title: An in vitro comparison of quantitative percussion diagnostics with a standard technique for determining the presence of cracks in natural teeth.
abstract: BACKGROUND
  The detection of cracks and fractures in natural teeth is a diagnostic challenge. Cracks are often not visible clinically nor detectable in radiographs.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the diagnostic parity of quantitative percussion diagnostics, transillumination, clinical microscopy, and dye penetration.
  
  
  METHODS
  Three independent examiners provided blind testing for the study. Examiner 1 transilluminated 30 extracted teeth and 23 three-dimensional copy replica control teeth and documented any visible cracks. Each tooth was then mounted in acrylic resin with a periodontal ligament substitute. Examiner 2 examined each specimen aided by the clinical microscope and transillumination and documented visible tooth cracks and fractures. Examiners 1 and 3 then independently tested all specimens with a device developed for quantitative percussion diagnostics. All visible cracks/fractures were removed with a water-cooled fine diamond rotary instrument. Crack visibility was enhanced by the use of a clinical microscope, dye penetrant, and accessory transillumination. This disassembly process was video documented/photographed for each specimen. One more quantitative percussion diagnostics testing was administered when the disassembly was complete.
  
  
  RESULTS
  Quantitative percussion diagnostics crack detection agreed with the gold standard microscope and transillumination method in 52 of 53 comparisons (98% agreement). Moreover, the method achieved 96% specificity and 100% sensitivity for detecting cracks and fractures in natural teeth. When all tooth cracks were removed, quantitative percussion diagnostics indicated no further structural instability.
  
  
  CONCLUSIONS
  Quantitative percussion diagnostics can nondestructively detect cracks and fractures in natural teeth with accuracy similar to that of the clinical microscope, transillumination, and dye penetrant. In addition, the method was able to reveal the presence of many cracks that were not detected by conventional transillumination.
authors.affiliation: Co-Executive Director, Research and Teaching Divisions, Newport Coast Oral Facial Institute, Newport Beach, Calif. Electronic address: cgsheets@ncofi.org.
authors.forename: Cherilyn G
authors.initials: CG
authors.lastname: Sheets
authors.affiliation: Researcher, Research Division, Newport Coast Oral Facial Institute, Newport Beach, Calif.
authors.forename: Devin L
authors.initials: DL
authors.lastname: Stewart
authors.affiliation: Co-Executive Director, Research and Teaching Divisions, Newport Coast Oral Facial Institute, Newport Beach, Calif.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Professor, Chemical Engineering and Materials Science and Biomedical Engineering, Henry Samueli School of Engineering at University of California-Irvine, Irvine, Calif.
authors.forename: James C
authors.initials: JC
authors.lastname: Earthman
mesh_terms: D004396:Coloring Agents; D003387:Cracked Tooth Syndrome / Q000175:diagnosis*; D006801:Humans; D066298:In Vitro Techniques; D008853:Microscopy / Q000379:methods; D010474:Percussion / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D010781:Photography; D011237:Predictive Value of Tests; D016628:Replica Techniques; D012680:Sensitivity and Specificity; D014048:Tolonium Chloride; D014082:Tooth Fractures / Q000175:diagnosis*; D014172:Transillumination / Q000379:methods; D014741:Video Recording
chemical_list: D004396:Coloring Agents; D014048:Tolonium Chloride