Incidence rates for complete cusp fracture

Objectives: Although complete cusp fracture is acknowledged to occur frequently, incidence rates have been reported rarely. This study determined incidence rates for complete coronal cusp fracture per person and per tooth type. Methods: All fractures presenting among enrollees in a dental health maintenance organization using two geographically isolated clinics were noted for 105 days. For a sample of these enrollees, likelihood of attending the clinic in the event of a fracture was assessed through a telephone survey, and the at-risk status of all teeth was determined through a record survey. Incidence rates were calculated for persons, and for individual tooth types for all complete fractures and for non-carious complete fractures, In addition, for posterior teeth the distribution of fractured cusps, and the severity of fractures were examined. Results: Per-person incidence rates for complete coronal fractures for all teeth were 89.0 and 72.7 per 1000 person years, respectively, for all fractures and for non-carious fractures. The rates for all anterior and all posterior teeth were 10.2 and 69.9, respectively, for all non-carious fractures. In mandibular posterior teeth, lingual cusps fractured twice as frequently as facial cusps, while the opposite was true for maxillary premolars. Among maxillary molars, the mesiofacial and distolingual cusps fractured most frequently. The large majority of fractures exposed dentin (95%), while pulpal exposure occurred infrequently (3%). A minority of fractures extended below the gingival crest (24%) or the DEJ (25%). Conclusions: This is the first report of fracture incidence rates for enumerated persons and teeth at risk and as such helps define the magnitude of the problem for dentists and their patients.