Treatment of Cracked Teeth
For cracked teeth, immediate placement of a full-coverage crown restoration is the definitive treatment to prevent crack propagation, with root canal therapy reserved only for teeth demonstrating pulpal necrosis or irreversible pulpitis. 1, 2
Initial Diagnostic Assessment
The diagnosis of cracked tooth syndrome requires specific clinical testing, as patients often cannot identify the affected tooth and may report a history of multiple unsuccessful dental procedures 3, 4:
- Pain pattern: Discomfort occurs during chewing hard foods that ceases when pressure is withdrawn 3
- Transillumination: Use a focused light source (such as an otoscope) directed axially onto the crown to visualize crack lines 5
- Bite test: Apply pressure to individual cusps to reproduce symptoms 1
- Periodontal probing: Measure probing depths along the crack line, as deep pockets indicate worse prognosis 6
Classification-Based Treatment Algorithm
Infraction (Craze Line)
- Treatment: Place resin sealant over the crack line to prevent staining, or monitor without treatment if asymptomatic 5
- Follow-up: Monitor for signs of pulpal necrosis until the tooth is definitively restored 5
Cracked Tooth (Incomplete Fracture)
The treatment depends entirely on pulpal status, not the presence of the crack itself 1, 6:
For vital pulp without irreversible pulpitis:
- Immediate crown placement without root canal treatment to brace remaining tooth structure and prevent crack propagation 1, 2
- This approach has 74.1-96.8% survival at 5 years 2
For irreversible pulpitis or pulpal necrosis:
- Root canal treatment followed by crown restoration 6
- In one study, 83.3% of cracked teeth required root canal treatment before crown placement, though this reflects delayed presentation to specialists 6
Fractured Cusp
Split Tooth or Vertical Root Fracture
- Extraction is indicated, as these teeth cannot be predictably restored 1
Critical Management Principles
Early intervention is paramount - the longer a crack exists, the more likely it will propagate into the pulp chamber or extend subgingivally, necessitating root canal treatment or extraction 6:
- Teeth with deep periodontal probing depths (>6mm) along the crack have significantly worse prognosis 6
- Cracks in non-bonded restorations (gold, amalgam) or intact teeth are common, occurring in 48.6% of intact teeth in one series 6
- Mandibular and maxillary first molars are most frequently affected (52.8% combined) 6
Common pitfall: Performing root canal treatment prophylactically on all cracked teeth - only 16.7% of cracked teeth can be managed with crown placement alone if diagnosed early, avoiding unnecessary endodontic treatment 6
Restoration material matters: Bonded full-coverage restorations are essential to prevent flexion and further crack propagation 2. Partial coverage restorations or conservative approaches fail to adequately brace the tooth 1, 2.
Prognosis Factors
Teeth with cracked tooth syndrome have a guarded but acceptable prognosis when properly managed 2: