The cracked tooth: histopathologic and histobacteriologic aspects.

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.

[1]  H. Trowbridge.  2. Pathogenesis of pulpitis resulting from dental caries , 1981 .

[2]  D. Pashley,et al.  Bacterial Penetration of Human Dentin in vitro , 1980, Journal of dental research.

[3]  H. Trowbridge.  Pathogenesis of pulpitis resulting from dental caries. , 1981, Journal of endodontics.

[4]  E. Natkin,et al.  Diagnosis and treatment of vertical root fractures. , 1983, Journal of endodontics.

[5]  J. Türp,et al.  The cracked tooth syndrome: an elusive diagnosis. , 1996, Journal of the American Dental Association.

[6]  L. Tronstad,et al.  Histochemical observations on human dentin exposed by attrition. , 1971, Scandinavian journal of dental research.

[7]  J. Siqueira,et al.  A scanning electron microscopic evaluation of in vitro dentinal tubules penetration by selected anaerobic bacteria. , 1996, Journal of endodontics.

[8]  L. Tronstad,et al.  Effect of Attrition on Subjacent Dentin and Pulp , 1971, Journal of dental research.

[9]  P. M. DiFiore,et al.  Treating the cracked tooth with a full crown. , 1991, Journal of the American Dental Association.

[10]  D. Pashley.  Dynamics of the pulpo-dentin complex. , 1996, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[11]  R Garberoglio,et al.  Scanning electron microscopic investigation of human dentinal tubules. , 1976, Archives of oral biology.

[12]  D. Seo,et al.  Analysis of factors associated with cracked teeth. , 2012, Journal of endodontics.

[13]  R. Love.  Bacterial penetration of the root canal of intact incisor teeth after a simulated traumatic injury. , 1996, Endodontics & dental traumatology.

[14]  I. Okar,et al.  In vitro study of the penetration of Streptococcus sanguis and Prevotella intermedia strains into human dentinal tubules. , 2000, Journal of endodontics.

[15]  A. Moule,et al.  Bacterial contamination of cracks in symptomatic vital teeth. , 2000, Australian endodontic journal : the journal of the Australian Society of Endodontology Inc.

[16]  P. Wesselink,et al.  Penetration of bacteria in bovine root dentine in vitro. , 2000, International endodontic journal.

[17]  L. Blanco,et al.  A demographic analysis of vertical root fractures. , 2006, Journal of endodontics.

[18]  L. Berman,et al.  Fracture necrosis: diagnosis, prognosis assessment, and treatment recommendations. , 2010, Journal of endodontics.

[19]  G. Bergenholtz,et al.  Bacterial status in root-filled teeth exposed to the oral environment by loss of restoration and fracture or caries--a histobacteriological study of treated cases. , 2003, International Endodontic Journal.

[20]  T. Nishikawa,et al.  Dentinal response against carious invasion: localization of antibodies in odontoblastic body and process. , 1980, Journal of dental research.

[21]  H. J. Liu,et al.  Bacterial invasion into dentinal tubules of human vital and nonvital teeth. , 1995, Journal of endodontics.

[22]  G. Bergenholtz.  Effect of bacterial products on inflammatory reactions in the dental pulp. , 1977, Scandinavian journal of dental research.

[23]  A Tamse,et al.  Pattern of bone resorption in vertically fractured, endodontically treated teeth. , 2000, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[24]  Gunnar Bergemholtz.  Effect of bacterial products on inflammatory reactions in the dental pulp. , 1977 .

[25]  R M Love,et al.  Invasion of dentinal tubules by oral bacteria. , 2002, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[26]  D. Pashley,et al.  Clinical considerations of microleakage. , 1990, Journal of endodontics.

[27]  C. Behle.  Conservative direct and indirect resin posterior restorative alternatives for cracked dentition. , 1997, Practical periodontics and aesthetic dentistry : PPAD.

[28]  노병덕.  Analysis of 154 cases of teeth with cracks , 2006 .

[29]  L. Spångberg,et al.  Dentin permeability to bacterial proteins in vitro. , 1994, Journal of endodontics.

[30]  Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration , 2008, BDJ.

[31]  J. Andreasen,et al.  Intraalveolar root fractures: radiographic and histologic study of 50 cases. , 1967, Journal of oral surgery.

[32]  DiFiore Pm,et al.  Treating the Cracked Tooth with a Full Crown , 1991 .

[33]  R. D. Taylor.  Modification of the Brown and Brenn gram stain for the differential staining of gram-positive and gram-negative bacteria in tissue sections. , 1966, American journal of clinical pathology.

[34]  R. Walton,et al.  The histopathogenesis of vertical root fractures. , 1984, Journal of endodontics.

[35]  P. Calas,et al.  Migration of a Streptococcus sanguis strain through the root dentinal tubules. , 1993, Journal of endodontics.

[36]  Behle Ca.  Conservative direct and indirect resin posterior restorative alternatives for cracked dentition. , 1997 .

[37]  T. Watts,et al.  A six-year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis , 2008, BDJ.

[38]  L. Tronstad,et al.  Electron microscopy of human dentin exposed by attrition. , 1971, Scandinavian journal of dental research.

[39]  M. Tsutsui,et al.  Serum Proteins and Secretory Component in Human Carious Dentin , 1979, Journal of dental research.

[40]  Byoung-Duck Roh,et al.  Analysis of 154 cases of teeth with cracks. , 2006, Dental traumatology : official publication of International Association for Dental Traumatology.

[41]  E. Hoshino,et al.  Bacterial invasion of non-exposed dental pulp. , 1992, International endodontic journal.

[42]  J. Klein,et al.  Ultrastructural localization of immunoglobulins in carious human dentine. , 1981, Archives of oral biology.

[43]  L. Blanco,et al.  Vertical root fractures: clinical and radiographic diagnosis. , 2003, Journal of the American Dental Association.

[44]  C. Yeh,et al.  Fatigue root fracture: a spontaneous root fracture in non-endodontically treated teeth , 1997, British Dental Journal.

[45]  J. Siqueira.  Treatment of Endodontic Infections , 2011 .

[46]  C. E. Cameron.  CRACKED-TOOTH SYNDROME. , 1964, Journal of the American Dental Association.