Cracked teeth

牙齿断裂
  • 文章类型: Journal Article
    牙髓是与牙髓和骨周组织疾病最重要的牙科专业。临床医生经常面对有不同症状的患者,必须严格评估二维和三维的射线照相图像,得出复杂的诊断和决策,并提供复杂的治疗。与由非标准化临床技术引起的放射学解释和治疗结果变化的低观察者内部和观察者之间的一致性配对,存在对人工智能(AI)形式的支持的未满足需求,提供自动生物医学图像分析,决策支持,治疗期间的援助。在过去的十年里,牙髓的AI研究稳步增长,但临床应用有限.这篇综述的重点是批判性地评估牙髓AI临床应用研究的最新进展。包括根尖病变等牙髓病变的检测和诊断,骨折和再吸收,以及临床治疗结果预测。它讨论了人工智能辅助诊断的好处,治疗计划和执行,以及未来的方向,包括增强现实和机器人技术。它严格审查了牙髓数据集的性质所带来的局限性和挑战,人工智能的透明度和泛化,和潜在的伦理困境。在不久的将来,人工智能将显著影响牙髓的日常工作流程,教育,和持续学习。
    Endodontics is the dental specialty foremost concerned with diseases of the pulp and periradicular tissues. Clinicians often face patients with varying symptoms, must critically assess radiographic images in 2 and 3 dimensions, derive complex diagnoses and decision making, and deliver sophisticated treatment. Paired with low intra- and interobserver agreement for radiographic interpretation and variations in treatment outcome resulting from nonstandardized clinical techniques, there exists an unmet need for support in the form of artificial intelligence (AI), providing automated biomedical image analysis, decision support, and assistance during treatment. In the past decade, there has been a steady increase in AI studies in endodontics but limited clinical application. This review focuses on critically assessing the recent advancements in endodontic AI research for clinical applications, including the detection and diagnosis of endodontic pathologies such as periapical lesions, fractures and resorptions, as well as clinical treatment outcome predictions. It discusses the benefits of AI-assisted diagnosis, treatment planning and execution, and future directions including augmented reality and robotics. It critically reviews the limitations and challenges imposed by the nature of endodontic data sets, AI transparency and generalization, and potential ethical dilemmas. In the near future, AI will significantly affect the everyday endodontic workflow, education, and continuous learning.
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  • 文章类型: Journal Article
    背景:这项前瞻性研究的目的是调查使用正畸带进行初始稳定治疗的可逆性牙髓炎隐裂牙齿的1年牙髓存活率,其次是日冕覆盖修复。
    方法:招募了125名患有可逆性牙髓炎的牙齿破裂患者。收集术前患者和牙齿数据。在正畸绑扎中期确定确定牙髓诊断后,放置了日冕覆盖修复体。Cox和logistic回归分析用于评估可能的预后因素,并将正畸带中的初始时间与牙髓稳定与最终结果相关联。使用临床和影像学检查结果确定纸浆存活率。
    结果:在1年时随访了一百六颗有裂纹的牙齿。在81颗牙齿(76.4%)中发现了基于临床和影像学检查结果的牙髓存活率。在25次失败中,11(44%)在正畸带阶段需要根管治疗(RCT),10(40%)在冠状覆盖修复过程中或之后需要RCT。在为期一年的审查中,有四颗牙齿(16%)偶然发现了根尖周围的放射性,而没有临床症状。在确定牙髓诊断之前,发现需要RCT的牙齿在正畸带中需要更长的时间(p<0.05)。
    结论:通过使用正畸绑扎来监测牙髓状态的逐步方法可以通过确定的冠状覆盖修复来减少患有可逆性牙髓炎的裂牙所需的RCT的发生率。
    BACKGROUND: The aim of this prospective study was to investigate the 1-year pulp survival of cracked teeth with reversible pulpitis managed with initial stabilization using orthodontic bands, followed by coronal coverage restorations.
    METHODS: One-hundred-and-twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative patient and tooth data were collected. After definitive pulp diagnoses were determined following an interim period of orthodontic banding, coronal coverage restorations were placed. Cox and logistic regression analyses were used to assess possible prognostic factors and to correlate initial time to pulp stabilization while in orthodontic bands with eventual outcome. Pulp survival was determined using both clinical and radiographic findings.
