A Survey of Cusp Fractures in a Population of General Dental Practices

Purpose: This study was conducted to expand the knowledge on the incidence of complete cusp fractures of posterior teeth in Dutch general practices. Materials and Methods: During a 3-month period, data were obtained from 28 general practitioners, representing 46,394 patients. For each new case of complete cusp fracture, clinicians recorded information using a standard form with questions relating to location of the fracture, cause of fracture, and restorative status of the tooth prior to the cusp fracture. Results: There were 238 cases of complete cusp fracture recorded. The results of this study indicate an incidence rate of cusp fractures of 20.5 per 1,000 person-years at risk. Molars were more frequently registered with cusp fractures than premolars (79% vs 21%). Maxillary molars presented more fractures of buccal cusps (66% vs 34%), while mandibular molars presented more fractures of lingual cusps (75% vs 25%). Almost 77% of the cases had been restored on three or more surfaces. Statistical analysis revealed a positive correlation between history of endodontic treatment and subgingival fracture location. Mastication was most frequently reported as the cause for fracture (54%), although one can argue whether the occlusal force was the cause or the immediate reason. Conclusion: This study revealed that complete cusp fracture is a common phenomenon in dental practice and has shown differences in cusp fracture with respect to tooth type and restorative status of the tooth. Teeth with a history of endodontic treatment are susceptible to unfavorable subgingival fracture locations.