorations. Forty‐five cracks were observed in the maxillary posterior teeth (molars and premolars), 40 in the mandibular posterior teeth and only two cracks in the anterior teeth, both in maxilla. Based on the depth of the crack, teeth were categorized as proximal radicular cracked teeth (PRCT), in which the fracture line was restricted within the pulpal floor or the coronal one‐third of the root and deep radicular cracked teeth (DRCT), in which the fracture line extended to the middle and apical thirds of the root canal up to the apex. Bone loss/recovery was evaluated radiographically at 1‐year follow‐up. All patients were treated using surgical microscopy by the same operator. Logistic regression analysis was performed to determine independent predictors of extraction. Kaplan–Meier survival curves were used to analyse PRCT and DRCT. Results Among 87 cracked teeth, 66 were molars, 19 premolars and 2 incisors. Fifty‐two were DRCT, 35 were PRCT, 46 had a periodontal probing defect. Patients were followed up for a mean of 66.9 months (standard deviation 44.6, min 1 to max 172). Lack of probing depth was a significant protective factor against extraction (odds ratio [OR] 0.027, 95% confidence interval [CI] 0.003–0.27, p < .05), whereas further bone loss (OR 10.63, 95% CI 2.08–54.36, p < .05) was a risk factor for extraction. More than 50% of teeth treated with the adhesive protocol were functional (46 of 87 teeth [χ2 test], p < .05) at 5‐year follow‐up. Among the PRCT group, a 78% survival rate at 5 years was found, while among the DRCT group, a 58% survival rate was found. Conclusion Composite resin restorations resulted in tooth survival in >50% of patients; 85.4% of PRCT and 61.5% of DRCT were functional after 5 years of follow‐up.

Treatment of cracked teeth: A comprehensive narrative review

“…On the other hand, certain investigators proceeded directly to coronal restoration of previously endodontically treated cracked teeth without providing retreatment (Mahgoli et al, 2019;Michaelson, 2015Michaelson, , 2017 while others did not explain whether secondary endodontic treatment was part of their management (Abou-Rass, 1983;Liao et al, 2022;Malentacca et al, 2021).…”

“…Irrigation protocol was mainly based on the use of 1%-5.25% sodium hypochlorite solution (Fawzy et al, 2020;Kim et al, 2013;Sim et al, 2016;Tan et al, 2006) with supplementary sonic or ultrasonic activation (Davis & Shariff, 2019;Malentacca et al, 2021).…”

“…Besides, Lu et al (2021) combined sodium hypochlorite with 3% hydrogen peroxide, while others used 17% ethylene diamine tetra acetic acid (EDTA) solution for the removal of the smear layer, either as a final (Fawzy et al, 2020) or a penultimate irrigant followed by 2% chlorhexidine (Davis & Shariff, 2019) or 96% ethyl alcohol (Malentacca et al, 2021).…”

“…Regardless of the definitive treatment being a crown (Davis & Shariff, 2019;Gutmann & Rakusin, 1994;Liu & Sidhu, 1995) superior seal of the crack line compared to that provided by guttapercha (Pisano et al, 1998) and increase the radicular fracture resistance (Nagas et al, 2010). Various materials have been employed for this technique; earlier reports reported using amalgam (Liu & Sidhu, 1995) or a mixture of amalgam and glass-ionomer cement (Gutmann & Rakusin, 1994) while more recent studies reported microscope-assisted placement of resin composite (Davis & Shariff, 2019;Malentacca et al, 2021). Another method that has been shown to enhance the fracture of endodontically treated cracked teeth restored with crowns is the annular placement of polyethylene fibers as a core reinforcement, although current evidence solely relies on laboratory data (Shi et al, 2021) (Table 4).…”

“…Although both research teams employed intra-orifice resin barriers in the post-endodontic restoration, Davis and Shariff (2019) proceeded to an expeditious crown provision while Malentacca et al (2021) performed direct cuspal coverage composite restorations. In addition, Davis and Shariff (2019) employed a stricter post-endodontic protocol with specific postoperative instructions and regular reviews.…”