    RESULTS: One-hundred-and-six cracked teeth were followed up at 1 year. Pulp survival based on clinical and radiographic findings was found in 81 teeth (76.4%). Out of 25 failures, 11 (44%) required root canal treatment (RCT) in the orthodontic band stage and 10 (40%) required RCT during the process of or after coronal coverage restorations. Four teeth (16%) had incidental findings of periapical radiolucencies at the 1-year review without clinical symptoms. Teeth requiring RCT were found to have required longer periods in orthodontic bands prior to a definitive pulp diagnosis (P < .05).
    CONCLUSIONS: A step-by-step approach by using orthodontic banding to monitor pulp status may reduce the incidence of RCT required through definitive coronal coverage restorations for cracked teeth with reversible pulpitis.
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  • 文章类型: Journal Article
    流行病学研究表明,微骨折(裂缝)是工业化国家牙齿脱落的第三大常见原因。未被发现的裂缝将继续发展,经常有明显的疼痛,直到牙齿掉了.先前尝试利用锥形束计算机断层扫描(CBCT)来检测牙齿中的裂纹的成功非常有限。我们提出了一种模型,该模型通过将信号增强与基于深层CNN的裂纹检测模型相结合,在高分辨率(hr)CBCT扫描中检测裂纹牙齿。我们对45颗离体人类牙齿的数据集进行了实验,其中31颗破裂,14颗对照。我们证明,将经典的基于小波特征与深3DCNN模型相结合的模型可以在微型计算机断层扫描(地面实况)和hr-CBCT扫描中提高断牙检测精度。CNN模型被训练以预测示出最可能的断裂区域的概率图。基于该骨折概率图,我们检测骨折的存在,并且能够将骨折的牙齿与对照牙齿区分开。我们将这些结果与基于2DCNN的方法进行比较,我们表明我们的方法提供了出色的检测结果。我们还表明,所提出的解决方案能够在从hr-CBCT扫描中检测骨折方面优于口腔和颌面放射科医生。早期发现裂纹将导致设计更合适的治疗方法和更长的牙齿保留时间。
    Epidemiological studies indicate that microfractures (cracks) are the third most common cause of tooth loss in industrialized countries. An undetected crack will continue to progress, often with significant pain, until the tooth is lost. Previous attempts to utilize cone beam computed tomography (CBCT) for detecting cracks in teeth had very limited success. We propose a model that detects cracked teeth in high resolution (hr) CBCT scans by combining signal enhancement with a deep CNNbased crack detection model. We perform experiments on a dataset of 45 ex-vivo human teeth with 31 cracked and 14 controls. We demonstrate that a model that combines classical wavelet-based features with a deep 3D CNN model can improve fractured tooth detection accuracy in both micro-Computed Tomography (ground truth) and hr-CBCT scans. The CNN model is trained to predict a probability map showing the most likely fractured regions. Based on this fracture probability map we detect the presence of fracture and are able to differentiate a fractured tooth from a control tooth. We compare these results to a 2D CNN-based approach and we show that our approach provides superior detection results. We also show that the proposed solution is able to outperform oral and maxillofacial radiologists in detecting fractures from the hr-CBCT scans. Early detection of cracks will lead to the design of more appropriate treatments and longer tooth retention.
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  • 文章类型: Journal Article
    文献证据描述了各种治疗方案,这些方案已被用于改善生存率和解决相关的牙齿破裂症状的有效性。
    本系统综述调查了牙髓治疗的隐裂牙齿的生存能力和相关评估,专注于各种治疗方案。
    PRISMA指南用于指导本综述的文章选择框架。2023年5月,在各种数据库中对相关文献进行了全面搜索,并选择符合纳入标准的研究。数据提取,以标准化形式为指导,捕捉到关键细节,包括学习特点,治疗方案,和治疗结果,提高信息收集的一致性和准确性。数据提取和合成由两名审阅者独立完成。纽卡斯尔渥太华工具用于衡量研究的方法学质量。最终纳入了六项观察性研究。
    下颌磨牙特别容易出现裂纹,研究表明对牙齿问题的敏感性更高。研究表明,经过牙髓治疗的牙齿破裂具有75.8%至100%的总体存活率。偏见的风险评估,利用纽卡斯尔渥太华量表,表明在所有研究中风险适中,强调仔细解释发现的必要性。
    经牙髓治疗的隐裂牙齿在存活方面取得了显著的成功,随着牙髓治疗后牙冠的加入,显著提高了寿命和恢复力。
    UNASSIGNED: Literature evidence describes various treatment protocols that have been employed for the effectiveness in improving survival and addressing associated symptoms of cracked teeth.
