Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea.
Department of Electrical & Electronic Engineering, BK21 FOUR Project, Yonsei University College of Engineering, Yonsei University College of Dentistry, Seoul, Korea.
Int Endod J. 2021 Oct;54(10):1727-1737. doi: 10.1111/iej.13597. Epub 2021 Jul 22.
This prospective clinical study evaluated the clinical performance of managing cracked teeth with reversible pulpitis through a combination of internal and external splinting and investigated factors that can affect pulp survival after splinting.
Thirty-four teeth diagnosed with cracks and reversible pulpitis were enrolled and treated with bidirectional crack splinting: 1) immediate splinting with a stainless-steel band, 2) internal splinting with crack line removal and resin filling and 3) external splinting with a temporary crown followed by final crown placement. If the symptoms remained/recurred, root canal treatment was performed. Patients were followed up at 3, 6 and 12 months, then annually thereafter. Kaplan-Meier survival analysis to calculate the survival of the treated teeth and Cox univariate proportional hazards regression model to investigate prognostic factors were performed.
Twenty-nine (97%) teeth were followed up for up to 4 years. The pulp survival rate was 72% after banding and 91% after final crown cementation. No tooth was extracted (100% tooth survival rate). In the univariate Cox proportional hazard test, pain on percussion was the only statistically significant factor (hazard ratio = 11.77). Teeth with pain on percussion at the first visit had a pulp survival rate of 46% during the follow-up period. In comparison, their counterparts without pain had a 94% pulp survival rate.
Bidirectional splinting successfully managed cracked teeth with reversible pulpitis. Pain on percussion (mechanical allodynia) may be an important factor in deciding whether to attempt root canal treatment on symptomatic cracked teeth. A step-by-step approach with bidirectional crack splinting should be encouraged for a cracked tooth with a vital pulp without mechanical allodynia rather than pre-emptive root canal treatment.
本前瞻性临床研究通过内、外夹板联合治疗可复性牙髓炎伴裂纹牙，评估其临床效果，并探讨影响夹板治疗后牙髓存活的因素。
纳入 34 颗诊断为裂纹和可复性牙髓炎的牙齿，并采用双向裂纹夹板治疗：1）立即用不锈钢带夹板固定，2）去除裂纹线并用树脂填充进行内部夹板固定，3）用临时冠进行外部夹板固定，然后再放置最终的牙冠。如果症状持续/复发，则进行根管治疗。患者在 3、6 和 12 个月时进行随访，此后每年进行随访。采用 Kaplan-Meier 生存分析计算治疗后牙齿的生存率，采用 Cox 单因素比例风险回归模型探讨预后因素。
29 颗（97%）牙齿最长随访 4 年。带环固定后牙髓存活率为 72%，最终牙冠粘固后为 91%。无牙被拔除（100%牙存活率）。在单因素 Cox 比例风险检验中，叩诊痛是唯一具有统计学意义的因素（风险比=11.77）。初次就诊时叩诊痛的牙齿在随访期间牙髓存活率为 46%，而无叩诊痛的牙齿牙髓存活率为 94%。
双向夹板成功治疗了可复性牙髓炎伴裂纹牙。叩诊痛（机械性感觉过敏）可能是决定是否对有症状的裂纹牙进行根管治疗的重要因素。对于无机械性感觉过敏的活髓裂纹牙，应采用双向裂纹夹板的分步治疗方法，而不是预防性根管治疗。
