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CC BY-NC-ND 4.0 · Eur J Dent 2015; 09(02): 293-303
DOI: 10.4103/1305-7456.156840
Review Article
Dental Investigation Society

Cracked tooth diagnosis and treatment: An alternative paradigm

John S. Mamoun
1   Private Practice in Manalapan, NJ, USA
,
Donato Napoletano
2   Private Practice in Middletown, NY, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
04 September 2019 (online)

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ABSTRACT

This article reviews the diagnosis and treatment of cracked teeth, and explores common clinical examples of cracked teeth, such as cusp fractures, fractures into tooth furcations, and root fractures. This article provides alternative definitions of terms such as cracked teeth, complete and incomplete fractures and crack lines, and explores the scientific rationale for dental terminology commonly used to describe cracked teeth, such as cracked tooth syndrome, structural versus nonstructural cracks, and vertical, horizontal, and oblique fractures. The article explains the advantages of high magnification loupes (×6–8 or greater), or the surgical operating microscope, combined with co-axial or head-mounted illumination, when observing teeth for microscopic crack lines or enamel craze lines. The article explores what biomechanical factors help to facilitate the development of cracks in teeth, and under what circumstances a full coverage crown may be indicated for preventing further propagation of a fracture plane. Articles on cracked tooth phenomena were located via a PubMed search using a variety of keywords, and via selective hand-searching of citations contained within located articles.

Key words:

Crack propagation - cracked tooth syndrome - microscopes - tooth fractures
 

  • REFERENCES

  • 1 Ellis SG. Incomplete tooth fracture – Proposal for a new definition. Br Dent J 2001; 190: 424-8
    CrossrefPubMedGoogle Scholar
  • 2 Rosen H. Cracked tooth syndrome. J Prosthet Dent 1982; 47: 36-43
    CrossrefPubMedGoogle Scholar
  • 3 Majorana A, Pasini S, Bardellini E, Keller E. Clinical and epidemiological study of traumatic root fractures. Dent Traumatol 2002; 18: 77-80
    CrossrefPubMedGoogle Scholar
  • 4 De Bruyne MA, De Moor RJ. Influence of cracks on leakage and obturation efficiency of root-end filling materials after ultrasonic preparation: An in vitro evaluation. Quintessence Int 2008; 39: 685-92
    PubMedGoogle Scholar
  • 5 Clark DJ, Sheets CG, Paquette JM. Definitive diagnosis of early enamel and dentin cracks based on microscopic evaluation. J Esthet Restor Dent 2003; 15: 391-401
    CrossrefPubMedGoogle Scholar
  • 6 Mamoun JS. A rationale for the use of high-powered magnification or microscopes in general dentistry. Gen Dent 2009; 57: 18-26
    PubMedGoogle Scholar
  • 7 van As G. Magnification and the alternatives for microdentistry. Compend Contin Educ Dent 2001; 22: 1008-12 1014
    PubMedGoogle Scholar
  • 8 Cameron CE. The cracked tooth syndrome: Additional findings. J Am Dent Assoc 1976; 93: 971-5
    CrossrefPubMedGoogle Scholar
  • 9 Seo DG, Yi YA, Shin SJ, Park JW. Analysis of factors associated with cracked teeth. J Endod 2012; 38: 288-92
    CrossrefPubMedGoogle Scholar
  • 10 Abou-Rass M. Crack lines: The precursors of tooth fractures-their diagnosis and treatment. Quintessence Int Dent Dig 1983; 14: 437-47
