Journal of Endodontics
Volume 36, Issue 4 , Pages 609-617 , April 2010

Identifying and Reducing Risks for Potential Fractures in Endodontically Treated Teeth

  • Weirong Tang, DDS

      Affiliations

    • Department of Endodontics, College of Stomatology, Nanjing Medical University, Nanjing, PR China
    • ,
  • Younong Wu, DDS, MSc, PhD

      Affiliations

    • Department of Endodontics, College of Stomatology, Nanjing Medical University, Nanjing, PR China
    • Dental Research Institute, College of Stomatology, Nanjing Medical University, Nanjing, PR China
    • Corresponding Author InformationAddress requests for reprints to Professor Wu Younong, Dental Research Institute, College of Stomatology, Nanjing Medical University, 140 Han Zhong Road, Nanjing 210029, PR China.
    • ,
  • Roger J. Smales, BDS, MDS(Hons), DDSc

      Affiliations

    • School of Dentistry, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia

References 

  1. Salehrabi R, Rotstein I. Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study. J Endod. 2004;30:846–850
  2. Hansen EK, Asmussen E, Christiansen NC. In vivo fractures of endodontically treated posterior teeth restored with amalgam. Endod Dent Traumatol. 1990;6:49–55
  3. Zadik Y, Sandler V, Bechor R, Salehrabi R. Analysis of factors related to extraction of endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e31–e35
  4. Chen S-C, Chueh L-H, Hsiao CK, Wu H-P, Chiang C-P. First untoward events and reasons for tooth extraction after nonsurgical endodontic treatment in Taiwan. J Endod. 2008;34:671–674
  5. Kishen A. Mechanisms and risk factors for fracture predilection in endodontically treated teeth. Endodontic Topics. 2006;13:57–83
  6. Rivera E, Walton RE. Cracking the cracked tooth code: detection and treatment of various longitudinal tooth fractures. Endodontics: colleagues for excellence. American Association of Endodontists. 2008;(Summer):1–8
  7. Bader JD, Martin JA, Shugars DA. Incidence rates for complete cusp fracture. Community Dent Oral Epidemiol. 2001;29:346–353
  8. Bader JD, Shugars DA, Sturdevant JR. Consequences of posterior cusp fracture. Gen Dent. 2004;52:128–131
  9. Fennis WMM, Kuijs RH, Kreulen CM, Roeters FJ, Creugers NHJ, Burgersdijk RC. A survey of cusp fractures in a population of general dental practices. Int J Prosthodont. 2002;15:559–563
  10. Hansen EK. In vivo cusp fracture of endodontically treated premolars restored with MOD amalgam and MOD resin fillings. Dent Mater. 1988;4:169–173
  11. Akerboom HB, Advokaat JG, van Amerongen WE, Borgmeijer PJ. Long-term evaluation and rerestoration of amalgam restorations. Community Dent Oral Epidemiol. 1993;21:45–48
  12. Wahl MJ, Schmitt MM, Overton DA, Gordon MK. Prevalence of cusp fractures in teeth restored with amalgam and resin-based composite. J Am Dent Assoc. 2004;135:1127–1132
  13. Lynch CD, Burke FM, Ni Riordáin R, Hannigan A. The influence of coronal restoration type on the survival of endodontically treated teeth. Eur J Prosthodont Restor Dent. 2004;12:171–176
  14. Ratcliff S, Becker IM, Quinn L. Type and incidence of cracks in posterior teeth. J Prosthet Dent. 2001;86:168–172
  15. Krell KV, Rivera EM. A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. J Endod. 2007;33:1405–1407
  16. Homewood CI (Kip). Cracked tooth syndrome: incidence, clinical findings and treatment. Am Dent J 1998;43:217–22.
  17. Cameron CE. The cracked tooth syndrome: additional findings. J Am Dent Assoc. 1976;93:971–975
  18. Roh B-D, Lee Y-E. Analysis of 154 cases of teeth with cracks. Dent Traumatol. 2006;22:118–123
