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.
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.
J Endod. 2022 Sep;48(9):1100-1106. doi: 10.1016/j.joen.2022.06.004. Epub 2022 Jun 14.
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).
Ninety-five patients (95 teeth) diagnosed with a longitudinal fracture (only cracked teeth or VRF) through clinical visualization of the fracture line were included in this study. Clinical and radiographic data were collected from the patients' records to identify the characteristics associated with each condition. Fifty-four patients (54 teeth) had full radiographic (periapical [PA] radiography and a cone-beam computed tomographic [CBCT] scan) and clinical findings (probing depths and clinical images of the fracture line). PA and CBCT images were evaluated by 2 independent examiners to identify the different patterns of bone loss associated with these teeth (no defect, an angular defect, a J-shaped defect, or a combined defect). Cohen kappa analysis was used to compare the results between the 2 examiners and between the findings of the PA and CBCT images. Pearson chi-square analysis, the Fisher exact test, and adjusted Bonferroni post hoc testing were used to establish an association between the type and extension of the longitudinal fracture with the probing depth, the CBCT pattern of bony defects, and the presence/absence of the buccal plate and also to compare the clinical and radiographic characteristics of cracked teeth and teeth with VRF (P < .05).
CBCT images had 4.4 times the odds of detecting bony defects suggestive of longitudinal fractures compared with PA radiographs. Teeth with VRF were more associated with indirect restorations, deep probing (>6 mm), absence of the cortical plate, and a J-shaped defect on the CBCT image (P < .05). On the other hand, cracked teeth were associated with direct restorations, shallow probing (<6 mm), an intact cortical plate, and the presence of an angular defect on the CBCT image (P < .001). There was a significant correlation between a radicular extension of the fracture line and deep probing as well as J-shaped defects (P < .05).
Patterns of bone loss on CBCT imaging can likely differentiate between cracked teeth and teeth with VRF. The presence of an angular defect may suggest the presence of a crack in the tooth before intervention. J-shaped defects, deep probing (>6 mm), and loss of the cortical plate are likely suggestive of VRF.
本研究旨在确定具有纵向骨折的牙齿的临床和影像学特征，以协助诊断和区分裂纹牙和垂直根折（VRF）。
本研究纳入了 95 例（95 颗牙）通过临床观察骨折线诊断为纵向骨折（仅裂纹牙或 VRF）的患者。从患者的病历中收集临床和影像学数据，以确定与每种情况相关的特征。54 例患者（54 颗牙）进行了全影像学（根尖 [PA] 射线照相和锥形束计算机断层扫描 [CBCT] 扫描）和临床检查（探诊深度和骨折线的临床图像）。由 2 位独立的检查者评估 PA 和 CBCT 图像，以确定与这些牙齿相关的不同类型的骨丢失模式（无缺损、角形缺损、J 形缺损或混合缺损）。使用 Cohen kappa 分析比较 2 位检查者之间以及 PA 和 CBCT 图像之间的结果。使用 Pearson 卡方分析、Fisher 确切检验和调整后的 Bonferroni 事后检验，确定纵向骨折的类型和程度与探诊深度、CBCT 骨缺损模式以及颊板的存在/缺失之间的关系，以及比较裂纹牙和 VRF 牙齿的临床和影像学特征（P <.05）。
CBCT 图像检测提示纵向骨折的骨缺损的可能性是 PA 射线照相的 4.4 倍。VRF 牙齿更常与间接修复、深探诊（>6mm）、皮质板缺失和 CBCT 图像上的 J 形缺损相关（P <.05）。另一方面，裂纹牙与直接修复、浅探诊（<6mm）、完整的皮质板和 CBCT 图像上的角形缺损相关（P <.001）。骨折线根向延伸与深探诊和 J 形缺损之间存在显著相关性（P <.05）。
CBCT 成像上的骨丢失模式可能有助于区分裂纹牙和 VRF 牙齿。存在角形缺损可能提示干预前牙齿存在裂纹。J 形缺损、深探诊（>6mm）和皮质板缺失可能提示 VRF。