    UNASSIGNED: This systematic review investigates the survivability of endodontically treated cracked teeth and associated assessments, focusing on various treatment protocols.
    UNASSIGNED: The PRISMA guidelines were utilised for guiding the article selection framework of this review. A comprehensive search of relevant literature was conducted in May 2023 across various databases, and studies meeting the inclusion criteria were selected. Data extraction, guided by a standardized form, captured crucial details, including study characteristics, treatment protocols, and treatment outcomes, enhancing the consistency and accuracy of information collection. Data extraction and synthesis was done by two reviewers independently. The Newcastle Ottawa tool was used to measure the methodological quality of the study. Six observational studies were eventually included.
    UNASSIGNED: Mandibular molars are particularly prone to developing cracks, with research indicating a heightened susceptibility to this dental issue. Studies reveal that endodontically treated cracked teeth boast robust overall survival rates ranging from 75.8% to 100%. The risk of bias assessment, utilizing the Newcastle Ottawa scale, indicated a moderate risk across studies, highlighting the necessity for careful interpretation of findings.
    UNASSIGNED: Endodontically treated cracked teeth show marked success in survival, with the incorporation of crowns post-endodontic treatment significantly enhancing longevity and resilience.
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  • 文章类型: Journal Article
    准确,及时地检测牙齿破裂对人类口腔健康起着至关重要的作用。本文的目的是评估牙齿裂纹分割模型的性能(即,FDB-DeepLabv3+)在光学显微图像上。
    此处提出的FDB-DeepLabv3+模型通过用ResNet50替换主干来改进功能学习。引入特征金字塔网络(FPN)来融合多级特征。应用密集链接的无空间金字塔池化(密集ASPP)来实现更密集的像素采样和更宽的感受场。嵌入瓶颈注意模块(BAM)以增强局部特征提取。
    通过对自制的隐裂牙齿数据集进行测试,所提出的方法优于四个经典网络(FCN,U-Net,SegNet,DeepLabv3)对分割结果的平均像素精度(MPA)和平均交集(MIoU)。与DeepLabv3+相比,该网络的MPA增长了11.41%,MIoU增长了12.14%。消融实验表明所有的修饰都是有益的。
    设计了一种改进的网络,用于分割牙齿表面裂纹,具有良好的整体性能和坚固性,这可能在计算机辅助诊断牙齿破裂方面具有巨大的潜力。
    UNASSIGNED: Accurate and prompt detection of cracked teeth plays a critical role for human oral health. The aim of this paper is to evaluate the performance of a tooth crack segmentation model (namely, FDB-DeepLabv3+) on optical microscopic images.
    UNASSIGNED: The FDB-DeepLabv3+ model proposed here improves feature learning by replacing the backbone with ResNet50. Feature pyramid network (FPN) is introduced to fuse muti-level features. Densely linked atrous spatial pyramid pooling (Dense ASPP) is applied to achieve denser pixel sampling and wider receptive field. Bottleneck attention module (BAM) is embedded to enhance local feature extraction.
    UNASSIGNED: Through testing on a self-made hidden cracked tooth dataset, the proposed method outperforms four classical networks (FCN, U-Net, SegNet, DeepLabv3+) on segmentation results in terms of mean pixel accuracy (MPA) and mean intersection over union (MIoU). The network achieves an increase of 11.41% in MPA and 12.14% in MIoU compared to DeepLabv3+. Ablation experiments shows that all the modifications are beneficial.
    UNASSIGNED: An improved network is designed for segmenting tooth surface cracks with good overall performance and robustness, which may hold significant potential in computer-aided diagnosis of cracked teeth.
