裂齒之診斷與治療：敘述性文獻回顧

Diagnosis and Treatment of Cracked Teeth: A Narrative Literature Review

裂齒是牙科臨床中常見的一種現象，但對於其原因及機制尚未廣泛了解，也因此容易造成臨床診斷的困難。裂齒是指牙齒牙釉質和牙本質的淺層表面破裂，可能向牙根延伸至牙骨質，龜裂的實際深度或範圍臨床上無法判斷。裂齒好發於大臼齒區，以年齡層介於40–59歲較常見。裂紋造成牙髓病變，可能誘發轉移痛。此類型疼痛診斷困難。裂紋若侷限於牙冠區預後較好，若延伸到牙根區域會增加牙齒拔除的機率達11倍。5年存活率觀察值分別為：裂紋無延伸到牙髓腔底部區域為99%；裂紋延伸到牙髓腔底部區域為88%。儘早放置全覆蓋牙冠可顯著提高裂齒牙的存活率。早期修復裂齒的11年總體成功率為93.0%。本篇文章透過文獻回顧探討裂齒之致病因子、診斷、治療及預後，提供相關資訊希望臨床牙醫師對裂齒能及早診斷及治療。

Cracked teeth are a phenomenon that is commonly observed in dental daily practice but they are not widely understood. This can make formulating a proper diagnosis difficult and their presence can lead to inappropriate treatment. A cracked tooth is a thin surface disruption of enamel and dentin, and possibly cementum, of unknown depth or extension. The most frequently involved tooth positions are molars, among patients aged between 40–59 years. If the crack extends only until the dental pulp, the inflamed vital pulps are substantiated and associated with the presence of referred pain. This type of pain can make forming an appropriate and accurate diagnosis of an offending tooth exceptionally difficult. Coronal cracks may be predictably treated, whereas radicular cracks increase the odds of the tooth being extracted by 11-fold. The 5-year survival estimate in the absence and presence of crack extension onto the pulpal floor is 99% and 88%, respectively. Moreover, early placement of full-coverage crowns should be implemented for cracked teeth regardless of direction or the number of crack lines because it is associated with a higher cracked tooth survival rate. Toubes et al. demonstrated that the overall success rate of cracked teeth restored early was 93.0%. This article provides a comprehensive literature review to introduce cracked teeth, including predisposing factors, diagnosis, treatment and prognosis. Through this article, dental clinicians can utilize the updated information to manage target teeth more efficiently and accurately.