Cracked tooth syndrome is tooth problem present once a tooth has an extremely small fracture in it. Cracked tooth syndrome is among the most challenging dental conditions to identify due to the fact the discomfort is not consistent. Cracked tooth syndrome occurs when a tooth has a crack that’s too small to show up on X-rays, or is under the gum and challenging to identify. They occur most often on molars and premolars.

• Cracked Tooth Syndrome Crown Pain
• Cracked Tooth Syndrome Crown Before And After
• Porcelain Cracked Tooth Crown

Full menu for topic: Dental Crowns / Caps

• Crown basics -
  
  • What are crowns (caps)? - What do they do? Construction materials. Age considerations.
  • When is a crown needed? - Applications for crowns.
• Choosing the right kind of crown -
  
  • Types of crowns - Ceramic, porcelain-fused-to-metal, all-metal (gold).
  • Alloy considerations - Precious, semiprecious, nonprecious. / Pros & Cons
  • 6 factors to consider when choosing which type of crown makes the best choice.
• Crown fabrication / placement. -
  
  • The single-appointment, one-hour crowning procedure.
  • Costs for crowns. / Bridges.
    
    • Will dental insurance cover crowns? How much? / Stipulations.
  • How long do crowns last? - Statistics / Reasons for replacement.
  • Steps you can take to prevent ever needing another crown.
• Applications -
  
  • Crowns vs. filling placement - Pros, Cons / How to decide.
  • Cracked and fractured teeth - Signs and symptoms. / Methods of repair.
  • Overview: Dental crown alternatives.
    
    • Veneers vs. Crowns - What's the difference?
• Common problems and complications.
  
  • Crowned tooth discomfort - Sensitivity, pain.
  • The root canal / crown placement relationship.
• Emergencies.
  
  • What to do if your crown comes off.
  • What to do if you swallow your crown.
    
• How to sell old crowns & dental work.

Can a cavity be too big to fill? Examples of large (risky) fillings. | How crowns strengthen teeth. | Situations where placing a filling makes a suitable, possibly preferred, choice.

Crowns vs. Fillings

You may find yourself in a situation where your tooth needs to be rebuilt. And your dentist says that either a dental crown or a filling might be placed. If so, the question that seems to run through many people's mind is:

• Does choosing crown placement ... the repair that costs moreCrown Fees than placing a fillingFilling Fees ... and takes more appointment time (usually two visits vs. just one) ... really make a significantly better choice?

That's the subject of this page.

Below, we examine the crown vs. filling issue from the standpoint of what might make the best choice in terms of creating the most favorable health outlook for your tooth. It explains situations where choosing one approach rather than the other might result in a significant negative event, with fracture being a primary concern.

Not discussed on this page is the subject of comparative restoration longevity. Generally, it's expected that a dental crown will tend to last longerHow long?. But a filling can provide reasonable service tooHow long?, if placed for appropriate applications like those discussed on this page.

Choosing between dental crown and filling placement. - Factors to consider.

a) Does the tooth require strengthening?

One of the biggest differences between a dental filling and a crown is the greater level of protection that the latter provides.

The way a crown encases its tooth helps to reinforce it.

• Crowns strengthen teeth. - One of the hallmark characteristics of a dental crown is the way that it reinforces and strengthens a tooth. This is due to the way it cups over and encases it (see illustration).
  

  The crown literally acts as a rigid splint that holds the tooth together. And that means that once one has been placed, the tooth can withstand a greater level of chewing forces without risk of damage.

• Dental fillings don't offer as much protection. - In comparison, a filling just rests in or on a tooth and generally doesn't offer any substantial strengthening effect. And as we explain below, in some cases choosing this option may actually place the tooth at greater risk for fracture.
  

  (Related page: Broken teeth - Repairs and outcomes.Example scenarios.)

Of course, if your tooth doesn't really require strengthening, then placing a crown is overkill. And in fact, doing so makes a poor choice for your tooth.

Background -

Actually, you can't have a valid discussion about crowns vs. fillings, without first describing the size of the filling that's planned.

1) With small fillings, there's usually no concern about tooth strength.

For small repairs, placing a filling makes the right choice.

With this situation, placing a filling (vs. a crown) is actually the superior choice.

