Predictable management of the cracked tooth

Article information

Restor Dent Endod. 2016;41(1):79-79

Publication date (electronic) : 2015 December 23

doi : https://doi.org/10.5395/rde.2016.41.1.79

Sin-Young Kim

Seoul St. Mary's Dental Hospital, the Catholic University, Korea.

Q

How can I treat cracked teeth more efficiently?

A

The diagnosis of cracked tooth is difficult in the early stage because the symptoms are not consistent, and often a crack line is not visible. Early detection and proper treatment of cracked tooth are important because all cracks have the potential to become a split tooth.

1. Be reminded that cracked tooth occurs usually on mandibular and maxillary first molars in patients in their 40s and 50s. If the tooth has a large restoration such as gold inlay or amalgam filling, then cracks occur easily.1 2 3

2. If pulp status is reversible pulpitis, remove the old restoration and crack line carefully because cracks are always colonized by bacterial biofilms. Fill the cavity with bonded direct or indirect restoration.2 4 5 6 If biting pain persists, then make a provisional crown and reevaluate the necessity of root canal treatment.

3. If pulp status is irreversible pulpitis or necrotic, perform root canal treatment initially and make a provisional crown.2 4 7 If symptom disappears, then make a final crown.

4. If a crack extends subgingivally and deep periodontal pocket is associated with the crack, explain the poor prognosis to the patient and decide whether to treat or extract the cracked tooth.8

Acknowledgement

Readers' forum is edited by Professor Kyung-Mo Cho (Gangneung-Wonju National University).

References

1. Seo DG, Yi YA, Shin SJ, Park JW. Analysis of factors associated with cracked teeth. J Endod 2012;38:288–292. 22341061.

2. 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;39:449–452. 23522534.

3. Roh BD, Lee YE. Analysis of 154 cases of teeth with cracks. Dent Traumatol 2006;22:118–123. 16643285.

4. Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Aust Dent J 2009;54:306–315. 20415928.

5. 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;34:808–811. 18570984.

6. Ricucci D, Siqueira JF Jr, Loghin S, Berman LH. The cracked tooth: histopathologic and hostobacteriologic aspects. J Endod 2015;41:343–352. 25447500.

7. American Association of Endodontists. Endodontics: Colleagues for excellence. Cracking the cracked tooth code: detection and treatment of various longitudinal root fractures. s2008;(summer):1-7 updated 2015 Dec 13. Available from: https://www.aae.org/uploadedfiles/publications_and_research/endodontics_colleagues_for_excellence_newsletter/ecfesum08.pdf.

8. Berman LH, Kuttler S. Fracture necrosis: diagnosis, prognosis assessment, and treatment recommendations. J Endod 2010;36:442–446. 20171360.

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