Dentin thickness as a risk factor for vertical root fracture in endodontically treated teeth: a case-control study
Author(s): Silva LR, de Lima KL, Santos AA, Leles CR, Estrela C, de Freitas Silva BS, Yamamoto-Silva FP
Key words: Case-control; Cone-beam computed tomography; Dentin thickness; Endodontically treated teeth; Risk factor; Vertical root fracture.
Objectives: This study evaluated factors associated with vertical root fracture in endodontically treated teeth, using a cone-beam computed tomography (CBCT) image database.
Materials and methods: The sample for this case-control study consisted of 81 CBCT scans of teeth with vertical root fracture (VRF) and 81 CBCT scans of non-fractured teeth, matched by age, sex, and tooth position. The analyzed variables included dentin thickness, an intraradicular post, an adjacent implant, and a missing adjacent tooth. Student’s t test test was used to compare the quantitative variables. The chi-square test was used to compare the categorical variables. Logistic regression was performed to evaluate the association between the presence of VRF and the independent factors assessed.
Results: The mean dentin thickness of fractured teeth was 1.3 mm, whereas that of non-fractured ones was 1.5 mm (p < 0.001). There was no difference between the fractured and non-fractured groups, regarding implant frequency or missing adjacent tooth (p > 0.05). There were a significantly larger number of teeth with posts in the fractured versus non-fractured group (p = 0.007). However, dentin thickness ≤ 1.3 mm was the only factor associated with VRF in the multiple regression model (OR = 3.60, 95%CI = 1.76-7.37).
Conclusions: Dentin thickness may influence the development of VRF. Dentin thickness ≤ 1.3 mm is associated with a greater likelihood of fracture than ≥ 1.4 mm.
Clinical relevance: This study suggests there may be a minimum amount of safe dentin thickness that should be preserved after endodontic instrumentation.