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  • 文章类型: Journal Article
    目的:这项工作分析并比较了用不同材料和牙冠参数处理的相同裂纹牙齿模型的机械性能。因此,为牙科医生提供更结构化的方法来选择材料和几何参数,并确定裂纹牙齿的最强修复模型。
    方法:这项工作使用了有限元分析(FEA)。我们应用了25个恢复性模型,包括五种修复材料,和三个制备参数。采用相关分析法分析了有裂纹牙体的七种力学性能。
    结果:对于聚合为5°的牙冠,获得了最高的裂解制备寿命,宽度=0.8mm,和0.2毫米的长度偏移。ZC冠材料获得了最高的寿命,但用LU材料获得的裂纹尖端变形最小。
    结论:结果表明,较大的MOE材料用于牙冠,合理增加牙冠的厚度和长度是防止裂纹进一步扩展的有利方法。这项FEA研究,从而为临床指导制备适用于破裂牙齿的牙冠提供了新的基础。
    This work analyzed and compared the mechanical properties of identical cracked tooth models treated with different materials and crown parameters. Thus, to provide dentists with a more structured way to select materials and geometric parameters and determine the strongest restoration model for cracked teeth.
    This work used finite element analysis (FEA). We applied 25 restorative models, including five restorative materials, and three preparation parameters. Seven mechanical properties of the cracked tooth preparation were analyzed using correlation analysis.
    The highest lifetime of the cracked preparation was obtained for crowns with a 5° of polymerization, width = 0.8 mm, and a length offset of 0.2 mm. The highest lifetime was obtained with ZC crown material, but the least deformation of the cracked tip was obtained with LU material.
    The results showed that the larger MOE material for the crown and a reasonable increase in the thickness and length of the crown is a favorable method to prevent further cracks to extend. This FEA study, thereby forming a novel basis for clinical guidance as to preparation of dental crowns applicable to cracked teeth.
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  • 文章类型: Journal Article
    目的:本研究旨在使用立体显微镜和扫描电子显微镜(SEM)研究和比较根管预备过程中牙本质裂纹的建立。
    方法:将60颗摘除的人下颌前磨牙分为三组,每组20颗:两个实验组和一个对照。在随机对照实验组中,建立了根管。第一组:Waldentwalflex文件,第二组:Trunatomy(TRN)文件。第三组:对照组不接受制剂。在距顶点3、6和9mm处切片后,使用立体显微镜和SEM检查根部表面的牙本质裂纹。采用卡方检验对数据进行检验。
    结果:在对照组中,没有裂缝出现。WaldentWalflex的裂纹在3mm至6mm范围内几乎为66.7%。在6毫米和9毫米的水平,各实验组间差异无统计学意义(P>0.05)。发现样品的顶端区域的缺陷明显高于中位和冠状切片。
    结论:测试中使用的每个旋转文件都会产生牙裂。WaldentWalflex文件组中的缺陷比Trunatomy文件组中的缺陷更多。
    OBJECTIVE: This study aims to investigate and compare the establishment of dentinal cracks during root canal preparation using a stereomicroscope and a scanning electron microscope (SEM).
    METHODS: Sixty removed human mandibular premolars were separated into three groups of 20: two experimental and one control. Within the randomized controlled experimental groups, root canals were constructed. Group I: the Waldent walflex file and Group II: the Trunatomy (TRN) file. Group III: the control group received no preparations. The surfaces of the roots were checked for dentinal cracks using a stereomicroscope and SEM following sectioning at 3, 6, and 9 mm from the apex. The Chi-square test was used to examine the data.
    RESULTS: ​​​​​​ In the control group, no fissures appeared. Cracks in Waldent Walflex were almost 66.7% between the 3mm and 6mm range. At both the 6 mm and 9 mm levels, there was no statistically significant difference between the experimental groups (P > 0.05). Defects were found to be substantially higher in the apical region of samples than in the median and coronal sections.
    CONCLUSIONS: Dentinal fissures were created by every rotary file used in the tests. There were more flaws in the Waldent Walflex file group than in the Trunatomy file group.