In cases where only a minor amount of repair is needed, placing a crown instead of a filling can actually be detrimental to the tooth. That's because:

• The aggressive amount of tooth trimming that's needed for crown placementThis much. can stress it. Even to the point where irreversible harm may come to the tooth's nerve tissueA possible consequence., thus triggering the need for root canal treatment.
  
• Crowned teeth can be more difficult for a patient to clean (like effectively removing dental plaque from around its gum-line edges), with a primary concern being the development of gum disease and its complications.

Of course, these events don't occur in all cases. But the potential for them is great enough that placing a crown isn't justifiable if a simpler type of restoration can satisfy the tooth's needs.

2) How larger fillings frequently leave a tooth at risk.

Large dental fillings can leave a tooth vulnerable to fracture.

An analogy.

The structural integrity issue we're discussing here is a little like what you find with an eggshell.

• If you take a raw egg and you want to break it open, it really takes a pretty firm rap. That's because an eggshell, as an intact unit, is a surprisingly strong object.
• Now, in comparison, say you've broken the egg open and the two halves of the empty shell are lying on their sides. In this condition, it's a simple feat to crush each piece flat.
  
• That's because the shell's structural integrity has been compromised. It's no longer an intact unit that's capable of withstanding forces well.

How filling preparation size affects tooth strength.

The numbers shown are the reduction in tooth stiffness (a measure of tooth strength).

That's why teeth with big fillings can be fragile.

Research evidence.

Our animation illustrates the amount of stiffness reduction associated with the standard outline form of the different classifications of fillings evaluated by the study.

• 1 surface cavity preparation = -20%
  2 surface = -46%
  3 surface = -63%

▲Section references - Reeh

A filling may create a wedging effect that ultimately cracks its tooth.

b) Fillings can create a wedging effect that leads to tooth fracture.

A major difference between crowns and fillings.

▲Section references - Rosenstiel

This effect can take place with either large or small fillings. But as discussed above, those teeth that have comparatively larger restorations may already be at comparatively higher risk of fracture, and therefore this issue of greater concern with them.

c) The question isn't only 'if' a filling can be placed.

Don't confuse the issue of 'can a filling be placed' vs. 'should one be.'

Dentists are humans just like anyone else. And sometimes an aspect of the treatment options they offer has to do with trying to satisfy their patient's wishes (with cost issues often being the primary factor when crowns are involved).

Know what you're getting.

Just because they feel they can anchor some type of filling to replace your tooth's missing parts, you still need to ask them what they expect the results to be.

Should the restoration be considered to be a 'permanent' fix? Or instead, just an interim solution, with a crown hopefully placed before any further harm occurs?

Even the latter approach doesn't necessarily make a bad plan. But if that's the situation, you should be fully aware of it.

What constitutes a 'big' dental filling? When should a crown be placed instead?

As mentioned above, and discussed further below, a big part of determining when a crown is indicated for a tooth instead of a filling has to do with the size the filling would need to have.

That's because when larger amounts of tooth structure are missing, the tooth is typically in greater need of reinforcement (a function that crowns, as opposed to fillings, excel in providing).

Of course, deciding when a filling seems 'too big' (to provide needed strength or predictable service) is really only something your dentist's evaluation can determine. During this process, here are some of the issues they will consider.

Fillings greater than 1/3 the distance between cusp tips tends to significantly weaken a tooth.

Crowns vs. fillings - Common guidelines.

• A study by Larson determined that fillings that take up just 1/3rd of the 'intercuspal distance' of a tooth (see picture) reduce the tooth's resistance to fracture by more than one half.
  
• Geurtsen stated that a tooth's risk for fracture increased substantially as its filling approached 50% of its intercuspal distance. This paper's recommendation was that fillings, composites (white) or amalgam (silver), should not exceed 1/3 to 1/4 this distance.

Your mileage may vary.

Not all dentists are as conservative with their recommendations as suggested by the guidelines above. And from a practical standpoint, many teeth with 'larger' fillings do just fine, even over the long term. (A quick look in your mouth may confirm this.)

▲Section references - Larson, Geurtsen

The arrows indicate the most fragile portions of the tooth.

Examples of 'large' fillings.

Generally speaking, they're the cusp that the filling encroaches on the most. (Cusps that don't meet the requirements stated in the general rules above.)

Not all teeth with large fillings are problematic.

