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Mohammed Abdullah Alkahtani et al, 2020;4(2):490–493.

International Journal of Medicine in Developing Countries

Success and survival of endodontically cracked teeth: review

Mohammed Abdullah Alkahtani1*, Abdulrahman Rasmi M. Khairi1, Tail Alhumaidi Almotairi2, Adel Yahya Ali Shahir3, Awad Yahya Ali Shaher4, Mohammed Fayez Asiri5

Correspondence to: Mohammed Abdullah Alkahtani

*General participator, Ministry of Health, Jeddah, Saudi Arabia.

Email: dr.mao87 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 07 December 2019 | Accepted: 22 December 2019


ABSTRACT

Root canal treatment is a precise dental operation that should be properly performed for endodontic success and survival. It is known that the endodontically treated teeth have lower fracture strength than vital teeth. If cracking exists in the endodontically treated tooth, the fracture strength of the tooth is more decreased, so proper management and treatment are required for success and survival of this tooth. This study aimed to declare the affecting factors and the degree of success and survival of endodontically cracked teeth. In this review, a MEDLINE search was completed for the time period from 1990 to 2019 along with a manual search, to locate relevant peer-reviewed articles and textbooks published in English. Several keywords were used to obtain all possible articles concerned with the subject. We found 25 articles on our search, out of them, only 21 articles were specifically related to our subject. This review concluded that few studies have focused on studying the degree of success and survival of endodontically cracked teeth and most of them were trials. Also, there were no previous review articles studied on this subject.


Keywords:

Cracked teeth, success, survival, endodontic, radicular extension.


Introduction

Cracked tooth is defined as longitudinal incomplete fracture, which starts from the coronal tooth structure and extends apically; also, it has mesiodistal extensions involving the proximal surfaces and the marginal ridges [1]. Cracking can affect all types of teeth, but mainly affect the posterior teeth (maxillary molars, maxillary premolars, and mandibular molars) [2]. Cracks usually extend coronoapically in the vertical direction and may extend to the root surface but they differ from vertical root fractures [3]. Teeth with vertical root fracture are considered hopeless teeth in which the fracture usually occurs in buccolingual direction within endodontically treated teeth [4]. Proper diagnosis and treatment planning is required for managing cracked teeth. If the tooth is symptomatic with reversible pulpitis, full cuspal coverage is indicated in most cases without the need for endodontic treatment [5]. Other cases which show irreversible pulpitis or necrotic pulpal tissues in cracked teeth, endodontic treatment would be the required treatment for them followed by full cuspal coverage [6]. Preservation of teeth with cracks extending onto the root surface is considered a challenging case due to lack of guidelines concerning with management and restoration of these teeth [7] so that many dentists prefer to extract these teeth due to low prognosis [8]. Previous studies have concluded that preservation of cracked teeth with sub-gingival cracking extensions can occur with a success rate ranging from 66.7% to 88.3% at 21 years [9]. In this review, the literature investigates the success rate and survival percentage of endodontically cracked teeth with varying degrees and extensions of cracking.


Diagnosis of Cracked Teeth

Visual examination is considered as the main technique for crack examination and is ideally done with an electronic microscope [10]. In cracked teeth, the crack line is observed which is considered a line segment from the perimeter of the fracture plane. Crack line observation doesn`t indicate the fracture plane shape and size [11]. A crack line can be observed contiguous with margins of existing direct restoration, and in these cases, there may be a need to remove the existing restoration for proper observation of the full crack line extension under the restoration [12]. Mandibular molars are considered more prone to be cracked; this may be due to protruded palatal cusps of maxillary molars, which occlude powerfully with the opposing central grooves of mandibular molars [13]. Also, maxillary premolars are more prone to crack than mandibular premolars, this may be due to steep inclines existing on nonfunctional cusps of upper premolars that result in high torque forces during mastication [14]. Class II restored posterior tooth is the main source of discomfort and more liable to crack or even fracture, especially when it is the only remaining tooth in this quadrant [15,16]. Radiographic examination for teeth cracks may be un-useful as the X-ray photons pass through the extensive amounts of radio-opaque healthy tooth structure also pass through the radiolucent fracture plane [17]. On the other hand, many periapical lesions may appear on radiographic examination and the cause of the lesion is tooth cracks, like periapical radiolucency which may be contiguous with the furcation area or the radiolucency surround the entire root [18,19]. Teeth cracks usually don`t cause pain and the cracked teeth are usually asymptomatic, unless if the cracked teeth are affected with many other causes leading to pain like caries, irreversible pulpitis and periodontal diseases [20]. Also, a cracked tooth may show painful symptoms during percussion if irreversible pulpitis or periapical abscess exist in the cracked tooth [21]. Cracked teeth may not show any response to thermal sensitivity tests if the pulp has undergone necrosis [22]. Fracture plane is a consistent sign which exists within a cracked tooth; this fracture plane can be accelerated due to different causes like dental caries, which weaken the tooth structure near the fracture plane leading to propagation of the fracture plane [23].


