Department of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Department of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
J Endod. 2022 Feb;48(2):190-199. doi: 10.1016/j.joen.2021.10.010. Epub 2021 Nov 6.
Cracked teeth frequently require protective adhesive restorations. This long-term, longitudinal retrospective clinical study aimed to evaluate the factors influencing the success and survival rates of cracked teeth with crack lines (CLs) in different directions when restored early with onlays or full-coverage crowns.
The dental records of 71 patients with a total of 86 cracked teeth with different pulpal and periapical diagnoses and with follow-ups spanning over 1-11 years were included. Data regarding the demographics; clinical symptoms and signs; bruxism; occlusal interferences; eating habits; pulpal and periapical diagnoses; number, direction, location, and extent of CLs; probing depth; and coronary condition before and after the placement of definitive restorations were collected. Univariate associations between tooth survival and explanatory variables were assessed. The long-term survival rate was estimated using Kaplan-Meier analysis and the log-rank test. A multivariate analysis was performed using Cox regression analysis.
The overall success rate was 93.0%, and the overall survival estimates of cracked teeth restored early were 98.6%, 94.9%, and 55.9% at the 1-, 5-, and 11-year follow-ups, respectively. The direction of the CLs did not influence the survival of the tooth. No significant association was observed between the type of tooth, probing depth, root canal treatment, and tooth loss (P > .05). The multivariate analysis showed that previously treated cracked teeth (P < .05), the provision of onlay restorations (P < .05), and the placement of posts (P < .05) had higher correlations with tooth loss. Additionally, the placement of full-coverage crowns resulted in lower tooth loss compared with the placement of onlays (P < .05).
Previous endodontic treatment in teeth that subsequently develop CLs has a negative impact on the survival rate of the teeth. Moreover, early placement of full-coverage crowns should be implemented for cracked teeth regardless of the direction or the number of CLs because it is associated with a higher cracked tooth survival rate.
牙隐裂常需要进行保护性的粘接修复。本长期、纵向回顾性临床研究旨在评估不同方向牙隐裂（CL）的牙早期行嵌体或全冠修复后，影响其成功率和存活率的因素。
纳入 71 例患者共 86 颗牙隐裂的牙列，这些患牙的牙髓和根尖诊断不同，随访时间 1-11 年。收集的资料包括患者的人口统计学数据；临床症状和体征；磨牙症；咬合干扰；饮食习惯；牙髓和根尖诊断；CL 的数量、方向、位置和范围；探诊深度；以及修复前和修复后的冠部情况。对牙存活率与解释变量之间的单变量相关性进行评估。采用 Kaplan-Meier 分析和对数秩检验估计长期存活率。采用 Cox 回归分析进行多变量分析。
总体成功率为 93.0%，牙隐裂早期修复后的牙总体 1 年、5 年和 11 年的存活率分别为 98.6%、94.9%和 55.9%。CL 的方向并不影响牙的存活率。牙的类型、探诊深度、根管治疗和牙缺失之间未见显著相关性（P>.05）。多变量分析显示，之前接受过治疗的牙隐裂（P<.05）、提供嵌体修复（P<.05）和放置桩核（P<.05）与牙缺失的相关性更高。此外，与嵌体修复相比，全冠修复的牙缺失率更低（P<.05）。
CL 后牙之前的根管治疗会对牙的存活率产生负面影响。此外，对于牙隐裂，无论 CL 的方向和数量如何，都应早期行全冠修复，因为这与更高的牙隐裂存活率相关。
