Abstract
Objectives
To describe treatment and monitoring outcomes of posterior teeth with cracks at baseline followed in the National Dental Practice-Based Research Network for up to three years.
Materials and methods
Two hundred and nine dentists enrolled a convenience sample of 2,858 patients, each with a posterior tooth with at least one visible crack and followed them for three years. Characteristics at the patient, tooth, and crack level were recorded at baseline and at annual recall visits. Data on all teeth referred for extraction were reviewed. Data on all other teeth, treated or monitored, seen at one or more recall visits were reviewed for evidence of failure (subsequent extraction, endodontics, or recommendation for a re-treatment).
Results
The survival rate for teeth with cracks at baseline exceeded 98% (only 37 extractions), and the failure rate for teeth that were treated restoratively was only 14%. Also, only about 14% of teeth recommended at baseline for monitoring were later recommended to be treated, and about 6.5% of teeth recommended for monitoring at baseline were later treated without a specific recommendation. Thus, about 80% of teeth recommended at baseline for monitoring continued with a monitoring recommendation throughout the entire three years of the study. Treatment failures were associated with intracoronal restorations (vs. full or partial coverage) and male patients.
Conclusions
In this large 3-year practice-based study conducted across the USA, the survival rate of posterior teeth with a visible crack exceeded 85%.
Clinical relevance
Dentists can effectively evaluate patient-, tooth-, and crack-level characteristics to determine which teeth with cracks warrant treatment and which only warrant monitoring.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bader JD, Shugars DA, Roberson TM (1996) Using crowns to prevent tooth fracture. Community Dent Oral Epidemiol. 24:47–51
Krell KV, Rivera EM (2007) A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. J Endod. 33:1405–7
Tan L, Chen NN, Poon CY, Wong HB (2006) Survival of root filled cracked teeth in a tertiary institution. Int Endod J. 39:886–9
Kang SH, Kim BS, Kim Y (2016) Cracked teeth: distribution, characteristics, and survival after root canal treatment. J Endod. 42:557–62
Krell KV, Caplan DJ (2018) 12-month success of cracked teeth treated with orthograde root canal treatment. J Endod. 44:543–8
Sim IG, Lim TS, Krishnaswamy G, Chen NN (2016) Decision making for retention of endodontically treated posterior cracked teeth: a 5-year follow-up study. J Endod. 42:225–9
Davis MC, Shariff SS (2019) Success and survival of endodontically treated cracked teeth with radicular extensions: a 2- to 4-year prospective cohort. Journal of Endodontics. 45:848–55
Olivieri JG, Elmsmari F, Miró Q, Ruiz XF, Krell KV, García-Font M et al (2020) Outcome and survival of endodontically treated cracked posterior permanent teeth: a systematic review and meta-analysis. J Endod. 46:455–63
Opdam NJ, Roeters JJ, Loomans BA, Bronkhorst EM (2008) Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration. J Endod. 34:808–11
Signore A, Benedicenti S, Covani U, Ravera G (2007) A 4- to 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays. Int J Prosthodont. 20:609–16
Abbott P, Leow N (2009) Predictable management of cracked teeth with reversible pulpitis. Aust Dent J. 54:306–15
Kanamaru J, Tsujimoto M, Yamada S, Hayashi Y (2017) The clinical findings and managements in 44 cases of cracked vital molars. Journal of Dental Sciences. 12:291–5
Hilton TJ, Funkhouser E, Ferracane JL, Schultz-Robins M, Gordan VV, Bramblett BJ et al (2020) Recommended treatment of cracked teeth: results from the National Dental Practice-Based Research Network. J Prosthet Dent. 123:71–8
Gilbert GH, Williams OD, Korelitz JJ, Fellows JL, Gordan VV, Makhija SK et al (2013) Purpose, structure, and function of the United States National Dental Practice-Based Research Network. J Dent. 41:1051–9
Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Baltuck C, Benjamin P et al (2017) Correlation between symptoms and external characteristics of cracked teeth: findings from The National Dental Practice-Based Research Network. J Am Dent Assoc. 148:246–56.e1
Dheyriat A, Frutoso J (1996) Lissac M [The determination of the intensity of premolar and molar maximal forces during the isometric contraction of the masticatory muscles due to forced mandibular closure]. Bull Group Int Rech Sci Stomatol Odontol 39:87–94
Leong DJX, de Souza NN, Sultana R, Yap AU (2020) Outcomes of endodontically treated cracked teeth: a systematic review and meta-analysis. Clin Oral Investig. 24:465–73
Acknowledgements
An Internet site devoted to details about the nation’s network is located at http://NationalDentalPBRN.org.
We are very grateful to the network’s Regional Node Coordinators along with other network staff (Midwest Region: Tracy Shea, RDH, BSDH; Western Region: Stephanie Hodge, MA; Northeast Region: Patricia Ragusa, BA; South Atlantic Region: Hanna Knopf, BA, and Deborah McEdward, RDH, BS, CCRP; South Central Region: Shermetria Massengale, MPH, CHES, and Ellen Sowell, BA; Southwest Region: Stephanie Reyes, BA, Meredith Buchberg, MPH, and Colleen Dolan, MPH; network program manager (Andrea Mathews, BS, RDH) and program coordinator (Terri Jones)), along with network practitioners and their dedicated staff who conducted the study. The National Dental PBRN Collaborative Group comprises practitioners, faculty, and staff investigators who contributed to this network activity. A list of these persons is at http://www.nationaldentalpbrn.org/collaborative-group.php.
Funding
This work was supported by NIH/NIDCR grants U19-DE-28717 and U19-DE-22516. Opinions and assertions contained herein are those of the authors and are not to be construed as necessarily representing the views of the respective organizations or the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics approval
This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
The informed consent of all human subjects who participated in this investigation was obtained after the nature of the procedures had been explained fully.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supporting Information
ESM 1
Chronology of the 37 teeth extracted and withdrawn from the study, specifically differentiating those recommended at baseline (Y0) to be treated (Tx) or monitored (symp. = symptomatic, Fx = fracture, WD = withdrawn) (PNG 552 kb)
ESM 2
Restoration completion rate (%) by restoration type, among 899 teeth that were recommended for restorative treatment at Y0. Yes = restoration completed; No = not completed (PNG 183 kb)
ESM 3
Percent of the restoration types (%) for which multiple treatments (Tx) vs. a single definitive treatment was recommended at Y0 (PNG 178 kb)
Rights and permissions
About this article
Cite this article
Ferracane, J.L., Hilton, T.J., Funkhouser, E. et al. Outcomes of treatment and monitoring of posterior teeth with cracks: three-year results from the National Dental Practice-Based Research Network. Clin Oral Invest 26, 2453–2463 (2022). https://doi.org/10.1007/s00784-021-04211-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-021-04211-0