Précis & Objective
This was a prospective, observational 4-year cohort study of both symptomatic and asymptomatic cracked teeth in 3,000 patients of ages 19-85 from 150-300 National Dental PBRN practices. Subjects received patient-, tooth- and crack-level assessments of a cracked tooth at baseline and follow-up visits over the subsequent four years.
The primary objective of the study was to identify patient-, tooth-, and crack- level characteristics associated with initial tooth symptom status, and to determine, over a four-year follow-up period, the associations of these multi-level factors with changes (tooth “failure”) that occured in an initially symptomatic or asymptomatic cracked tooth. Changes in the study tooth over time—outcomes that define the development of tooth “failure”– included crack progression, sign/symptom development, need for restorative dentistry, endodontic therapy or tooth extraction, development of periradicular lucency and loss of pulp vitality.
Many teeth required treatment over the course of the study period. Therefore, secondary objectives of the study were to:
- Identify multi-level (practice-, practitioner-, patient-, tooth-, and crack- level) factors associated with treatment recommendations for asymptomatic and symptomatic teeth provided by practitioners across the US;
- Identify associations between crack characteristics and time-to-treatment rendered during the four-year follow-up period;
- Determine, among treated cracked teeth, associations between the external and internal crack characteristics, which included externally detectable characteristics and internal characteristics that are observed during invasive treatment of the tooth.
- Evaluate outcomes of various treatments rendered on cracked teeth by determining associations between treatment rendered and time to tooth failure after treatment has been rendered on cracked teeth during the four-year follow-up period. These tooth outcomes include crack progression, sign/symptom development, and further recommended treatment of the tooth, development of periradicular lucency and loss of pulp vitality.