  19. Hiatt WH. Incomplete crown-root fracture in pulpal-periodontal disease. J Periodontol. 1973;44:369–379
  20. Morfis AS. Vertical root fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1990;69:631–635
  21. Torbjörner A, Karlsson S, Ödman PA. Survival rate and failure characteristics for two post designs. J Prosthet Dent. 1995;73:439–444
  22. Fuss Z, Lustig J, Tamse A. Prevalence of vertical root fractures in extracted endodontically treated teeth. Int Endod J. 1999;32:283–286
  23. Hassan B, Metska ME, Ozok AR, van der Stelt P, Wesselink PR. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod. 2009;35:719–722
  24. Chan C-P, Lin C-L, Tseng S-C, Jeng J-H. Vertical root fracture in endodontically versus nonendodontically treated teeth: a survey of 315 cases in Chinese patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:504–507
  25. Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth. 4th ed.. Copenhagen: Munksgaard; 2007;
  26. Yang SF, Rivera EM, Walton RE. Vertical root fracture in nonendodontically treated teeth. J Endod. 1995;21:337–339
  27. Kinney JH, Nalla RK, Pople JA, Breunig TM, Ritchie RO. Age-related transparent root dentin: mineral concentration, crystallite size, and mechanical properties. Biomaterials. 2005;26:3363–3376
  28. Lehman ML. Tensile strength of human dentin. J Dent Res. 1967;46:197–201
  29. Mackie IC, Hill FJ. A clinical guide to the endodontic treatment of non-vital immature permanent teeth. Br Dent J. 1999;186:54–58
  30. Finucane D, Kinirons MJ. Non-vital immature permanent incisors: factors that may influence treatment outcome. Endod Dent Traumatol. 1999;15:273–277
  31. Ghose LJ, Baghdady VS, Hikmat BYM. Apexification of immature apices of pulpless permanent anterior teeth with calcium hydroxide. J Endod. 1987;13:285–290
  32. Giuliani V, Baccetti T, Pace R, Pagavino G. The use of MTA in teeth with necrotic pulps and open apices. Dent Traumatol. 2002;18:217–221
  33. Witherspoon DE, Ham K. One-visit apexification: technique for inducing root-end barrier formation in apical closures. Pract Proced Aesthet Dent. 2001;13:455–460
  34. Maroto M, Barberia E, Planells P, Vera V. Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA). Dent Traumatol. 2003;19:165–169
  35. Erdem AP, Sepet E. Mineral trioxide aggregate for obturation of maxillary central incisors with necrotic pulp and open apices. Dent Traumatol. 2008;24:e38–e41
  36. Saupe WA, Gluskin AH, Radke RA. A comparative study of fracture resistance between morphological dowel and cores and a resin-reinforced dowel system in the intraradicular restoration of structurally compromised roots. Quintessence Int. 1996;27:483–491
  37. Katebzadeh N, Dalton BC, Trope M. Strengthening immature teeth during and after apexification. J Endod. 1998;24:256–259
  38. Lawley GR, Schindler WG, Walker WA, Kolodrubetz D. Evaluation of ultrasonically placed MTA and fracture resistance with intracanal composite resin in a model of apexification. J Endod. 2004;30:167–72
  39. Tait CM, Ricketts DN, Higgins AJ. Restoration of the root-filled tooth: pre-operative assessment. Br Dent J. 2005;198:395–404
  40. Wu MK, van der Sluis LW, Wesselink PR. Comparison of mandibular premolars and canines with respect to their resistance to vertical root fracture. J Dent. 2004;32:265–268
  41. Zogheib LV, Pereira JR, do Valle AL, de Oliveira JA, Pegoraro LF. Fracture resistance of weakened roots restored with composite resin and glass fiber post. Braz Dent J. 2008;19:329–333
  42. Zhi-Yue L, Yu-Xing Z. Effect of post-core design and ferrule on fracture resistance of endodontically-treated maxillary central incisors. J Prosthet Dent. 2003;89:368–373
