A Study On The Early Diagnosis And Treatment Of Cracked Teeth To Preserve Pulp Vitality

[Objective]In this study,Tooth Slooth and laser fluorescence were used to explore new techniques for the early diagnosis of cracked teeth.So as to improve the accuracy of early diagnosis of cracked teeth and reduce misdiagnosis and missed diagnosis.Different management such as direct composites resin filling;metal crowns as well as metal crowns after composites resin filling were used to preserve the pulp vitality of cracked tooth.Exploring the indication of cracked tooth that treatment to preserves the vitality of the pulp and comparing the prognosis of different pulp preservation therapy,attempting to improve the prognosis of early treatment of cracked teeth.[Methods]Intact molar,without obvious decay,without filling or pit sealing agent;one or more crack exists and involve at least one marginal ridge and pulp is normal was selected.Two senior experienced practitioners examined these teeth respectively and patients diagnosed as cracked tooth were studied.Patients were asked to bite wet cotton rolls and the Tooth Slooth,and clinical findings were recorded.Then using DIAGNOdent 2190 to detect these cracked teeth and control teeth,recording the fluorescence reading.Different management such as direct composites resin filling;metal crowns as well as metal crowns after composites resin filling were used to preserve the pulp vitality of cracked tooth.The chi-square test was performed on the bite test results.Independent sample T test was performed for the results of laser fluorescence test.Then,regular follow-up after treatment was taken.Kaplan-Meier survival analysis was performed on the prognosis of each group to compare whether there were statistical differences.[Results]1.55 patients met the inclusion criteria were included in this study.The patients’ages ranged from 21 to 66 years old(mean age 45.4 years old),and most of the patients(76.4%)were aged between 30 and 60 years old.There were 32 males and 23 females.The incidence of the maxillary first molar was the highest(34.5%),followed by the mandibular first molars(25.5%)and maxillary second molar(23.6%);the incidence of mandibular second molars was relatively low.2.91.3%of the patients had pain when they bit the Tooth Slooth,32.6%of the patients had pain when they bit the wet cotton rolls.It is obvious that the relevance ratio of biting pain with the Tooth Slooth is higher than that of wet cotton rolls.The chi-square test was used to compare the relevance ratio of these two bite tests,and there was a statistical difference between these two methods(P<0.001).3.The fluorescence readings of the cracked teeth group was 7-33,and that in the control group was 0-5(55 cases).The fluorescence readings were higher in the cracked teeth group.41.8%(23 cases)of the cracked teeth’s fluorescence readings was 6-14,32.7%(18 cases)of the cracked teeth’s fluorescence readings was 15-20 and 25.5%(14 cases)of the cracked teeth’s fluorescence readings was>20.Independent sample T test was performed for the data of these two groups,and the difference between the cracked teeth group and the control group was statistically significant(P<0.001).4.At the end of the follow-up period,4 endodontic treatments(13.3%)were needed as a result of irreversible pulpitis or periapical periodontitis.2 in direct composites resin filling group,one after 2weeks and the second after 4weeks of follow-up;1 in metal crowns group after 3 months of follow-up;1 in metal crowns after composites resin filling group after 6 months of follow-up.Log-rank test indicated no significant differences between the groups were found for pulp survival(P=0.717).[Conclusions]1.Among the samples included in this study,the incidence of cracked teeth in males was higher than that in females;the proportion of maxillary first molar was the highest,and patients aged 30-60 years were the most likely to have cracked teeth.2.In this study,91.3%of the patients had pain when they bit the Tooth Slooth,which is obviously higher than that of wet cotton rolls.The Tooth Slooth was a reliable method to reproduce biting pain and was useful for early diagnosis of the cracked teeth.3.There was a statistical difference between the fluorescence readings of the cracked teeth group and the control group.Laser fluorescence can be used for early diagnosis of cracked teeth.4.Each group had one or two teeth needed endodontic treatment,log-rank test indicated no statistical difference between the groups with different management to preserve pulp vitality.The outcome of preserving pulp vitality in lyear was 86.7%.The prognosis of cracked teeth can be improved by treatment with preservation the pulp vitality of cracked tooth in an early stage.