What is it?

“This study aimed to identify clinical and radiographic characteristics of teeth with longitudinal fractures to assist in the diagnosis and differentiation between cracked teeth and teeth with vertical root fracture (VRF).” “The aim of this study was to correlate and compare the location and position of longitudinal fractures associated with cracked teeth and teeth with VRF to the preoperative clinical and radiographic findings using cone-beam computed tomography (CBCT) imaging.”

What problem does it aim to solve?

Not all tooth cracks are the same and they can’t all be treated in the same way. However, traditional radiography doesn’t always get the full picture. “Cracked teeth are challenging to diagnose because of the difficulty in identifying the location, direction, and extension of the crack line before and during the clinical treatment.”

How does it work?

“This evaluation was performed on a subset of the patients diagnosed with cracked teeth or VRF for whom full clinical and radiographic data were present…The radiographic assessment of teeth included PA radiographs and CBCT images. Two independent examiners (a board-certified endodontist and a senior endodontic resident) analyzed the PA radiographs and CBCT Digital Imaging and Communications in Medicine (DICOM) files.”

“PA radiographs showed evidence of bone loss suggestive of a longitudinal fracture in only 9 of 54 cases (16.6%), whereas CBCT imaging showed the same findings in 40 of 54 cases (72%). Of 41 cracked teeth, angular defects were only observed in 4 teeth (9%) using PA radiographs compared with 19 teeth (46%) using CBCT scans. Same findings were also noted among teeth with VRF. Of 13 teeth with VRF, J-shaped and combined defects were observed in 4 teeth using PA radiographs (30%) compared with 12 teeth using CBCT imaging (92%). CBCT imaging had 4.4 times the odds of detecting evidence of bony changes associated with cracks and VRF compared with PA radiographs (odds ratio = 14.3; 95% confidence interval, 36.5–5.58). CBCT scans also showed 100% positive prediction of the root with longitudinal fracture in cases with a J-shaped defect or a combined/irregular bone loss pattern (21/21 teeth) and 84% in cases with angular defects (16/19 teeth).”

What are the real-world implications?

“Within the limitations of this study, we can conclude that CBCT imaging can assist in the preclinical diagnosis of cracked teeth and VRFs through careful observation of the patterns of bone loss. The presence of an angular defect on the preoperative CBCT scan can be a pretreatment predictor for the presence of a crack limited to the crown. However, clinicians should attempt to confirm these findings through visualization of these crack lines under high magnification.”

What are the next steps?

“Further clinical studies using CBCT imaging and correlating clinical with radiographic findings should be conducted to further confirm these results.”

Source

“CBCT Patterns of Bone Loss and Clinical Predictors for the Diagnosis of Cracked Teeth and Teeth with Vertical Root Fracture”, Journal of Endodontics, Volume 48, Issue 9, September 2022, Pages 1100-1106 https://is.gd/ozujed

Authors

Ibrahim Alaugaily BDS, Division of Endodontics, University at Buffalo, School of Dental Medicine, Buffalo, New York, Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia

Adham A. Azim BDS, Division of Endodontics, University at Buffalo, School of Dental Medicine, Buffalo, New York, Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia, Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California