ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Pilot Data Suggests Use of Ultrasound Will Be Effective in Diagnosis of Incomplete Crown Fracture in The Future
Clinical Question In patients with pain on biting, is the use of ultrasound as effective, compared to radiographs in diagnosing cracked tooth syndrome?
Clinical Bottom Line Pilot data suggests that ultrasound use for detection of fractured teeth is effective, but more research is needed to determine appropriate use in clinical situations. In vivo studies are needed.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17907483Singh/20073 Simulated (Phantom) teeth and 6 extracted human molars.Pilot In vitro Study
Key resultsComparison Study of ultrasound use with various dental materials. A 25 µm thick crack was introduced into simulated dentin (auto-cured composite resin) in the 3 phantom teeth with porcelain, amalgam and gold restorations placed prior to crack. Crack depths of 0.94 ± 0.05 mm and 0.92 ± 0.02 mm for porcelain and amalgam phantom were recorded with ultrasound. Crack was not detected under phantom with gold restoration. Caliper measurements of crack in simulated teeth were consistent with recorded depths from ultrasound. A 10 µm crack was introduced into the 6 extracted molars without restorations. Crack was also detected in these teeth at a 1.2 mm distance using ultrasound. Consistent with caliper measurement of 1.2 ± .01 mm.
#2) 12403145Ghorayeb/2002 4 extracted teethPilot In vitro Study
Key resultsFour extracted teeth (intact tooth, tooth with amalgam and surface fissures, tooth with drilled hole to simulated cavitation and complete calcification tooth) were used to conduct 8 tests. Ultrasound was able to detect difference interface of enamel, enamel-dentin and dentin-pulp in intact tooth. Sound reflection was measured at 16.96 µs, 17.60 µs and 18.60 µs, respectively. Using velocities of sound for enamel and dentin, thickness of both were determined at 2.O mm and 1.9 mm. Sound refection of 1.8 µs was recorded between amalgam and surface fissure tooth, with a measurement of 4.0 mm for the restoration using the velocity of sound for amalgam. A measurement of 2.4 mm was calculated from tooth surface to drilled interface in tooth containing artificial cavitation. Tooth with complete calcification, only enamel interface produced sound echo (19.0 µs) due to complete obliteration of pulpal system.
Evidence Search tooth fracture/ultrasonography
Comments on
The Evidence
The validity of the use of ultrasound technology appears credible for future use. In both studies the researchers were able to accurately identify and measure locations and depths of varies transitions between materials and/or tooth structure. The lack of repeatable detection of cracks with gold restorations in the Singh paper makes its complete use in all clinical situations unlikely at this time. Further research is needed to determine specific frequency for detection thorough this type of material. Furthermore, as noted in both papers, cracks in teeth do not always have a complete linear orientation. More research is needed to understand ultrasound use with complex cracks or fractures, and in vivo studies are needed prior to its use in clinical applications.
Applicability In the future ultrasound diagnosis may play a role in detection of incomplete crown fracture, caries detection, implant dentistry and temporomandibular disorder. The use of ultrasound technology has the potential to be a pain-less, inexpensive way to detect both normal and abnormal anatomy, without the use of ionizing radiation. More research is warranted.
Specialty/Discipline (Endodontics) (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Ultrasound, Crack, Incomplete crown fracture, Ultrasonography, Cracked tooth, Cracked tooth syndrome
ID# 2551
Date of submission: 08/06/2013spacer
E-mail moncriefd@livemail.uthscsa.edu
Author Dionte R. Moncrief
Co-author(s) Priscila Liporoni
Co-author(s) e-mail Liporoni@uthscsa.edu
Faculty mentor/Co-author James Piper, DDS
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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