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  • 文章类型: Case Reports
    已经提出了不同的修复技术来治疗受裂牙综合征(CTS)影响的后牙。然而,有关如何使用计算机辅助设计-计算机辅助制造(CAD-CAM)系统制成的陶瓷修复体解决CTS的协议的文献很少。CAD-CAM通常在一次访问中提供快速有效的修复治疗,降低污染和微渗透的风险的裂纹线。这项工作的目的是描述3例牙齿破裂的临床病例,呈现不同方向的垂直断裂线和穿过纸浆的延伸,通过CAD-CAM系统恢复,5年随访。短期自发性咀嚼疼痛患者,选择寒冷的敏感性和没有牙尖覆盖的修复牙齿。拍摄数字X射线照片(DR)以确认牙髓和根尖状态。牙周探查深度,灵敏度,打击乐器,并进行了闭塞试验。在牙科光学显微镜(DOM)下识别出骨折线及其方向和延伸。治疗计划分两个阶段进行:立即治疗以稳定牙齿并最大程度地减少疼痛,并通过CAD-CAM系统进行最终修复处理以稳定裂纹。患者年龄在37至45岁之间。大多数研究的牙齿都提供了广泛的修复体,没有牙尖覆盖。咬合干扰的存在,在横向运动中,是一个不断的发现。在不可逆牙髓炎或牙髓坏死的情况下进行牙髓治疗。在这三种情况下,腔准备进行了全覆盖修复,随着断裂线向几个方向延伸,要求重新执行有关牙齿的颈部区域。经5年临床和影像学随访,报告病例的生存率为100%,表明CAD-CAM系统可能是CTS管理中的一种有前途的替代治疗方法,改善牙齿寿命。
    Different restorative techniques have been proposed for the treatment of posterior teeth affected by cracked tooth syndrome (CTS). However, the literature is scarce in protocols of how to solve CTS using ceramic restorations made by computer aided design-computer aided manufacturing (CAD-CAM) system. CAD-CAM provides a fast and efficient restorative treatment usually in a single visit, reducing the risk of contamination and micro-infiltration of the cracked line. The objective of this work was to describe 3 clinical cases of cracked teeth, which presented vertical fracture lines in different directions and extension through the pulp, restored by CAD-CAM system, with 5-year follow-up. Patients with short-term spontaneous masticatory pain, cold sensibility and restored teeth without cuspal coverage were selected. Digital radiographs (DR) were taken to confirm the pulp and periapical status. Periodontal probing depth, sensitivity, percussion, and occlusion tests were performed. The fracture lines with their direction and extension were identified under dental optical microscope (DOM). The treatment plan was performed in two stages: immediate treatment to stabilize the tooth and minimize pain, and final restorative treatment by CAD-CAM system to stabilize the crack. Patients were between the ages of 37 and 45 years. Most of the studied teeth presented extensive restorations without cuspal coverage. The presence of occlusal interference, in lateral movement, was a constant finding. Endodontic treatment was performed in cases of irreversible pulpitis or pulpal necrosis. In all three cases, cavity preparation was performed for full coverage restorations, as the fracture lines extended in several directions, requiring a re-enforcement of the cervical region of the teeth in question. The survival rate of the reported cases was 100% with 5-year clinical and radiographic follow-up, suggesting that CAD-CAM system may be a promising alternative treatment in the management of CTS, improving tooth longevity.
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  • 文章类型: Journal Article
    背景:本文回顾了从大型,多站点,由国家牙科实践为基础的研究网络进行的3年观察性研究后牙与裂纹。
    方法:在6年(2017-2022年)中发表的八篇文章描述了后牙裂纹的临床特征及其治疗和结果,并进行了回顾和讨论,以回答口腔保健临床医生面临的3个常见问题:哪些裂纹会变得更糟?从业者何时进行干预?最好的治疗方法是什么?
    结果:尽管牙齿裂纹普遍存在,很少会断裂(3%)或在3年内出现裂纹进展(12%)。指导临床医生治疗的特征包括活动性龋齿,咬人的疼痛,在较小的程度上,有一个用探险家探测到的裂缝,与修复连接,或阻断透射光;选择的主要治疗方法是完整的牙冠。在接受治疗的牙齿中(36%),少数人(14%)需要再治疗,但仍能存活,尽管也有内部裂缝。
    结论:尽管牙齿破裂通常会给临床医生带来困境,临床医生通常擅长决定治疗哪些牙齿,何时以及监测哪些牙齿。
    This article reviews the most salient lessons learned from a large, multisite, 3-year observational study of posterior teeth with cracks conducted by The National Dental Practice-Based Research Network.