    PubMedGoogle Scholar
  • 11 Kim SY, Kim SH, Cho SB, Lee GO, Yang SE. Different treatment protocols for different pulpal and periapical diagnoses of 72 cracked teeth. J Endod 2013; 39: 449-52
    CrossrefPubMedGoogle Scholar
  • 12 Ehrmann EH, Tyas MJ. Cracked tooth syndrome: Diagnosis, treatment and correlation between symptoms and post-extraction findings. Aust Dent J 1990; 35: 105-12
    CrossrefPubMedGoogle Scholar
  • 13 Gibbs JW. Cuspal fracture odontalgia. Dent Dig 1954; 60: 158-60
    Google Scholar
  • 14 Kalyan ChakravarthyPV, Telang LA, Nerali J, Telang A. Cracked tooth: A report of two cases and role of cone beam computed tomography in diagnosis. Case Rep Dent 2012; 2012: 525364
    PubMedGoogle Scholar
  • 15 Turp JC, Gobetti JF. The cracked tooth syndrome: An elusive diagnosis. J Am Dent Assoc 1996; 127: 1502-7
    CrossrefPubMedGoogle Scholar
  • 16 Moule AJ, Kahler B. Diagnosis and management of teeth with vertical root fractures. Aust Dent J 1999; 44: 75-87
    CrossrefPubMedGoogle Scholar
  • 17 Barkhordar RA. Treatment of vertical root fracture: A case report. Quintessence Int 1991; 22: 707-9
    PubMedGoogle Scholar
  • 18 Lynch CD, McConnell RJ. The cracked tooth syndrome. J Can Dent Assoc 2002; 68: 470-5
    PubMedGoogle Scholar
  • 19 Langer B, Stein SD, Wagenberg B. An evaluation of root resections. A ten-year study. J Periodontol 1981; 52: 719-22
    CrossrefPubMedGoogle Scholar
  • 20 Bühler H. Evaluation of root-resected teeth. Results after 10 years. J Periodontol 1988; 59: 805-10
    CrossrefPubMedGoogle Scholar
  • 21 Howe CA, McKendry DJ. Effect of endodontic access preparation on resistance to crown-root fracture. J Am Dent Assoc 1990; 121: 712-5
    CrossrefPubMedGoogle Scholar
  • 22 Reeh ES, Douglas WH, Messer HH. Stiffness of endodontically-treated teeth related to restoration technique. J Dent Res 1989; 68: 1540-4
    Google Scholar
  • 23 Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod 1989; 15: 512-6
    CrossrefPubMedGoogle Scholar
  • 24 Bearn DR, Saunders EM, Saunders WP. The bonded amalgam restoration – a review of the literature and report of its use in the treatment of four cases of cracked-tooth syndrome. Quintessence Int 1994; 25: 321-6
    PubMedGoogle Scholar
  • 25 Re GJ, Norling BK, Draheim RN. Fracture resistance of lower molars with varying faciocclusolingual amalgam restorations. J Prosthet Dent 1982; 47: 518-21
    CrossrefPubMedGoogle Scholar
  • 26 Goel VK, Khera SC, Gurusami S, Chen RC. Effect of cavity depth on stresses in a restored tooth. J Prosthet Dent 1992; 67: 174-83
    CrossrefPubMedGoogle Scholar
  • 27 Khairy MA. Fracture resistance in conservative Class II cavity preparation: Box vs tunnel. Egypt Dent J 1994; 40: 751-6
    PubMedGoogle Scholar
  • 28 Hood JA. Biomechanics of the intact, prepared and restored tooth: Some clinical implications. Int Dent J 1991; 41: 25-32
    PubMedGoogle Scholar
  • 29 Toparli M, Gökay N, Aksoy T. An investigation of the stress values on a tooth restored by amalgam. J Oral Rehabil 1999; 26: 259-63
    CrossrefPubMedGoogle Scholar
  • 30 Blaser PK, Lund MR, Cochran MA, Potter RH. Effect of designs of Class 2 preparations on resistance of teeth to fracture. Oper Dent 1983; 8: 6-10
    PubMedGoogle Scholar