Possibly by now you've already been to the mirror so you can judge the size of the dental fillings in your mouth. Did you see any 'large' ones?

Now, ask yourself, how long have those big fillings been in place? What's your answer? Two years, five years, longer? If so, what's the deal? If teeth with large fillings are so weak, why haven't parts of yours already fractured off? Don't these teeth need dental crowns, immediately?

What do experts say?

We found a section in the dental treatment planning textbook authored by Stefanac that discusses this type of scenario at length.

It goes as far as to state that diagnosing the need of a dental crown for a tooth that has a large filling that has provided acceptable service for some years and has no obvious deficiencies 'is one of the most common opportunities for overtreatment in dentistry.'

When should replacement be considered?

The book suggests that basic reasons for intervening include: a defect in the filling, the identification of tooth decay or a fracture line in the tooth, and pain on biting. And states that short of the presence of one or more of these symptoms, making a compelling case for crown placement can be difficult.

Of course as it should, the book expounds on more detailed scenarios and considerations that could be factors that tip the scale in favor of one treatment approach over the other. But the salient point we took away was that the act of crown placement can have unintended consequences, and as such a decision to place one must be based on a reasonable justification.

(We'll also state that we noticed that there's an added implication here that large fillings (at least those that survive an initial number of years) can make a reasonable choice for teeth.)

What to do?

Obviously, with this subject there are no cut and dried answers. The hope is, base on both their knowledge and clinical experience, that your dentist has the ability to formulate an educated opinion about which of your teeth have a true need for a crown.

▲Section references - Stefanac

Don't overlook that prevention is really the key.

As this page has discussed, in many, many cases the debate between placing a filling or a crown simply boils down to how much tooth structure has been lost. And that suggests that a person's potential for requiring a crown can be reduced if steps are taken to help to keep tooth damage to a minimum.

Of course, in many cases you'll have no control over this factor at all. But there actually are some habits and lifestyle choices that do increase a person's risk for tooth damage, and therefore crown placement. If you'd like to learn more, read this page: 8 things you can do to reduce your chances of ever needing a dental crown.Proactive steps.

Update log -

07/20/2020 - Content revision.

Full menu for topic: Dental Crowns / Caps

• Crown basics -
  
  • What are crowns (caps)? - What do they do? Construction materials. Age considerations.
  • When is a crown needed? - Applications for crowns.
• Choosing the right kind of crown -
  
  • Types of crowns - Ceramic, porcelain-fused-to-metal, all-metal (gold).
  • Alloy considerations - Precious, semiprecious, nonprecious. / Pros & Cons
  • 6 factors to consider when choosing which type of crown makes the best choice.
• Crown fabrication / placement. -
  
  • The single-appointment, one-hour crowning procedure.
  • Costs for crowns. / Bridges.
    
    • Will dental insurance cover crowns? How much? / Stipulations.
  • How long do crowns last? - Statistics / Reasons for replacement.
  • Steps you can take to prevent ever needing another crown.
• Applications -
  
  • Crowns vs. filling placement - Pros, Cons / How to decide.
  • Cracked and fractured teeth - Signs and symptoms. / Methods of repair.
  • Overview: Dental crown alternatives.
    
    • Veneers vs. Crowns - What's the difference?
• Common problems and complications.
  
  • Crowned tooth discomfort - Sensitivity, pain.
  • The root canal / crown placement relationship.
• Emergencies.
  
  • What to do if your crown comes off.
  • What to do if you swallow your crown.
    
• How to sell old crowns & dental work.

Page references sources:

Geurtsen W, et al. Diagnosis, therapy, and prevention of the cracked tooth syndrome.

Larson TD, et al. Effect of prepared cavities on the strength of teeth.

Reeh E, et al. Reduction in tooth stiffness as a result of Endodontic and Restorative procedures.

Rosenstiel SF, et al. Contemporary Fix Prosthodontics. Chapter: Principles of Tooth Preparation.

Stefanac SJ, et al. Diagnosis and Treatment Planning in Dentistry. Chapter: Evidence-Based Treatment Planning.

All reference sources for topic Dental Crowns.