    Eight articles published over a 6-year period (2017-2022) describing clinical characteristics of posterior teeth with cracks and their treatment and outcomes are reviewed and discussed to answer 3 common questions faced by oral health care clinicians: Which cracked teeth will get worse? When should practitioners intervene? What is the best treatment?
    Although cracks in teeth are prevalent, few will fracture (3%) or show crack progression in 3 years (12%). Characteristics that guide the clinician to treatment include active caries, biting pain, and to a lesser degree, having a crack detectable with an explorer, connecting with a restoration, or blocking transilluminated light; the main treatment chosen is a complete crown. Of those teeth treated (36%), few (14%) will need retreatment but will still survive, despite having an internal crack as well.
    Although cracked teeth often pose a dilemma to clinicians, clincians are generally good at deciding which teeth to treat and when and which to monitor.
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  • 文章类型: Journal Article
    背景:患有可逆性牙髓炎的断裂牙齿可以在最终修复前的临时使用正畸带进行处理。这项研究的目的是确定这些牙齿在放置正畸带之后的短期结果。还分析了正畸带放置后确定牙髓诊断所需的时间以及相关的预后因素。
    方法:招募了125名患有可逆性牙髓炎的牙齿破裂患者。收集术前数据,包括患者和牙齿因素。将断裂的牙齿绑扎并检查,直到症状消失,然后再转诊进行冠状覆盖。进行Kaplan-Meier和Cox分析以分析这些牙齿的牙髓存活。预后因素采用Pearson卡方检验和Studentt检验。
    结果:分析了122颗有裂纹的牙齿。一百十三颗(92.6%)牙齿在2个月内解决了牙髓炎(中位数40.0;四分位数范围28-61)。需要根管治疗的牙齿发展为不可逆性牙髓炎或牙髓坏死的中位时间为3个月(中位数90.0;四分位数范围68-110)。没有预后因素与牙髓症状的消退有关。然而,较高的术前触发疼痛评分(P<.05,风险比1.547)和无远端边缘脊裂(P<.05,风险比0.638)与确定牙髓诊断前持续时间较长相关.
    结论:放置正畸带之后,在术前可逆性牙髓炎中,有92.6%的隐裂牙齿获得了正常的牙髓诊断。可以在大约2个月内确定明确的牙髓诊断。具有较高术前触发疼痛评分的牙齿可能需要较长的复查期。
    BACKGROUND: Cracked teeth with reversible pulpitis can be managed with orthodontic bands in the interim before definitive restorations. The aim of this study was to determine short-term outcomes of these teeth following orthodontic band placement. The time taken for definitive pulp diagnoses after orthodontic band placement and associated prognostic factors was also analyzed.
    METHODS: One hundred twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative data including patient and tooth factors were collected. Cracked teeth were banded and reviewed until symptoms resolved before referral for coronal coverage. Kaplan-Meier and Cox analyses were performed to analyze pulp survival of these teeth. Prognostic factors were investigated using Pearson\'s chi-square and Student\'s t-test.
    RESULTS: One hundred twenty-two cracked teeth were analyzed. One hundred thirteen (92.6%) teeth had the pulpitis resolved within 2 months (median 40.0; interquartile range 28-61). The median time taken for progression to irreversible pulpitis or pulp necrosis for teeth that required root canal treatment was 3 months (median 90.0; interquartile range 68-110). No prognostic factors were associated with the resolution of pulpal symptoms. However, higher preoperative triggered pain scores (P < .05, hazards ratio 1.547) and absence of a distal marginal ridge crack (P < .05, hazards ratio 0.638) were correlated with a longer duration before definitive pulp diagnoses.
    CONCLUSIONS: Following orthodontic band placement, a normal pulp diagnosis was achieved in 92.6% of cracked teeth with preoperative reversible pulpitis. Definitive pulp diagnoses could be determined in approximately 2 months. Teeth with higher preoperative triggered pain scores may require a longer review period.
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