  • 31 Larson TD, Douglas WH, Geistfeld RE. Effect of prepared cavities on the strength of teeth. Oper Dent 1981; 6: 2-5
    PubMedGoogle Scholar
  • 32 Homewood CI. Cracked tooth syndrome – incidence, clinical findings and treatment. Aust Dent J 1998; 43: 217-22
    CrossrefPubMedGoogle Scholar
  • 33 Caron GA, Murchison DF, Cohen RB, Broome JC. Resistance to fracture of teeth with various preparations for amalgam. J Dent 1996; 24: 407-10
    CrossrefPubMedGoogle Scholar
  • 34 Panitvisai P, Messer HH. Cuspal deflection in molars in relation to endodontic and restorative procedures. J Endod 1995; 21: 57-61
    CrossrefPubMedGoogle Scholar
  • 35 Tennert C, Eismann M, Goetz F, Woelber JP, Hellwig E, Polydorou O. A temporary filling material used for coronal sealing during endodontic treatment may cause tooth fractures in large Class II cavities in vitro . Int Endod J 2015; 48: 84-8
    CrossrefPubMedGoogle Scholar
  • 36 American Association of Endodontics. Cracking the Cracked Tooth Code. Endodontics: Colleagues for Excellence Newsletter; Fall/Winter 1997
    Google Scholar
  • 37 Hiatt WH. Incomplete crown-root fracture in pulpal-periodontal disease. J Periodontol 1973; 44: 369-79
    CrossrefPubMedGoogle Scholar
  • 38 Schneider AR, Binder H. Periodontal considerations relevant to treating the fractured tooth. J Prosthet Dent 1984; 51: 624-7
    CrossrefPubMedGoogle Scholar
  • 39 Polson AM. Periodontal destruction associated with vertical root fracture. J Periodontol 1977; 48: 27-32
    CrossrefPubMedGoogle Scholar
  • 40 Cavel WT, Kelsey WP, Blankenau RJ. An in vivo study of cuspal fracture. J Prosthet Dent 1985; 53: 38-42
    CrossrefPubMedGoogle Scholar
  • 41 Batalha-Silva S, Gondo R, Stolf SC, Baratieri LN. Cracked tooth syndrome in an unrestored maxillary premolar: A case report. Oper Dent 2014; 39: 460-8
    CrossrefPubMedGoogle Scholar
  • 42 Alassaad SS. Incomplete cusp fractures: Early diagnosis and communication with patients using fiber-optic transillumination and intraoral photography. Gen Dent 2011; 59: 132-5
    PubMedGoogle Scholar
  • 43 Pane ES, Palamara JE, Messer HH. Stainless steel bands in endodontics: Effects on cuspal flexure and fracture resistance. Int Endod J 2002; 35: 467-71
    CrossrefPubMedGoogle Scholar
  • 44 Wright EF, Bartoloni JA. Diagnosing, managing, and preventing cracked tooth syndrome. Gen Dent 2012; 60: e302-7
    PubMedGoogle Scholar
  • 45 West JD. The cracked tooth syndrome. Dent Today 2002; 21: 88-97
    PubMedGoogle Scholar
  • 46 Heithersay GS, Moule AJ. Anterior subgingival fractures: A review of treatment alternatives. Aust Dent J 1982; 27: 368-76
    CrossrefPubMedGoogle Scholar
  • 47 McCord JF, Harvie H. An alternative treatment of anterior teeth fractured beneath the gingival margin. Br Dent J 1984; 157: 320-2
    CrossrefPubMedGoogle Scholar
  • 48 Keçeli TI, Kutlu B, Gungor HC. Preserving alveolar bone growth following cervical root fracture: A case report. J Can Dent Assoc 2013; 79: d158
    PubMedGoogle Scholar
  • 49 Ozcopur B, Akman S, Eskitascioglu G, Belli S. The effect of different posts on fracture strength of roots with vertical fracture and re-attached fragments. J Oral Rehabil 2010; 37: 615-23
    PubMedGoogle Scholar
  • 50 Milot P, Stein RS. Root fracture in endodontically treated teeth related to post selection and crown design. J Prosthet Dent 1992; 68: 428-35
