Prof.

Asaad Javaid
DEPARTMENT OF OPERATIVE DENTISTRY
BAQAI DENTAL COLLEGE, BMU,
KARACHI

Cracked tooth syndrome

Syndrome

Association of several clinical signs and symptoms

which often occur together

Cracked tooth syndrome

Incomplete fracture of any part of a tooth,

characterized by pain during mastication and
sensitivity to heat, cold, sweet or sour tastes; it is
often undiagnosed because the tooth is usually X-ray
negative and normal to pulp vitality tests

What is your opinion??

Enamel crack
No pain
No percussion
X-ray normal

Causes

An accident or injury
Uneven biting or chewing
Stress
Bruxism
Large Intracoronal restorations
Root canal therapy or large post placement

Types of cracked tooth

Cuspal fracture
Vertical fracture
Split fracture
Root fracture

Cuspal fracture
When a cusp of a tooth
becomes weakened, the
cusp will fracture

Vertical fracture
It extends from the

occlusal surface vertically

towards the root and
sometimes below the
gum line
A cracked tooth is not
completely split into two
distinct movable
segments

Vertical fracture

Split fracture

A split tooth is a cracked

tooth in which the crack
has progressed so there
are 2 distinct segments
that can be separated
from one another.

Root fracture

Symptoms are associated

with a tooth having
endodontic therapy

Sign & Symptoms

Pain on mastication specially on releasing biting - pressure

Pain on hot and cold (specially cold)
Discomfort when the tooth is exposed to air
Toothache for no apparent reason
Percussion: -ve
X- ray : inconclusive

Diagnosis

History

Transilluminatin

Examination
Bite test

x rays

Periodontal probing

Surgical assessment

Staining

Restoration removal

History

Previous trauma
Previous cracked tooth
Bruxism and teeth clenching
Dietary habits
Excessive bone loss in the suspected area

Examination
Check teeth in dry field to look for
Crazes
Cracks
Wear facets
Steep cusp
Cracked restoration
Abnormal gap b/w restoration and the tooth

Bite test
Place rubber wheel,

wooden stick or tooth

slooth on each cusp
ask patient to bite on it
Pain may be present in
early crack propagation
but absence of pain
doesnt mean that crack
is not present

Periodontal probing

Thorough probing along entire tooth reveals

presence of shallow pocket

This pocket restricts side to side movement of the
probe which indicates that pocket is not a broad
based pocket occurring due to periodontal disease

Staining

Methylene blue or acid red

if applied on eternal surface
disclose the cracks

Transillumination

Fibre optic light is used

The beam of light is placed perpendicular to the

suspected crak
If crack is present, it will block the light

Transillumination

Dark
side

Light is blocked by the crack

X ray
Mesiodistal crack never appear
Buccolingual crack appear if
there is a separation of the
segments

X ray
Changes in chamber, canal or periradicular
space indicate presence of a crack

Thickened
PD ligament

radiolucency

X - ray

Taking x-rays from different angles and a bitewing xray help in catching a crack induced periodontal
pocket in early stages

X ray
Filled roots show radio opaque line where GP or

sealer has been expressed into the crack during

obturation
A consistent radiolucent line along the length of
Root filling material is indicative of crack
Sealer showing in horizontal plane in apical area
suggests root fracture
Presence of posts in the canal increases the risk of
root facture

Restoration removal
It allows visual inspection of suspected tooth
Magnification and staining may help

Surgical assessment

If presence of a crack is highly suspected and other

means of diagnosis fail, then exploration surgery
allows visual examination of the root surface

Treatment

Cuspal fracture

A cuspal fracture present

on first molar

Cuspal fracture
Remove the restoration
Remove the cusp
Fill composite
Give full crown covering

the fractured margins

Perform RCT if pulp is
involved

Vertical fracture

The crack runs from occlusal

Surface apically without
Separation of the two segments

Vertical fracture

Treatment depends upon location and extent of #

Pulp floor is partially involved
Pulp floor is fully involved

Partial pulp floor involvement

Insert orthodontic band

Partial pulp floor involvement

Perform RCT

Fill with composite

Give crown

Entire pulp floor involvement

Prognosis is poor
Extraction should be considered

Split fracture

If split fragment is small, remove it

and restore the tooth
If fragment is big then extraction
is the solution

Vertical root fracture

Treatment depends on tooth involved and may be
Extraction
Root amputation
Hemisection

MB root amputation

Hemisection