Contents

• What is cracked tooth syndrome

Cracked tooth syndrome may be defined as a tooth fracture plane of unknown depth, which originate from the crown, passes through the tooth structure involving the dentine and occasionally extends into the pulp and extends subgingivally, and may progress to connect with the pulp space and/or periodontal ligament . Cracked tooth syndrome presents mainly in patients aged between 30 years and 50 years . Men and women are equally affected . Mandibular second molars, followed by mandibular first molars and maxillary premolars, are the most commonly affected teeth . While the crack tends to have a mesiodistal orientation in most teeth, it may run buccolingually in mandibular molars .

Two classic patterns of crack formation exist . The first occurs when the crack is centrally located, and following the dentinal tubules may extend to the pulp; the second is where the crack is more peripherally directed and may result in cuspal fracture. Pressure applied to the crown of a cracked tooth leads to separation of the tooth components along the line of the crack. Such separation in dentine results in the movement of fluid in the dentinal tubules,stimulating odontoblasts in the pulp as well as the stretching and rupturing odontoblastic processes lying in the tubules,3thus stimulating pulpal nociceptors. Ingress of saliva along the crack line may further increase the sensitivity of dentine . Direct stimulation of pulpal tissues occurs if the crack extends into the pulp.

Cracked tooth syndrome is probably one of the hardest dental condition to diagnose. This is because of the fact that the patient often finds it hard to point out where exactly the pain is coming from, hence the difficulty of the dental professional to make a definitive diagnosis. In order to pinpoint the problem, your dentist will need to make thorough examination of the area where the pain is coming from.

Even with X-rays, these are hard to find since these cracks are usually too fine to be seen on these. Sometimes, these are also hard to locate due to their being found underneath a person’s gums. If this is left untreated, the damage to the person’s tooth will progress to bigger and oftentimes more painful dental problems. These often happen in the lower back areas of your mouth, where the lower molars can be found. These cracks happen due to a number of reasons, such as constant clenching or grinding, or even due to the habit of chewing ice. These cracks can also appear due to accidents like biting into something hard unexpectedly (a bone or a pit) or because of a recent trauma. Whatever the case may be, these can and do occur, and if left unchecked, can result in a broken tooth, infection, and even more pain.

The most common tip dentists give patients who suffer from these cracks is, in order to avoid or prevent more of these from happening, they will need to rid themselves of such habits as chewing ice, clenching and grinding. They will also be advised to try and be careful when eating or chewing since biting down on hard substances that are in food can also crack a person’s tooth.

Treatments for cracked tooth syndrome are not guaranteed to solve it or relieve the person of it. Treatments will also depend on where the cracks can be found, how deep these are, and how large such cracks are. Some of the more common treatments include the use of crowns on such teeth, and root canals. You may also find your dentist removing such a tooth, if the damage is too extensive, and they may also suggest an implant to replace the missing tooth.

If you suspect that you have cracks in your teeth, you should consult with your dentist as soon as possible to prevent the worsening of such a problem. Pain when you chew or when you bite are indicators of such a dental issue. If you are constantly grinding and clenching your teeth, having your dentist check your teeth for cracks is also a must.

Cracked tooth syndrome causes

Causes of cracked tooth syndrome:

• Natural wear: Over the years, the repetitive everyday use of the teeth for biting and chewing may cause cracks on teeth.
• Clenching or grinding teeth (bruxism) is one of the major causes of fractured tooth syndrome. Grinding and clenching puts teeth under excessive pressure making them more susceptible to cracks.
• Bad chewing habits such as biting pencils or chewing on hard foods.
• Trauma to the mouth.
• Large fillings can weaken the teeth resulting in tooth fracture.
• Untreated extensive tooth decay.
• Complications during/after endodontic therapy. Sometimes the pressure applied on a tooth during root canal treatment may cause a crack. After a root canal treatment teeth become brittle and they are more susceptible to cracked tooth syndrome.

