Abstract
Introduction
The diagnosis and treatment planning of cracked teeth depend on the understanding
of how cracks affect the surrounding tissues. This study evaluated the dentin and
pulp conditions in teeth affected by cracks and attrition.
Methods
Specimens under investigation included 12 cracked posterior teeth and 8 teeth with
severe attrition. These teeth were obtained consecutively in a private practice and
were extracted for reasons not related to this study. Teeth were processed for histopathologic
and histobacteriologic analyses.
Results
Cracks were histologically detected in all specimens, including the teeth with severe
attrition. The cracks in all teeth were colonized by bacterial biofilms. One tooth
showed several craze lines in the enamel, one of which reached dentin to a shallow
depth. In some teeth, the crack ended in the dentin. Dentinal tubules were invaded
by bacteria, especially when the crack extended perpendicularly into the dentin. Severe
accumulations of inflammatory cells were present in the pulp zone subjacent to tubules
involved with the crack. In many cases, the crack extended to the pulp, leading to
reactions with intensities ranging from acute inflammation to total pulpal necrosis.
Symptoms occurred in most cases in which the pulp was affected. In some cases, polymorphonuclear
neutrophils were seen migrating from the pulp into the crack space and facing the
bacterial biofilm located therein. Severe pulp reactions were also observed when the
crack extended to the pulp chamber floor.
Conclusions
Cracks are always colonized with bacterial biofilms. The pulp tissue response varies
according to the location, direction, and extent of the crack.
Key Words
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Article info
Publication history
Published online: October 30, 2014
Identification
Copyright
© 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