  43. Lang H, Korkmaz Y, Schneider K, Raab WH-M. Impact of endodontic treatments on the rigidity of the root. J Dent Res. 2006;85:364–368
  44. Nissan J, Zukerman O, Rosenfelder S, Barnea E, Shifman A. Effect of endodontic access type on the resistance to fracture of maxillary incisors. Quintessence Int. 2007;38:e364–e367
  45. Chankhrit S, Joseph P, Darunee P, Harold HM. Effect of root canal size and external root surface morphology on fracture susceptibility and pattern: a finite element analysis. J Endod. 2005;31:288–292
  46. Versluis A, Messer HH, Pintado MR. Changes in compaction stress distributions in roots resulting from canal preparation. Int Endod J. 2006;39:931–939
  47. Lam PPS, Palamara JEA, Messer HH. Fracture strength of tooth roots following canal preparation by hand and rotary instrumentation. J Endod. 2005;31:529–532
  48. Zandbiglari T, Davids H, Schäfer E. Influence of instrument taper on the resistance to fracture of endodontically treated roots. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:126–131
  49. Bier CA, Shemesh H, Tanomaru-Filho M, Wesselink PR, Wu MK. The ability of different nickel-titanium rotary instruments to induce dentinal damage during canal preparation. J Endod. 2009;35:236–238
  50. Adorno CG, Yoshioka T, Suda H. The effect of root preparation technique and instrumentation length on the development of apical root cracks. J Endod. 2009;35:389–392
  51. Peng B. Atlas of endodontics. 1st ed.. Beijing: People's Medical Publishing House; 2008;
  52. Saleh AA, Ettman WM. Effect of endodontic irrigation solutions on microhardness of root canal dentine. J Dent. 1999;27:43–46
  53. Grigoratos D, Knowles J, Ng YL, Gulabivala K. Effect of exposing dentine to sodium hypochlorite and calcium hydroxide on its flexural strength and elastic modulus. Int Endod J. 2001;34:113–119
  54. Yasuda G, Inage H, Kawamoto R, et al. Changes in elastic modulus of adhesive and adhesive-infiltrated dentin during storage in water. J Oral Sci. 2008;50:481–486
  55. Calt S, Serper A. Time-dependent effects of EDTA on dentin structures. J Endod. 2002;28:17–19
  56. White JD, Lacefield WR, Chavers LS, Eleazer PD. The effect of three commonly used endodontic materials on the strength and hardness of root dentin. J Endod. 2002;28:828–830
  57. Sayin TC, Serper A, Cehreli ZC, Otlu HG. The effect of EDTA, EGTA, EDTAC, and tetracycline-HCl with and without subsequent NaOCl treatment on the microhardness of root canal dentin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:418–424
  58. Williams C, Loushine RJ, Weller RN, Pashley DH, Tay FR. A comparison of cohesive strength and stiffness of Resilon and gutta-percha. J Endod. 2006;32:553–555
  59. Shipper G, Ørstavik D, Teixeira FB, Trope M. An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod. 2004;30:342–347
  60. Skidmore LJ, Berzins DW, Bahcall JK. An in vitro comparison of the intraradicular dentin bond strength of Resilon and gutta-percha. J Endod. 2006;32:963–966
  61. Hsieh K-H, Liao K-H, Lai EH-H, Lee B-S, Lee C-Y, Lin C-P. A novel polyurethane-based root canal-obturation material and urethane acrylate-based root canal sealer: part 1—synthesis and evaluation of mechanical and thermal properties. J Endod. 2008;34:303–305
  62. Stuart CH, Schwartz SA, Beeson TJ. Reinforcement of immature roots with a new resin filling material. J Endod. 2006;32:350–353
  63. Wilkinson KL, Beeson TJ, Kirkpatrick TC. Fracture resistance of simulated immature teeth filled with Resilon, gutta-percha or composite. J Endod. 2007;33:480–483
