AIM:The purpose of this study was to analyse the diagnostic features and clinical characteristics of cracked molar teeth. MATERIALS AND METHODS:Patients diagnosed with cracked molar teeth were selected for this study. Clinical signs and symptoms, age, gender, and radiographic findings were recorded. Data collected included tooth number, presence/absence of restoration, direction and location of the crack, pulp vitality testing (cold test/electronic pulp testing), transillumination findings, methylene blue dye staining results, bite test response, percussion and palpation findings, presence of wear facets, presence or absence of periodontal pocket depth, and the final pulpal and periapical diagnoses. RESULTS:Out of 220 patients, 33 patients with cracked teeth were diagnosed. Cracked teeth were most frequently observed in patients aged between 30 and 40 years. A sensitive response to the bite test was observed in 98% of cases. Transillumination and methylene blue dye were effective in detecting cracks in 99% of cases. Mandibular first molar (55%) was most commonly affected, followed by mandibular second molar (36%) and maxillary first molar (9%). Most cracks (67%) were found in intact teeth, while 33% were associated with restored teeth, which was significant ( P = 0.021). Cracks were not significantly associated with deep periodontal pockets (18%) ( P = 0.026). The presence of wear facets was not significantly higher in cracked teeth. ( P = 0.602). Fifteen per cent of cracked teeth showed reversible pulpitis, 45% irreversible pulpitis, and 39% pulpal necrosis. CONCLUSION:A combined approach using history, clinical signs and symptoms, and tests, such as bite test, transillumination, and staining with methylene blue dye, is recommended for detecting cracks in teeth. Most cracked teeth showed pulpal diagnosis of irreversible pulpitis and pulpal necrosis, for which root canal treatment is recommended.
Since the earliest days of dentistry, professionals have recognized the importance of magnification in improving clinical precision. Advances in intraoral magnification, including loupes and operating microscopes, have ushered in the era of micro-dentistry and transformed dental practice. The effective use of these technologies requires a high level of skill and expertise to achieve optimal treatment outcomes in periodontics. However, microsurgical procedures such as connective tissue grafts and periodontal flap surgeries remain technically challenging due to increased instrument complexity and a restricted field of vision, along with limited precise documentation of techniques. Thus, enhanced tissue management practices support the development of the emerging subspecialty of microsurgical periodontics.
Background: Interdental papilla loss ("black triangles") is a prevalent aesthetic and functional deficit with limited non-surgical treatment options.1,4 Microneedling (MN) and injectable platelet-rich fibrin (i-PRF) individually promote soft tissue regeneration;5,6 however, their combined efficacy relative to MN alone has not been rigorously compared. Objective: To compare the clinical efficacy of MN alone versus MN combined with i-PRF for interdental papilla augmentation and gingival thickness improvement in patients with Class II papilla loss and thin periodontal phenotype. Materials and Methods: Twenty systemically healthy patients with Class II interdental papilla loss (Nordland and Tarnow classification) were randomly allocated to Group A (MN only, n = 10) or Group B (MN + i-PRF, n = 10). Both groups received four treatment sessions at 10-day intervals commencing 14 days after oral prophylaxis. i-PRF was prepared by centrifugation of 10 mL autologous venous blood at 700 rpm for 3 minutes9 and delivered immediately following MN. Primary outcomes were gingival thickness (transgingival probing) and Nordland and Tarnow class (standardised clinical photography) at baseline, 1 month, 3 months, and 6 months. Statistical analysis was performed using paired t-test (within-group) and independent t-test (between-group), with significance set at p < 0.05. Results: Both groups demonstrated statistically significant improvements in gingival thickness from baseline (p < 0.05). Group B showed significantly greater gains at 3 months (1.61 ± 0.13 mm vs 1.42 ± 0.11 mm, p = 0.001) and 6 months (1.82 ± 0.15 mm vs 1.49 ± 0.12 mm, p < 0.001) compared with Group A. Net gingival thickness gain was +0.63 mm in Group B versus +0.28 mm in Group A. Papilla class improved to Class I in 80% of Group B participants versus 30% in Group A at 6 months. No serious adverse events were recorded in either group. Conclusion: MN combined with i-PRF is significantly more effective than MN alone for interdental papilla augmentation and gingival thickness improvement in patients with thin periodontal phenotypes. This protocol constitutes a promising minimally invasive, autologous drug delivery strategy for non-surgical soft tissue regeneration in aesthetic periodontics.
AIM:This clinical study investigated coronal microstrain values in mandibular first molars of patients with tooth wear. MATERIALS AND METHODS:Thirty patients (40-60 years) with and without occlusal tooth wear in mandibular first molars were selected and categorised into three groups ( n = 10 each). Group 1 was the control group with Tooth Wear Index 0 (TWI: 0); Group 2 had TWI grade 1-2; and Group 3 had TWI grade 3. Initially, the maximum physiologic bite force in the first molar regions were determined using Flexiforce sensors, followed by the occlusal contact area. Next, the buccal and lingual microstrain values of mandibular first molars were recorded after a physiologic bite load. Additionally, all parameters were recorded for Group 3 after composite restoration and adjustments of non-functional occlusal contacts. Data were analysed using the Kruskal-Wallis test with Bonferroni correction ( P < 0.05). RESULTS:Mean bite force values were similar between groups ( P = 1.000). Mean buccal and lingual microstrain values in Group 3 were significantly higher than those of controls ( P = 0.003, 0.021). Mean lingual microstrain values of Group 3 were significantly higher than those of Group 2 ( P = 0.009). Restoration of molars in Group 3 resulted in reduced mean microstrain values that were similar to those of the controls ( P = 0.190). CONCLUSION:Coronal microstrain values of mandibular molars increased with severe tooth wear but reduced after placement of composite restorations and elimination of non-functional contacts. Severe occlusal wear increases coronal strain, and placement of a bonded restoration and occlusal correction can limit further wear and fracture.