Correlations with Success and Survival of Endodontically Cracked Teeth with or Without Radicular Extensions

Success and survival of cracked teeth, which undergone root canal treatment, depend primarily on proper endodontic treatment and proper protection of the tooth [24]. New techniques have been used for dealing with cracked teeth during endodontic treatment, like usage of intraorifice barriers beyond the fracture extent [25]. These barriers allow superior coronal seal to gutta-percha and also improve the fracture resistance, so it is considered a very important step in the modern root canal treatment with an effective role in maintaining the endodontic teeth [26]. Also, the barriers have a role in decreasing the bacterial biofilms in the cracks, especially the radicular cracks, as the prosthetic crown margins will not cover the full extent of the crack [27]. There are many precautions, the dentist should take care of, to preserve the tooth and decrease the crack propagation like [28] as follows:

  • The occlusal surface of the teeth should be reduced after endodontic treatment and before coronal restoration, to decrease the force stresses on the tooth which may increase the crack propagation.
  • Patients should avoid chewing from the side of the endodontic cracked teeth as it is a weak tooth.
  • Full coverage restoration is preferred after root canal treatment for tooth preservation.

Many researchers have concluded that the full crown restoration for endodontically cracked teeth decreases the liability for crown fracture four times in comparison with endodontic teeth which is not fully covered with a crown restoration [29]. Also, uncovered endodontically cracked teeth not only increase the crack propagation but also lead to periodontal destruction which can be ensured with probing examination that shows increased probing depth, especially if radicular extension exists [30,31]. A high percentage of patients need post-operative occlusal adjustment for their final restoration, this is because of many factors like masticatory forces and malocclusion and parafunctional stresses, which induce propagation of the crack apically [32]. So, the patients are asked to follow-up for 6 weeks for verifying the occlusion and the final restoration [33]. Many studies have shown different results in determining the success and survival rate of endodontically cracked teeth, the causes for this variation may be due to the followed technique in treatment and management, also the degree of crack distribution. Most of the researchers concluded that teeth with coronal cracks have a higher prognosis than those with sub-gingival or radicular extended cracks [34]. Some studies have listed the main factors that affect the success and survival rate of the endodontically cracked teeth [35]:

  • Multiple crack directions.
  • Radicular or subgingival extension of the crack.
  • The dental arch with an affected tooth (increased in the mandible).
  • Type of affected tooth.
  • Deep probing depth (more than 6 mm) is significantly associated with reduced survival of the endodontically cracked teeth [36].
  • The affected tooth is the terminal tooth in the arch.
  • Pre-operative pain.
  • Presence of class II cavities.
  • Pulp necrosis at initial examination.

Conclusion

This study has concluded that the success and survival of endodontically cracked teeth are affected by many variable factors related to the dentist techniques used for the treatment and the tooth condition itself. Endodontic teeth with limited crack extension have a high prognosis for success and survival than teeth with multiple crack directions with radicular or sub-gingival extensions. There is a limitation in studies that were conducted on studying the success and survival of endodontically cracked teeth, also most of them were trials and showed unclear results. It is recommended to conduct more studies which focus on declaring affecting factors and the percentage of the success and survival of endodontically cracked teeth.