  64. Hammad M, Qualtrough A, Silikas N. Effect of new obturating materials on vertical root fracture resistance of endodontically treated teeth. J Endod. 2007;33:732–736
  65. Grande NM, Plotino G, Lavorgna L, et al. Influence of different root canal filling materials on the mechanical properties of root canal dentin. J Endod. 2007;33:859–863
  66. Blum JY, Machtou P, Micallef JP. Analysis of forces developed during obturations: wedging effect—part II. J Endod. 1998;24:223–228
  67. Piskin B, Aydin B, Sarikanat M. The effect of spreader size on fracture resistance of maxillary incisor roots. Int Endod J. 2008;41:54–59
  68. Wilcox LR, Roskelley C, Sutton T. The relationship of root canal enlargement to finger-spreader induced vertical root fracture. J Endod. 1997;23:533–534
  69. Hofmann N, Just N, Haller B, Hugo B, Klaiber B. The effect of glass ionomer cement or composite resin bases on restoration of cuspal stiffness of endodontically treated premolars in vitro. Clin Oral Investig. 1998;2:77–83
  70. Mulvay PG, Abbott PV. The effect of endodontic access preparation and subsequent restorative procedures on molar crown retention. Aust Dent J. 1996;41:134–139
  71. Mattison GD, Delivanis PD, Thacker RW, Hassel KJ. Effect of post preparation on the apical seal. J Prosthet Dent. 1984;51:785–789
  72. Raiden GC, Gendleman H. Effect of dowel space preparation on the apical seal of root canal fillings. Endod Dent Traumatol. 1994;10:109–112
  73. Rahimi S, Shahi S, Nezafati S, Reyhani MF, Shakouie S, Jalili L. In vitro comparison of three different lengths of remaining gutta-percha for establishment of apical seal after post-space preparation. J Oral Sci. 2008;50:435–439
  74. Nakamura T, Ohyama T, Waki T, et al. Stress analysis of endodontically-treated anterior teeth restored with different types of post material. Dent Mater J. 2006;25:145–150
  75. Fokkinga WA, Kreulen CM, Vallittu PK, Creugers NHJ. A structural analysis of in vitro failure loads and failure modes of fiber, metal, and ceramic post-and-core systems. Int J Prosthodont. 2004;17:476–482
  76. Salameh Z, Sorrentino R, Papacchini F, et al. Fracture resistance and failure patterns of endodontically treated mandibular molars restored using resin composite with or without translucent glass fiber posts. J Endod. 2006;32:752–755
  77. Salameh Z, Sorrentino R, Ounsi HF, et al. Effect of different all-ceramic crown system on fracture resistance and failure pattern on endodontically treated maxillary premolars restored with and without glass fiber posts. J Endod. 2007;33:848–851
  78. Salameh Z, Sorrentino R, Ounsi HF, Sadig W, Atiyeh F, Ferrari M. The effect of different full-coverage crown systems on fracture resistance and failure pattern of endodontically treated maxillary incisors restored with and without glass fiber posts. J Endod. 2008;34:842–846
  79. Soares CJ, Soares PV, de Freitas Santos-Filho PC, Castro CG, Magalhaes D, Versluis A. The influence of cavity design and glass fiber posts on biomechanical behavior of endodontically treated premolars. J Endod. 2008;34:1015–1019
  80. Al-Wahadni AM, Hamdan S, Al-Omiri M, Hammad MM, Hatamleh MM. Fracture resistance of teeth restored with different post systems: in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e77–e83
  81. Hu YH, Pang LC, Hsu CC, Lau YH. Fracture resistance of endodontically treated anterior teeth restored with post-and-core system. Quintessence Int. 2003;34:349–353
  82. Mou Y-B, Chen Y-M, Smales RJ, Yip KH-K. In vitro evaluation of the optimum post and tooth root diameters for a cast post-core system. Am J Dent. 2009;(in press)
