A statistically significant risk factor for tooth loss was the number of remaining teeth at the start of maintenance. One retrospective study has shown that most teeth lost were nonvital teeth (92%), and the most common cause of tooth loss was tooth fracture (62%). These incidence estimations, although different, show posterior teeth fractures are a frequent and relevant problem due to a lack of scientific knowledge. Some studies have investigated fractures on posterior teeth reporting different prevalence/incidence rates, varying from 20. Overall, teeth with endodontic treatment presented a higher subgingival fracture. Most of the patients did not show previous symptoms and signs. Fractures were more common in teeth where the restoration had an isthmus wider than 1/3 of the intercuspid distance and/or involved more than three restored surfaces. In general, lingual cusps were the most fractured and were associated with a higher prevalence of severe fractures (total fractures at the subgingival level). However, upper pre-molars showed more fractures in functional cusps and lower molars presented more fractures on the nonfunctional cusps.

Conclusion: Indications of classic protection on functional cusps (LUBL) was refuted since, generally, nonfunctional cusps fractured more than the functional cusps. On lingual cusps, fracture type and location were significantly associated, being that total fractures were 3.2 times more likely to occur than partial fractures, and subgingival were 3.62 times more likely to occur than supragingival fractures. Teeth with endodontic treatment presented a higher subgingival fracture. Fractures were more common in teeth with isthmus wider than 1/3 of the intercuspid distance and/or more than three restored surfaces. Non-functional and lingual cusps presented a higher fracture than functional and buccal cusps, respectively. Results: One hundred and seventy-seven (177) patients from 16 to 66 years old (±41.56), from 1998 to 2016, were included in this study. Statistical analysis was performed by the Fisher exact test, and uni- and multivariate logistic regression (α = 0.05). Demographic and clinical data were collected to draw the patient profiles and establish how teeth were affected individually.

Fractured teeth already treated, with antagonist absence, or with prosthesis (total or removable) were excluded. Methods: Patients presented cusp fractures on posterior permanent teeth, clinically assessed in up to 7 days after the event, and requesting dental treatment at two public services were included in this cross-sectional study.

Objectives: This cross-sectional study aimed to evaluate the frequency and risk factors associated with cusp fractures in posterior permanent teeth.

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