Conflict of interest <AQ1>

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Not applicable.


Ethical approval

Not applicable.


Author details

Mohammed Abdullah Alkahtani1, Abdulrahman Rasmi M. Khairi1, Tail Alhumaidi Almotairi2, Adel Yahya Ali Shahir3, Awad Yahya Ali Shaher4, Mohammed Fayez Asiri5

  1. General participator, Ministry of Health, Jeddah, Saudi Arabia
  2. General participator, Ministry of Health, Riyadh, Saudi Arabia
  3. Resident dentist, Ministry of Health, Ahad Rifaydah, Saudi Arabia
  4. General participator, Ministry of Health, Ahad Rifaydah, Saudi Arabia
  5. General participator, Ministry of Health, Khamis Mushet, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alkahtani MA, Khairi ARM, Almotairi TA, Shahir AYA, Shaher AYA, Asiri MF. Success and survival of endodontically cracked teeth: review. IJMDC. 2020; 4(2): 490-493. doi:10.24911/IJMDC.51-1575755755


Web Style

Alkahtani MA, Khairi ARM, Almotairi TA, Shahir AYA, Shaher AYA, Asiri MF. Success and survival of endodontically cracked teeth: review. https://www.ijmdc.com/?mno=77059 [Access: October 15, 2021]. doi:10.24911/IJMDC.51-1575755755


AMA (American Medical Association) Style

Alkahtani MA, Khairi ARM, Almotairi TA, Shahir AYA, Shaher AYA, Asiri MF. Success and survival of endodontically cracked teeth: review. IJMDC. 2020; 4(2): 490-493. doi:10.24911/IJMDC.51-1575755755



Vancouver/ICMJE Style

Alkahtani MA, Khairi ARM, Almotairi TA, Shahir AYA, Shaher AYA, Asiri MF. Success and survival of endodontically cracked teeth: review. IJMDC. (2020), [cited October 15, 2021]; 4(2): 490-493. doi:10.24911/IJMDC.51-1575755755



Harvard Style

Alkahtani, M. A., Khairi, . A. R. M., Almotairi, . T. A., Shahir, . A. Y. A., Shaher, . A. Y. A. & Asiri, . M. F. (2020) Success and survival of endodontically cracked teeth: review. IJMDC, 4 (2), 490-493. doi:10.24911/IJMDC.51-1575755755



Turabian Style

Alkahtani, Mohammed Abdullah, Abdulrahman Rasmi M. Khairi, Tail Alhumaidi Almotairi, Adel Yahya Ali Shahir, Awad Yahya Ali Shaher, and Mohammed Fayez Asiri. 2020. Success and survival of endodontically cracked teeth: review. International Journal of Medicine in Developing Countries, 4 (2), 490-493. doi:10.24911/IJMDC.51-1575755755



Chicago Style

Alkahtani, Mohammed Abdullah, Abdulrahman Rasmi M. Khairi, Tail Alhumaidi Almotairi, Adel Yahya Ali Shahir, Awad Yahya Ali Shaher, and Mohammed Fayez Asiri. "Success and survival of endodontically cracked teeth: review." International Journal of Medicine in Developing Countries 4 (2020), 490-493. doi:10.24911/IJMDC.51-1575755755



MLA (The Modern Language Association) Style

Alkahtani, Mohammed Abdullah, Abdulrahman Rasmi M. Khairi, Tail Alhumaidi Almotairi, Adel Yahya Ali Shahir, Awad Yahya Ali Shaher, and Mohammed Fayez Asiri. "Success and survival of endodontically cracked teeth: review." International Journal of Medicine in Developing Countries 4.2 (2020), 490-493. Print. doi:10.24911/IJMDC.51-1575755755



APA (American Psychological Association) Style

Alkahtani, M. A., Khairi, . A. R. M., Almotairi, . T. A., Shahir, . A. Y. A., Shaher, . A. Y. A. & Asiri, . M. F. (2020) Success and survival of endodontically cracked teeth: review. International Journal of Medicine in Developing Countries, 4 (2), 490-493. doi:10.24911/IJMDC.51-1575755755