  83. Raiden G, Costa L, Koss S, Hernandez JL, Acenolaza V. Residual thickness of root in first maxillary premolars with post space preparation. J Endod. 1999;25:502–505
  84. Gluskin AH, Radke RA, Frost SL, Watanabe LG. The mandibular incisor: rethinking guidelines for post and core design. J Endod. 1995;21:33–37
  85. Naumann M, Sterzenbach G, Rosentritt M, Beuer F, Frankenberger R. Is adhesive cementation of endodontic posts necessary?. J Endod. 2008;34:1006–1010
  86. Snyder MD, Lang BR, Razzoog ME. The efficacy of luting all-ceramic crowns with resin modified glass ionomer cement. J Am Dent Assoc. 2003;134:609–612
  87. Morgano SM, Brackett SE. Foundation restorations in fixed prosthodontics: current knowledge and future needs. J Prosthet Dent. 1999;82:643–657
  88. Wang VJ-J, Chen Y-M, Yip KH-K, Smales RJ, Meng Q-F, Chen L. Effect of two fiber post types and two luting cement systems on regional post retention using the push-out test. Dent Mater. 2008;24:372–377
  89. Santos AFV, Tanaka CB, Lima RG, et al. Vertical root fracture in upper premolars with endodontic posts: finite element analysis. J Endod. 2009;35:117–120
  90. Peutzfeldt A, Sahafi A, Asmussen E. A survey of failed post-retained restorations. Clin Oral Investig. 2008;12:37–44
  91. Morgano SM, Rodrigues AHC, Sabrosa CE. Restoration of endodontically treated teeth. Dent Clin North Am. 2004;48:397–416
  92. Cheung W. A review of the management of endodontically treated teeth: post, core and the final restoration. J Am Dent Assoc. 2005;136:611–619
  93. Soares PV, Santos-Filho PC, Queiroz EC, et al. Fracture resistance and stress distribution in endodontically treated maxillary premolars restored with composite resin. J Prosthodont. 2008;17:114–119
  94. Mannocci F, Qualtrough AJ, Worthington HV, Watson TF, Pitt Ford TR. Randomized clinical comparison of endodontically treated teeth restored with amalgam or with fiber posts and resin composite: five-year results. Oper Dent. 2005;30:9–15
  95. Reeh ES, Douglas WH, Messer HH. Stiffness of endodontically-treated teeth related to restoration technique. J Dent Res. 1989;68:1540–1544
  96. Fennis WMM, Kuijs RH, Kreulen CM, Roeters FJ, Verdonschot N, Creugers NHJ. Fatigue resistance of teeth restored with cuspal-coverage composite restorations. Int J Prosthodont. 2004;17:313–317
  97. Opdam NJM, Roeters JJM, Loomans BAC, Bronkhorst EM. Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration. J Endod. 2008;34:808–811
  98. Mondelli RF, Ishikiriama SK, de Oliveira Filho O, Mondelli J. Fracture resistance of weakened teeth restored with condensable resin with and without cusp coverage. J Appl Oral Sci. 2009;17:161–165
  99. Mohammadi N, Kahnamoii MA, Yeganeh PK, Navimipour EJ. Effect of fiber post and cusp coverage on fracture resistance of endodontically treated maxillary premolars directly restored with composite resin. J Endod. 2009;35:1428–1432
  100. Nagasiri R, Chitmongkolsuk S. Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study. J Prosthet Dent. 2005;93:164–170
  101. Sorensen JA, Martinoff JT. Endodontically treated teeth as abutments. J Prosthet Dent. 1985;53:631–636
  102. Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosthet Dent. 2002;87:256–263
  103. Mannocci F, Bertelli E, Sherriff M, Watson TF, Pitt Ford TR. Three-year clinical comparison of survival of endodontically treated teeth restored with either full cast coverage or with direct composite restoration. J Prosthet Dent. 2002;88:297–301
  104. Creugers NHJ, Mentink AGM, Fokkinga WA, Kreulen CM. 5-year follow-up of a prospective clinical study on various types of core restorations. Int J Prosthodont. 2005;18:34–39
