Siwen Wu1, Hui Pau Lew2, Nah Nah Chen2. 1. Department of Restorative Dentistry, National Dental Centre, Singapore. Electronic address: wu.si.wen@ndcs.com.sg. 2. Department of Restorative Dentistry, National Dental Centre, Singapore.
Abstract
INTRODUCTION: This retrospective cohort study aimed to observe the incidence of pulpitis and necrosis in teeth with cracks that were not endodontically treated. METHODS: One hundred eighty-four patients with 199 cracked teeth that were diagnosed with reversible pulpitis and were treated from January 2010 to December 2013 at National Dental Centre, Singapore, were recruited. Cracked teeth were identified by inspection, transillumination, and positive bite tests. A diagnosis of reversible pulpitis was made if the tooth had no history of spontaneous pain, was positive but non-lingering to cold, and there was an absence of any periapical pathosis. Upon diagnosis, orthodontic bands were cemented, and these teeth were referred for crowns. Patients were recalled back at least 3 years after diagnosis, except for those patients whose cracked teeth had undergone endodontic treatment or were extracted. RESULTS: Fifty-eight out of 199 (29.1%) teeth had pulpal complications. Thirty-eight of 58 (65.5%) were diagnosed as irreversible pulpitis after approximately 1.2 years (437 days), and 20 of 58 (34.5%) were diagnosed with necrotic pulp after approximately 2 years (755.5 days). The absence of a full-coverage crown increased the risks of pulp complications (odds ratio = 8.74, P = .000), and males had an increased incidence of pulp complications compared with females (odds ratio = 1.96, P = .056). CONCLUSIONS: Seventy-one percent (141/199) of cracked teeth with reversible pulpitis remained healthy after 3 years. It is essential to brace the cracked tooth to minimize cusp flexion and provide full coverage of the crack from the oral environment. When treated early, these teeth may still reasonably survive for at least 3 years.
INTRODUCTION: This retrospective cohort study aimed to observe the incidence of pulpitis and necrosis in teeth with cracks that were not endodontically treated. METHODS: One hundred eighty-four patients with 199 cracked teeth that were diagnosed with reversible pulpitis and were treated from January 2010 to December 2013 at National Dental Centre, Singapore, were recruited. Cracked teeth were identified by inspection, transillumination, and positive bite tests. A diagnosis of reversible pulpitis was made if the tooth had no history of spontaneous pain, was positive but non-lingering to cold, and there was an absence of any periapical pathosis. Upon diagnosis, orthodontic bands were cemented, and these teeth were referred for crowns. Patients were recalled back at least 3 years after diagnosis, except for those patients whose cracked teeth had undergone endodontic treatment or were extracted. RESULTS: Fifty-eight out of 199 (29.1%) teeth had pulpal complications. Thirty-eight of 58 (65.5%) were diagnosed as irreversible pulpitis after approximately 1.2 years (437 days), and 20 of 58 (34.5%) were diagnosed with necrotic pulp after approximately 2 years (755.5 days). The absence of a full-coverage crown increased the risks of pulp complications (odds ratio = 8.74, P = .000), and males had an increased incidence of pulp complications compared with females (odds ratio = 1.96, P = .056). CONCLUSIONS: Seventy-one percent (141/199) of cracked teeth with reversible pulpitis remained healthy after 3 years. It is essential to brace the cracked tooth to minimize cusp flexion and provide full coverage of the crack from the oral environment. When treated early, these teeth may still reasonably survive for at least 3 years.