ccc ou ccm pour fêlure

merci pour vos réponses. il semble donc que personne n'ait connaissance d'études montrant la supériorité de telle ou telle technique.

vulpi

06/04/2021 à 17h14

c'est difficile de faire une étude "honnête" sur ce sujet, chaque fêlure étant particulière.
Perso je fais un moignon le moins haut possible (dans les 3 à 4 millimètres) pour limiter les contraintes sur les parois résiduelles et avec les arrêtes arrondies pour la même raison, je scelle et c'est TRES pifométrique:-))

merci.

Sethef

09/04/2021 à 16h53

Je note que personne n'a évoqué la distinction entre fêlure amélaire, amélodentinaire n'intéressant pas la pulpe, fêlure atteignant la pulpe et fêlure intéressant le plancher.

Le pronostic est différent, le traitement aussi.

vulpi

09/04/2021 à 17h01

En fonction de la dent aussi.
Je pense que nous évoquions la fêlure amelo dentinaire avec débordement au niveau d'une racine.

Sethef

09/04/2021 à 21h07

Si on descend infra gingival, ça semble effectivement compromis.

Bien que grand partisan des RCR collées, je pense comme toi que cela n'a aucune influence sur le pronostic d'une fêlure. Si le collage de 2 fragments disjoints pouvait rester étanche dans le temps, ça se saurait.

En terme de mécanique, si on ne peut pas cercler plus bas que la fêlure, ou fraiser la fêlure jusqu'au bout, je ne vois pas comment cela pourrait bien se finir.
Et collage ou scellement, métal ou résine n'y changeront pas grand chose.

« Introduction
There are no long-term, prospective clinical studies assessing outcomes of endodontically treated cracked teeth with radicular extensions. The purpose of this prospective study was to examine the 2- to 4-year success and survival rates of endodontically treated, coronally restored, cracked teeth, specifically where the crack extends beyond the level of the canal orifice internally.

Methods
Seventy consecutive teeth requiring endodontic treatment with cracks extending to the level of the canal orifice and up to 5 mm beyond were included in the cohort. Treatment was performed by a single endodontist using current techniques, and cases were followed over time. Specific treatment and posttreatment protocols were used. A tooth was “survived” if it was present, asymptomatic, and functional. The category of “success” was given to a case if strict radiographic and clinical criteria were met.

Results
Fifty-nine teeth were eligible for survival analysis, and 53 teeth were available for success analysis. There was a 100% survival rate in the first 2 years and 96.6% survival up to the 4-year period; 90.6% were classified as “success” in the 2- to 4-year term. No significant differences (P < .05) were found for periodontal pocketing (up to 7 mm) at the site of the crack, marginal ridge involvement, crack depth, or pretreatment diagnoses.

Conclusions
This study showed that the success and survival rates for cracked teeth with radicular extensions may be similar to endodontically treated teeth in general and may be higher than previously reported in cracked tooth studies. Treatment outcomes in cracked teeth with radicular extensions may be improved by using the following protocols: microscope-assisted intraorifice barriers placed apical to the extent of the crack, complete occlusal reduction, specific postoperative instructions, and expeditious placement of a full-coverage restoration. »

Journal of endodontics juillet 2019