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PubMed1995

Diagnosis and management of vertical root fractures.

Vertical root fractures constitute a significant management problem for dentists. The diagnosis of root fractures is difficult because several of their signs and symptoms are shared with other common dental or oral pathologies. However, reaching an accurate diagnosis is crucial to establishing the prognosis for a fractured tooth and selecting the appropriate treatment. This review describes current knowledge of the causes, diagnosis, and management of vertical root fractures, with special attention to the periodontal aspects of this condition.

Humans↗
PubMed2003

Repair of untreated horizontal root fracture: a case report.

We report a clinical case of horizontal root fracture in the mandibular first premolar induced by a traffic accident. The fractured tooth spontaneously healed and diagnosed radiographically after 2 years. Fractured fragments were separated by a narrow radiolucent line and the edges were rounded, and healing of the tooth is likely to be related to interproximal connective tissue healing. Our case is an example of spontaneously healed fracture roots. An interesting finding is that the healing was observed even in the presence of two root canals, the vitality of the pulp was preserved and displacement of fragments were prevented.

Accidents, Traffic↗
PubMed2002

Incidence of root fractures and methods used for post removal.

AIM: This study was undertaken to determine the incidence of root fractures during post removal, as well as the methods used and the success rates achieved with various post removal devices and techniques. METHODOLOGY: Patient records from a specialist endodontic practice were examined. A total of 1600 teeth from which posts were removed were identified. These teeth had no preoperative signs or symptoms to suggest root fractures. The incidence of root fractures was determined and a subset of 234 patient records were examined in detail to determine the methods used to remove different types of posts. RESULTS: Only one tooth fractured during post removal (0.06%) and all posts were successfully removed, typically in about 3 min. Most cast posts were removed with an Eggler post remover but some dislodged when the crown was removed; ultrasonics was used occasionally. Most parallel-sided posts were removed with ultrasonics and threaded posts were unscrewed. The Masserann kit and ultrasonics were combined to remove fractured cast posts and some parallel-sided posts. CONCLUSIONS: This study indicates that, with good case selection, post removal is a predictable procedure. If appropriate techniques and devices are used for the particular type of post being removed, then root fracture is a rare occurrence.

Cohort Studies↗
PubMed2003

Fracture toughness of tooth acrylics.

The hardness, fracture toughness, toughness, flexural strength and Young's moduli of three acrylic tooth polymers were investigated. The first polymer was based on a conventional homopolymer poly(methylmethacrylate). The second was based on cross-linked poly(methylmethacrylate) with an uncross-linked poly(methylmethacrylate) coating. The third material was based on an interpenetrating polymer network (IPN) of a cross-linked and uncross-linked poly(methylmethacrylate). All three polymers had similar hardness values. The cross-linked and IPN polymers had higher fracture toughness (K(IC)) and toughness (G(IC)) values than the conventional homopolymer poly(methylmethacrylate) polymer and lower flexural strengths (sigma(f)). The toughness of the cross-linked and IPN polymers was higher due to crack deflection around the polymer bead structure and the polymer beads acting as crack pinning sites.

Journal Article↗
PubMed1989

Fracture resistance of teeth restored with Class II composite restorations.

Teeth with large mesio-occlusal-distal cavity preparations fracture more easily than intact teeth. An intracoronal restoration capable of increasing tooth fracture resistance is desired. This in vitro study compared the fracture resistance of maxillary premolars restored with enamel bonding and dentin bonding. The effects of the type of curing system (chemical or photochemical) and marginal preparation (beveled or not) were also evaluated. Premolars restored with large MOD composite resin restorations were approximately twice as strong as the unrestored prepared tooth. However, all restored teeth were no more than half as strong as the intact tooth. Dentin bonded restorations were not significantly stronger than enamel bonded restorations.

Acid Etching, Dental↗
PubMed2005

Stress ratio contributes to fatigue crack growth in dentin.