  105. Stavropoulou AF, Koidis PT. A systematic review of single crowns on endodontically treated teeth. J Dent. 2007;35:761–767
  106. Fokkinga WA, Kreulen CM, Bronkhorst EM, Creugers NHJ. Composite resin core-crown reconstructions: an up to 17-year follow-up of a controlled clinical trial. Int J Prosthodont. 2008;21:109–115
  107. Libman WJ, Nicholls JI. Load fatigue of teeth restored with cast posts and cores and complete crowns. Int J Prosthodont. 1995;8:155–161
  108. de Oliveira JA, Pereira JR, do Valle AL, Zogheib LV. Fracture resistance of endodontically treated teeth with different heights of crown ferrule restored with prefabricated carbon fiber post and composite resin core by intermittent loading. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e52–e57
  109. Meng QF, Chen YM, Guang HB, Yip KHK, Smales RJ. Effect of a ferrule and increased clinical crown length on the in vitro fracture resistance of premolars restored using two dowel-and-core systems. Oper Dent. 2007;32:595–601
  110. Meng Q-F, Chen L-J, Meng J, Chen Y-M, Smales RJ, Yip KH-K. Fracture resistance after simulated crown lengthening and forced tooth eruption of endodontically-treated teeth restored with a fiber post-and-core system. Am J Dent. 2009;22:147–150
  111. Ng CCH, Dumbrigue HB, Al-Bayat MI, Griggs JA, Wakefield CW. Influence of remaining coronal tooth structure location on the fracture resistance of restored endodontically treated anterior teeth. J Prosthet Dent. 2006;95:290–296
  112. Ichim I, Kuzmanovic DV, Love RM. A finite element analysis of ferrule design on restoration resistance and distribution of stress within a root. Int Endod J. 2006;39:443–452
  113. Stankiewicz NR, Wilson PR. The ferrule effect: a literature review. Int Endod J. 2002;35:575–581
  114. Goga R, Purton DG. The use of endodontically treated teeth as abutments for crowns, fixed partial dentures, or removable partial dentures: a literature review. Quintessence Int. 2007;38:41–46
  115. Nyman S, Lindhe J. A longitudinal study of combined periodontal and prosthetic treatment of patients with advanced periodontal disease. J Periodontol. 1979;50:163–169
  116. Sorensen JA, Martinoff JT. Endodontically treated teeth as abutments. J Prosthet Dent. 1985;53:631–636
  117. Hatzikyriakos AH, Reisis GI, Tsingos N. A 3-year postoperative clinical evaluation of posts and cores beneath existing crowns. J Prosthet Dent. 1992;67:454–458
  118. Walton TR. An up to 15-year longitudinal study of 515 metal-ceramic FPDs: part 1—outcome. Int J Prosthodont. 2002;15:439–445
  119. Walton TR. An up to 15-year longitudinal study of 515 metal-ceramic FPDs: part 2—modes of failure and influence of various clinical characteristics. Int J Prosthodont. 2003;16:177–182
  120. De Backer H, Van Maele G, De Moor N, Van den Berghe L. Long-term results of short-span versus long-span fixed dental prostheses: an up to 20-year retrospective study. Int J Prosthodont. 2008;21:75–85
  121. Valderhaug J, Jokstad A, Ambjornsen E, Norheim PW. Assessment of the periapical and clinical status of crowned teeth over 25 years. J Dent. 1997;25:97–105
  122. Wegner PK, Freitag S, Kern M. Survival rate of endodontically treated teeth with posts after prosthetic restoration. J Endod. 2006;32:928–931
  123. Decock V, De Nayer K, De Boever JA, Dent M. 18-year longitudinal study of cantilevered fixed restorations. Int J Prosthodont. 1996;9:331–340

PII: S0099-2399(09)01054-1

doi: 10.1016/j.joen.2009.12.002

Journal of Endodontics
Volume 36, Issue 4 , Pages 609-617 , April 2010

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