    CrossrefPubMedGoogle Scholar
  • 51 Mamoun JS. On the ferrule effect and the biomechanical stability of teeth restored with cores, posts, and crowns. Eur J Dent 2014; 8: 281-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Sorensen JA, Engelman MJ. Ferrule design and fracture resistance of endodontically treated teeth. J Prosthet Dent 1990; 63: 529-36
    CrossrefPubMedGoogle Scholar
  • 53 Ertas H, Sagsen B, Arslan H, Er O, Ertas ET. Effects of physical and morphological properties of roots on fracture resistance. Eur J Dent 2014; 8: 261-4
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Uzunoglu E, Aktemur S, Uyanik MO, Durmaz V, Nagas E. Effect of ethylenediaminetetraacetic acid on root fracture with respect to concentration at different time exposures. J Endod 2012; 38: 1110-3
    CrossrefPubMedGoogle Scholar
  • 55 Dang DA, Walton RE. Vertical root fracture and root distortion: Effect of spreader design. J Endod 1989; 15: 294-301
    CrossrefPubMedGoogle Scholar
  • 56 Harvey TE, White JT, Leeb IJ. Lateral condensation stress in root canals. J Endod 1981; 7: 151-5
    CrossrefPubMedGoogle Scholar
  • 57 Aydemir S, Cimilli H, Hazar YoruçAB, Kartal N. Evaluation of two different root-end cavity preparation techniques: A scanning electron microscope study. Eur J Dent 2013; 7: 186-90
    Article in Thieme ConnectPubMedGoogle Scholar
  • 58 Davis R, Overton JD. Efficacy of bonded and nonbonded amalgam in the treatment of teeth with incomplete fractures. J Am Dent Assoc 2000; 131: 469-78
    CrossrefPubMedGoogle Scholar
  • 59 Opdam NJ, Roeters JJ, Loomans BA, Bronkhorst EM. Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration. J Endod 2008; 34: 808-11
    CrossrefPubMedGoogle Scholar
  • 60 Eakle WS. Reinforcement of fractured posterior teeth with bonded composite resin restorations. Quintessence Int 1985; 16: 481-2
    PubMedGoogle Scholar
  • 61 Baxter PW. Management of vertical incomplete fractures of posterior teeth with composite resin. Br Dent J 1987; 162: 219-20
    CrossrefPubMedGoogle Scholar
  • 62 Trushkowsky R. Restoration of a cracked tooth with a bonded amalgam. Quintessence Int 1991; 22: 397-400
    PubMedGoogle Scholar
  • 63 Agar JR, Weller RN. Occlusal adjustment for initial treatment and prevention of the cracked tooth syndrome. J Prosthet Dent 1988; 60: 145-7
    CrossrefPubMedGoogle Scholar
  • 64 Ito K, Nanba K, Akashi T, Murai S. Incomplete fractures in intact bilateral maxillary first molars: A case report. Quintessence Int 1998; 29: 243-8
    PubMedGoogle Scholar
  • 65 Lin CL, Chang YH, Hsieh SK, Chang WJ. Estimation of the failure risk of a maxillary premolar with different crack depths with endodontic treatment by computer-aided design/computer-aided manufacturing ceramic restorations. J Endod 2013; 39: 375-9
    CrossrefPubMedGoogle Scholar
  • 66 Banerji S, Mehta SB, Millar BJ. Cracked tooth syndrome. Part 2: Restorative options for the management of cracked tooth syndrome. Br Dent J 2010; 208: 503-14
    CrossrefPubMedGoogle Scholar
  • 67 Qian Y, Zhou X, Yang J. Correlation between cuspal inclination and tooth cracked syndrome: A three-dimensional reconstruction measurement and finite element analysis. Dent Traumatol 2013; 29: 226-33
    CrossrefPubMedGoogle Scholar