An experimental study of fatigue crack growth in dentin was conducted, and the influence of stress ratio (R) on the crack growth rate and mechanisms of cyclic extension were examined. Double Cantilever Beam (DCB) fatigue specimens were sectioned from bovine molars and then subjected to high cycle fatigue loading (10(5) < N < 10(6)) under hydrated conditions. The evaluation consisted of Mode I loads with stress ratios that ranged from -0.5 to 0.5. The fatigue crack growth rates were measured and used to estimate the crack growth exponent (m) and coefficient (C) according to the Paris Law model. The fatigue crack growth rates for steady-state extension (Region II) ranged from 1E-7 to 1E-4 mm/cycle. It was found that the rate of cyclic extension increased significantly with increasing R, and that the highest average crack growth rate occurred at a stress ratio of 0.5. However, the crack growth exponent decreased with increasing R from an average of 4.6 (R = 0.10) to 2.7 (R = 0.50). The stress intensity threshold for crack growth decreased with increasing R as well. Results from this study suggest that an increase in the cyclic stress ratio facilitates fatigue crack growth in dentin and increases the rate of cyclic extension, both of which are critical concerns in minimizing tooth fractures and maintaining lifelong oral health.

Animals↗
PubMed2002

Vertical root fracture treated by bonding fragments and rotational replantation.

These case reports describe a new treatment method for complete vertical root fractures. This method is composed of two steps. First, the fractured tooth is intentionally extracted atraumatically, and then the separated fragments are bonded with an adhesive resin cement. The restored tooth is replanted by rotating approximately 180 degrees into the original socket and fixing with an orthodontic wire. For both cases reported here, bone regeneration was observed at the 3-year follow-up. Since this modality adopts the respective advantages of both intentional replantation and adhesive treatment, it might be the treatment of choice in cases of vertical root fracture.

Aged↗
PubMed2005

Rehydration of crown fragment 1 year after reattachment: a case report.

The reattachment of the crown fragment to a fractured tooth is a conservative treatment that should be considered for patients with crown fractures of anterior teeth. This case report describes the reattachment of crown fragment that is discolored because of dehydration. After 1 month, the fragment had regained some of the original color and translucency. After 1 year, the reattached fragment had satisfying esthetics and excellent function. The reattachment of the crown fragment should be done even if the crown fragment is discolored.

Child↗
PubMed2004

Fracture resistance of roots endodontically treated with a new resin filling material.

BACKGROUND: The authors evaluated the fracture resistance of endodontically treated teeth filled with either gutta-percha or a new resin-based obturation material. METHODS: The authors prepared and randomly divided 80 single-canal extracted teeth into five groups: lateral and vertical condensation with gutta-percha, lateral and vertical condensation with the new resin-based obturation material, and a control group with no filling material. The specimens were stored in 100 percent humidity for two weeks, mounted in polyester resin and loaded to failure. RESULTS: The authors found statistically significant differences among the experimental groups (P < .05). The groups with the new material displayed higher mean fracture loads and the gutta-percha groups lower mean fracture load values than the control unfilled group. However, the differences were not significant. The groups with the new material displayed significantly higher mean fracture loads than gutta-percha groups independent of the filling technique used. CONCLUSIONS: Filling the canals with the new resin-based obturation material increased the in vitro resistance to fracture of endodontically treated single-canal extracted teeth when compared with standard gutta-percha techniques. CLINICAL IMPLICATIONS; If other properties of the new resin-based obturation material compare favorably with those of gutta-percha for filling the root canal, it should be considered as a replacement for gutta-percha, as the results of this study indicate that it could provide enhanced resistance to tooth fracture.

Analysis of Variance↗
PubMed1994

The age of restorations in situ.

