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Endodontics Supporting Your Practice

Endodontic Treatment Prognosis for Cracked Teeth

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By Dr. Carolyn Boyd

Highlights

  1. Long-term studies examining the treatment outcomes of “cracked teeth” that received orthograde root canal treatment in the United States do not exist.
  2. The purpose of the present study was to examine the distribution and 1-year treatment outcomes of cracked teeth receiving orthograde root canal treatment in 1 private endodontic practice over a 25-year period.
  3. The 3 factors most significant in bivariate analyses were pocket depth, distal marginal ridge crack, and periapical diagnosis, which were used to generate a prognostic index for success of orthograde root canal therapy in cracked teeth called the Iowa Staging Index.
  4. The results of this study suggest that cracked teeth that received root canal treatment can have prognoses at higher success rates than previously reported. The Iowa Staging Index may prove to be useful in clinical treatment decision making.

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  1. Endodontic Treatment Prognosis for Cracked Teeth (PPT)
  2. Endodontic Treatment Prognosis for Cracked Teeth (PDF)

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Until next time!
CDA Oasis Team

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1 Comment

  1. Robert Kaufmann March 13, 2020

    1 Year Post op study? Pretty much meaningless.

    Any case that fails in the year probably has the following problems :
    (1) Inadequate temporization at time of Endo (No cusp relieved core placed at the time endo was completed) (2) Delays in crown restoration due to insurance considerations? How long, days? Weeks? Months? How does this affect outcome?
    (3) Poor case selection

    27% recall over just one year is VERY poor for just one year but is more consistent with the recall rates in some longer studies.

    The real question is: What is the LONGER term outcome for these cases? As a practicing Endodontist of almost 35 years , I have treated many thousands of “Cracked Teeth” – the definition of which demands a clearer explanation – (i.e./ involving furca? Into orifice? both marginal ridges ? M-D vs. Bu-Li etc)

    Ask most endodontists and they will tell you that (depending on the crack) many of these crowned cases (that had lesser pocketing at treatment) fail periodontally on recall at the 5-10 year range, depending on the individual case, promptness of restoration, occlusion etc.

    So…is the financial investment in a molar Endo/core/crown merited when we compare it to implant replacement? When a patient asks you “How long will this cracked tooth last?”, can we give them a definitive answer? Probably not. At best we can give them a range…when the tooth is restored promptly and optimally.

    Then again, if you are only looking at surviving for one year, the answer (according to this study) says yes.

    Most of my patients prefer their investments to last longer than that.

    Reply

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