Restorative procedures

• Inadequate design features
  • Over-preparation of cavities
  • Insufficient cuspal protection in inlay/onlay design
  • Deep cusp–fossa relationship
• Stress concentration
  • Pin placement
  • Hydraulic pressure during seating of tightly fitting cast restorations
  • Physical forces during placement of restoration, e.g., amalgam or soft gold inlays (historical)
  • Non-incremental placement of composite restorations (tensile stress on cavity walls)
  • Torque on abutments of long-span bridges

Occlusal

• Masticatory accident: Sudden and excessive biting force on a piece of bone
• Damaging horizontal forces: Eccentric contacts and interferences (especially mandibular second molars)
• Functional forces:
  • Large untreated carious lesions
  • Cyclic forces
• Parafunction: Bruxism

Developmental

• Incomplete fusion of areas: Occurrence of cracked tooth syndrome in unrestored teeth of calcification

Miscellaneous

• Thermal cycling: Enamel cracks
• Foreign body: Lingual barbell
• Dental instruments: Cracking and crazing associated with high-speed handpieces

Historically, cracked tooth syndrome was associated with the placement of“soft gold” inlays (Class I Gold) that were physically adapted to the cavity using a mallet . Nowadays, common causes include masticatory accidents, such as biting on a hard, rigid object with unusually high force or excessive removal of tooth structure during cavity preparation . Parafunctional habits such as bruxism are also associated with the development of cracked tooth syndrome .

Commonly, the tooth has been structurally compromised by removal of tooth substance during restorative procedures . Occlusal contact occurring on extensive occlusal or proximo-occlusal intracoronal restorations (either cast metal or plastic restorations) subject the remaining weakened tooth structure to lateral masticatory forces, particularly during chewing . Such cyclic forces result in the establishment and propagation of cracks . Deep cusp–fossa relationships due to over-carving of restorations or cast restorations placed without proper consideration for cuspal protection , also render the tooth vulnerable. Cameron describes a case where he fitted a gold inlay on a molar tooth that subsequently developed symptoms of cracked tooth syndrome. The patient complained of pain on application of pressure to the tooth. Having repeatedly performed occlusal adjustments over a one year period, complete relief of symptoms did not occur until a distal cusp fractured off the tooth .

Excessive condensation pressures, expansion of certain poorer quality amalgam alloys when contaminated with moisture, placement of retentive pins and extensive composite restorations placed without due care for incremental technique (resulting in tensile forces in the tooth structure due to polymerization contraction) predispose to fracture formation . Other iatrogenic causes of cracked tooth syndrome include excessive hydraulic pressure in luting agents when cementing crowns11or bridge retainers . Long-span bridges exert excessive torque on the abutment teeth, leading to crack generation .

The higher incidence of cracked tooth syndrome in mandibular second molars may be associated with their proximity to the temporo-mandibular joint , based on the principle of the“lever” effect — the mechanical force on an object is increased at closer distances to the fulcrum . Eccentric contacts expose these teeth to significant occlusal trauma in this manner . Functional forces on teeth that have untreated carious lesions can also lead to crack formation .

Cracked tooth syndrome has been reported in pristine (unrestored) teeth or in those with minor restorations, which has led to the suggestion that there may be developmental weaknesses (arising within coalescence of the zones of calcification) within those teeth . This contrasts with the findings of Cameron, who claimed that the teeth involvedwere usually quite heavily restored . Thermal cycling and damaging horizontal forces or parafunctional habits havealso been implicated in the development of enamel cracks in such unrestored teeth, with subsequent involvement of the underlying tooth . There are reports in the recent literature of the generation of such cracks associated withlingual barbells .

Cracked tooth syndrome prevention

Most tooth fractures cannot be avoided because they happen when you least expect them. However, you can reduce the risk of breaking teeth by:

• Trying to eliminate clenching habits during waking hours,
• Avoiding chewing hard objects (eg bones, pencils, ice),
• Avoiding chewing hard foods such as pork crackling and hard-grain bread

Awareness of the existence and cause of cracked tooth syndrome is an essential component of its prevention . It is very important to preserve the strength of your teeth so they are not as susceptible to fracture. Try to prevent dental decay and have it treated early. Heavily decayed and therefore heavily filled teeth are weaker than teeth that have never been filled. Individuals who have problems with tooth wear or “cracked tooth syndrome” should consider wearing a nightguard while sleeping. This will absorb most of the grinding forces. Relaxation exercises may be beneficial.

Cavities should be prepared as conservatively as possible . Rounded internalline angles should be preferred to sharp line angles to avoid stress concentration. Adequate cuspal protection should be incorporated in the design of cast restorations . Cast restorations should fit passively to prevent generationof excess hydraulic pressure during placement . Pinsshould be placed in sound dentine, at an appropriatedistance from the enamel to avoid unnecessary stress concentration . The prophylactic removal of eccentric contacts has been suggested for patients with a history ofcracked tooth syndrome to reduce the risk of crack formation, though there is little clinical evidence to support this practice .