In a cross-sectional survey the age of restorations in situ was recorded in three patient groups. Group A were randomly examined regular attenders, group B were irregular attenders randomly chosen from patient treatment records, and in group C the age of posterior gold and composite resin restorations was recorded in selected regular attenders. The study material included 8310 restorations in group A, 1281 in group B, and 500 restorations in group C. The three materials amalgam, composite, and gold accounted for more than 90% of all restorations. In group A 3.3% of the restorations were scheduled for replacement. The most prevalent reasons for replacement were secondary caries, bulk fractures of the restoration, and tooth fractures. The median age of the failed restorations was fairly similar to the median age of the acceptable restorations in situ among the regular patients (group A). The data indicate median ages of 20 years for gold restorations, 12-14 years for amalgam restorations, and 7-8 years for composite resin restorations. The restoration ages were influenced by the type and size of the restoration, the restorative material used, and possibly also the intra-oral location of the restorations.

Composite Resins↗
PubMed1992

The effect of slot preparation length on the transverse strength of slot-retained restorations.

An in vitro study was conducted (1) to compare fracture strength of amalgam restorations retained with retentive slots of different lengths when stressed with a transverse force, (2) to determine if beveling the slot preparation resulted in an increase in fracture resistance to a transverse force, and (3) to evaluate the incidence of unrestorable tooth fracture as it relates to slot preparation length. Six groups of 10 specimens were prepared with slots of increasing length, with each specimen receiving four slots of equal length. Slot preparations in group 6 were beveled. Results showed that shorter slot preparations provided statistically equal amounts of resistance to a transverse force as did the longer preparations. Beveling the slot preparation did not significantly increase fracture strength. Specimens restored with longer slot preparations failed unrestorably more often than restorations retained with shorter slot preparations.

Dental Amalgam↗
PubMedDate not supplied

Traumatically injured primary incisors: a clinical and histological study.

World-wide epidemiological studies state that from 8 percent to 30 percent of children up to 7 years of age sustain injury to primary incisors, including crown fracture, root fracture, tooth avulsion, and dental displacement, which result in malformation of permanent incisors depending upon their state of development. In this study, traumatized primary incisors were evaluated clinically and radiographically, with the following data recorded: exact or approximate time-interval of traumatic episode(s) and extraction, mobility, color change, sensitivity to percussion/palpation, swelling, sinus tract, caries, crown/root fracture, periodontal/periapical lesions, external/internal root resorption, mineralization, and obturation. Based upon the local damage and developmental age, 138 teeth were extracted, fixed in 10 percent formalin, and processed for histological evaluation according to routine methodology. Histologic findings were: the presence of varying extent of necrosis, bacteria in the area of necrosis--not in all cases--neutrophilic leukocytes, chronic inflammatory cells, pulpal calcifications, resorption/apposition, and circulatory changes. The blood pigment distinguished hemorrhage due to extraction from pathologic circulatory changes. All the described reactions varied in intensity and extent with the time interval and the assumed force of the original trauma. Physical trauma to primary teeth caused pulpal damage, which could involve periapical tissue, depending on the extent of the initial damage.

Child↗
PubMedDate not supplied

Effect of restored and unrestored non-carious cervical lesions on the fracture resistance of previously restored maxillary premolar teeth.

OBJECTIVES: The effect of non-carious cervical lesions (NCCL) on tooth fracture resistance has not previously been investigated. The aims of this in vitro study were to examine the fracture resistance of a group of extracted maxillary premolar teeth with mesio-occlusal-distal (MOD) restorations of amalgam, and restored or unrestored simulated NCCL. METHOD: Forty sound maxillary, premolar teeth were divided at random into four groups, each of 10 teeth, which were fixed crown uppermost and long axis vertical in stainless steel moulds. Groups 1,2,3 and 4 were prepared with standardized parallel-sided MOD cavities, then restored with amalgam. Groups 1, 2 and 3 were further prepared with standardized NCCL. The NCCL in Group 1 were restored using a resin-modified polyalkenoate (glass-ionomer) cement, and the NCCL in Group 2 were restored with an adhesive composite resin system. The NCCL in Group 3 were left unrestored. The specimens were loaded compressively at 1 mm min-1 using a universal testing machine. RESULTS: Mean fracture loads (KN) of 1.08, 1.03, 0.98 and 1.14, respectively, were recorded for Groups 1, 2, 3 and 4. Two-way ANOVA and Scheffe's Multiple Range Test showed no statistically significant difference between the groups. CONCLUSIONS: It is concluded that the presence of a standardized NCCL in an extracted maxillary premolar tooth does not reduce the fracture resistance of the tooth when loaded compressively at 1 mm min-1. The restoration of NCCL with the materials tested did not result in an increase in the fracture resistance of the previously restored premolar teeth, when loaded compressively at 1 mm min-1.

