Management of a Fully Cracked Tooth
A fully cracked tooth does not automatically require extraction—management depends critically on the extent and location of the crack, with treatment options ranging from monitoring and restoration to extraction only when the crack extends deep into the root or causes irreversible complications.
Understanding "Fully Cracked" vs. Other Fracture Types
The term "fully cracked" requires clarification, as different crack patterns have vastly different prognoses 1:
- Infraction (crack line): A superficial crack in enamel only—the tooth remains intact and functional 1
- Incomplete fracture (Cracked Tooth Syndrome): A crack extending through enamel into dentin, possibly reaching the pulp, but the tooth segments remain together 2, 3
- Complete fracture (Split tooth): The tooth is separated into distinct segments—this typically requires extraction 4
Treatment Algorithm Based on Crack Depth
Enamel-Only Cracks (Infractions)
- No treatment or simple smoothing of sharp edges if causing soft tissue irritation 1
- Monitor for signs of pulpal necrosis (tooth discoloration, abscess formation) until natural exfoliation or indefinitely 1
- Prognosis is excellent; extraction is not indicated 1
Enamel and Dentin Cracks Without Pulp Exposure
- Restoration with bonded composite or full coverage crown is the treatment of choice 1, 5
- The goal is to bind the tooth segments together and prevent crack propagation 2, 5
- Dental referral within a few days is appropriate 1, 6
- Extraction is not indicated unless the patient cannot cooperate with restorative care 1
Cracks With Pulp Exposure (Complicated Fractures)
- Pulp therapy (pulpotomy or pulpectomy) followed by restoration is first-line treatment 1
- Extraction is indicated only if: the patient's behavior precludes pulp therapy, the crack extends deep into the root making restoration impossible, or there is severe crown-root involvement 1
- Immediate dental referral is required 6
Root Fractures
The location of the root fracture determines management 1:
- Fracture near the root apex: Excellent prognosis; rarely requires treatment beyond monitoring 1
- Fracture near the crown: Poor prognosis; the crown segment is usually removed 1
- Mid-root fractures: May be managed conservatively if the crown segment is stable 1
- Extraction of the entire tooth is indicated only when the root fracture compromises stability or poses aspiration risk 1
Key Clinical Pitfalls to Avoid
Do not extract based on the presence of a crack alone—many cracked teeth can be successfully restored and maintained for years 2, 3, 5. The critical error is assuming all cracks require extraction when most benefit from conservative management.
Delayed referral for pulp-exposed fractures leads to pulpal necrosis and infection, significantly worsening prognosis 6. These require same-day dental evaluation.
Cracked Tooth Syndrome is frequently misdiagnosed because symptoms are variable and the crack may be difficult to visualize 2, 3. Patients often report pain with chewing that ceases when pressure is released, and may have a history of multiple unsuccessful dental procedures 2.
When Extraction IS Indicated
Extraction becomes necessary in these specific scenarios 1:
- The tooth is split into separate segments (complete fracture through the entire tooth) 4
- Severe crown-root fracture where restoration is not feasible 1
- The crack extends so deep into the root that periodontal attachment is compromised 1
- Root fracture near the crown with excessive mobility and aspiration risk 1
- Patient cannot cooperate with restorative or endodontic treatment 1
- In primary dentition: when a luxated or fractured tooth interferes with occlusion and is near natural exfoliation 1