  • 68 Guthrie RC, DiFiore PM. Treating the cracked tooth with a full crown. J Am Dent Assoc 1991; 122: 71-3
    PubMedGoogle Scholar
  • 69 Bader JD, Shugars DA, Roberson TM. Using crowns to prevent tooth fracture. Community Dent Oral Epidemiol 1996; 24: 47-51
    CrossrefPubMedGoogle Scholar
  • 70 Johnson R. Descriptive classification of traumatic injuries to the teeth and supporting structures. J Am Dent Assoc 1981; 102: 195-7
    CrossrefPubMedGoogle Scholar
  • 71 Thoma KH. Oral Pathology. 4th ed.. St. Louis: Mosby; 1954: p. 220
    Google Scholar
  • 72 Ritchey B, Mendenhall R, Orban B. Pulpitis resulting from incomplete tooth fracture. Oral Surg Oral Med Oral Pathol 1957; 10: 665-70
    CrossrefPubMedGoogle Scholar
  • 73 Down CH. The treatment of permanent incisor teeth of children following traumatic injury. Aust Dent J 1957; 2: 9
    CrossrefGoogle Scholar
  • 74 Sutton PR. Transverse crack lines in permanent incisors of polynesians. Aust Dent J 1961; 6: 144-50
    CrossrefGoogle Scholar
  • 75 Sutton PR. Greenstick fracture of the tooth crown. Br Dent J 1962; 112: 362-3
    Google Scholar
  • 76 Cameron CE. Cracked-tooth syndrome. J Am Dent Assoc 1964; 68: 405-11
    CrossrefPubMedGoogle Scholar
  • 77 Wiebusch FB. Hairline fracture of a cusp: Report of case. J Can Dent Assoc (Tor) 1972; 38: 192-4
    PubMedGoogle Scholar
  • 78 Silvestri AR. The undiagnosed split-root syndrome. J Am Dent Assoc 1976; 92: 930-5
    CrossrefPubMedGoogle Scholar
  • 79 Maxwell EH, Braly BV. Incomplete tooth fracture. Prediction and prevention. CDA J 1977; 5: 51-5
    PubMedGoogle Scholar
  • 80 Andreasen JO. Traumatic Injuries of the Teeth. 2nd ed.. Copenhagen: Munksgaard; 1981: p. 19
    Google Scholar
  • 81 Caufield JB. Hairline tooth fracture: A clinical case report. J Am Dent Assoc 1981; 102: 501-2
    CrossrefPubMedGoogle Scholar
  • 82 Luebke RG. Vertical crown-root fractures in posterior teeth. Dent Clin North Am 1984; 28: 883-94
    PubMedGoogle Scholar
  • 83 Kahler W. The cracked tooth conundrum: Terminology, classification, diagnosis, and management. Am J Dent 2008; 21: 275-82
    PubMedGoogle Scholar
  • 84 Rivera EM, Walton RE. Cracking the cracked tooth code: Detection and treatment of various longitudinal tooth fractures. American Association of Endodontists. Colleagues for Excellence, Newsletter, Summer; 2008
    Google Scholar
  • 85 Nguyen V, Palmer G. A review of the diagnosis and management of the cracked tooth. SADJ 2010; 65: 396-8 400
    PubMedGoogle Scholar
  • 86 Lubisich EB, Hilton TJ, Ferracane J. Northwest Precedent. Cracked teeth: A review of the literature. J Esthet Restor Dent 2010; 22: 158-67
    CrossrefPubMedGoogle Scholar
  • 87 Banerji S, Mehta SB, Millar BJ. Cracked tooth syndrome. Part 1: Aetiology and diagnosis. Br Dent J 2010; 208: 459-63
    CrossrefPubMedGoogle Scholar
  • 88 Dewberry JA. Vertical fractures of posterior teeth. In: Weine FS. editor. Endodontic Therapy. St. Louis: CV Mosby; 1982: p. 8-15
    Google Scholar
  • 89 Schetritt A, Steffensen B. Diagnosis and management of vertical root fractures. J Can Dent Assoc 1995; 61: 607-13
    PubMedGoogle Scholar
  • 90 Geurtsen W, Schwarze T, Günay H. Diagnosis, therapy, and prevention of the cracked tooth syndrome. Quintessence Int 2003; 34: 409-17
    PubMedGoogle Scholar