Analysis of Variance↗
PubMed1988

Rigid internal fixation for fractures involving tooth-bearing maxillary segments.

Fracture dislocations of the middle third of the face usually involve a complex combination of the three types of fractures initially described by LeFort. Treatment of these injuries requires a six- to eight-week period of intermaxillary fixation, unless rigid internal fixation devices (plates and screws) are used to stabilize the fractures. However, rigid fixation carries the risk of producing a malunion and serious malocclusion if not performed correctly. A review of 22 patients with complex LeFort fractures treated with rigid fixation revealed that the only absolute contraindication to its use is difficulty in interdigitating the maxillary and mandibular teeth in a passive fashion at the time of fracture reduction. Rigid internal fixation should therefore be considered as an alternative treatment for most fractures of the middle third of the face.

Fracture Fixation, Internal↗
PubMed1996

Fractured anterior teeth among mentally handicapped school children in Ibadan, Nigeria.

Prevalence of fractured anterior teeth among 205 mentally handicapped school children in Ibadan, Nigeria is presented. A high prevalence of 20% was found and a higher proportion of females wes found to have fractured anterior teeth than males. The 13-15 years age group had the highest percentage prevalence. Tooth fractures occurred more in the upper jaw. Seizure disorders was found to be a statistically significant predisposing factor among this group of children. Management of these children depends on prevention as there are factors which may prevent the provision of good restorative care for this group of children.

Adolescent↗
PubMed2005

A retrospective study on the approach to the tooth in the fracture line of the mandible.

UNLABELLED: The presence of a tooth in the fracture line constitutes a specific problem in mandibular fractures. Therefore, our objective was to characterize the approach to teeth in the fracture line used in the Department of Maxillofacial Surgery, Plovdiv, by retrospectively investigating the association between various preoperative factors and the decision to extract or preserve the tooth. MATERIAL AND METHODS: The following variables were studied based on data from available hospital records: 1) gender and age of patients; 2) local preoperative infections; 3) time from trauma to treatment; 4) degree of fracture displacement; 5) relationship between tooth and fracture line; 6) periapical pathology; 7) periodontal diseases; 8) type of tooth in the fracture line; 9) degree of eruption; 10) method of treatment. RESULTS: 593 fractures with a tooth in the fracture line were included in the study. The tooth was preserved in 69.90 +/- 0.14% of the cases, it was extracted in 29.30 +/- 1.91% and exarticulated in 0.80 +/- 0.38% of all fracture lines. The results demonstrated the existing association between the studied variables and the decision to extract or preserve the tooth. Extraction was generally preferred in the following cases: if a local preoperative infection was present; the time from trauma to treatment was more than 72 hours; there was a significant displacement of the fracture; the dental root was fractured; periapical pathology or periodontal disease was present; the tooth was multi-rooted; or treatment consisted of open reduction and internal fixation. CONCLUSIONS: Making a decision to extract or preserve the tooth in the fracture line is a complex process. Each case, therefore, should be approached individually.

Adolescent↗
PubMed1991

Dental injuries: "first aid" knowledge of Southampton teachers of physical education.

A total of 66 teachers of physical education within the Southampton telephone area responded to a postal questionnaire related to their knowledge of the first aid treatment of dental injuries. In a case study investigating tooth fracture, 64% gave an appropriate answer. In a second case study relating to avulsion (loss) of a permanent tooth, 43% gave an appropriate answer. There was an unclear relationship between the point in their careers at which teachers had received first aid training and the accuracy of their responses. There is a need for further information in this area.

Adolescent↗