Cracked tooth syndrome symptoms

Pain when you chew or when you bite are indicators of cracked tooth syndrome. If you are constantly grinding and clenching your teeth, having your dentist check your teeth for cracks is also a must. The crack will expose the inside of the tooth (the ‘dentine’) that has very small fluid filled tubes that lead to the nerve (‘pulp’). Flexing of the tooth opens the crack and causes movement of the fluid within the tubes. When you let the biting pressure off the crack closes and the fluid pressure simulates the nerve and causes pain.

Symptoms of cracked tooth syndrome include:

• Tooth sensitivity to hot and cold temperatures.
• Pain in the tooth upon biting or chewing. Pain is not constant as that in case of tooth decay or tooth abscess. The tooth may be painful only when eating certain foods or when chewing in a specific way. If the pain is usually experienced upon release of biting pressure, it is a sign that it is a case of cracked tooth syndrome.
• If the crack is severe, there may be signs of increased tooth mobility.

Cracked tooth syndrome diagnosis

Successful diagnosis of cracked tooth syndrome requires awareness of its existence and of the appropriate diagnostic tests . The history elicited from the patient can give certain distinct clues. Pain on biting that ceases after the pressure has been withdrawn is a classical sign . Incidences usually occur while eating or where objects such as a pencil or a pipe are placed between the teeth . The patient may have difficulty in identifying the affected tooth (there are no proprioceptive fibers in the pulp chamber) . Vitality testing usually gives a positive response and the tooth is not normally tender to percussion in an axial direction . Significantly, symptoms can be elicited when pressure is applied to an individual cusp . This is the principle of the so-called “bite tests” where the patient is instructed to bite on various items such as a toothpick, cotton roll, burlew wheel, wooden stick or the commercially available Tooth Slooth . Pain increases as the occlusal force increases, and relief occurs once the pressure is withdrawn (though some patients may complain of symptoms after the force on the tooth has been released) . The results of these “bite tests” are conclusive in forming a diagnosis of cracked tooth syndrome.

The tooth often has an extensive intracoronal restoration . There may be a history of courses of extensive dental treatment, involving repeated occlusal adjustments or replacement of restorations, which fail to eliminate the symptoms. The pain may sometimes occur following certain dental treatments, such as the cementation of an inlay, which may be erroneously diagnosed as interferences or “high spots” on the new restoration . Recurrent debonding of cemented intracoronal restorations such as inlays may indicate the presence of underlying cracks . Heavily restored teeth may also be tested by application of a sharp probe to the margins of the restoration. Pain evoked in this manner can indicate the presence of a crack in the underlying tooth, which may be revealed upon removal of the restoration .

Patients with a previous incidence of cracked tooth syndrome can frequently self-diagnose their condition. Diagnosis should exclude pulpal, periodontal or periapical causes of pain . Galvanic pain associated with recent placement of amalgam restorations should also be considered in this differential diagnosis . Such pain occurs on closing the teeth together but decreases as full contact is made, unlike cracked tooth syndrome where the pain increases as the teeth close further together, due to increasing occlusal force . The medical history should also be considered to exclude incidences of orofacial pain or psychiatric disorders .

Cracked Tooth Syndrome Crown Pain

Visual inspection of the tooth is useful, but cracks are notoften visible without the aid of a microscope, specialized techniques such as transillumination or staining with dyes such as methylene blue . Particular attention should be paid to mesial and distal marginal ridges . Cracks are sometimes stained by caries or food and are visible to the unaided eye. Not all stained and visible crack lines lead to the development of cracked tooth syndrome. Other clues evident on examination include the presence of facets on the occlusal surfaces of teeth (identifies teeth involved in eccentric contact and at risk from damaging lateral forces) , the presence of localized periodontal defects (found where cracks extend subgingivally) , or the evocation of symptoms by sweet or thermal stimuli . Radiographic examination is usually inconclusive as cracks tend to run in a mesiodistal direction .

Cracked tooth syndrome treatment

A decision flowchart of cracked tooth syndrome treatment options is presented in Figure 1. Immediate treatment of the tooth depends on the size of the involved portion of the tooth. If the tooth portion is relatively small and avoids the pulp, it may be fractured off and the tooth restored in the normal way . If, however, the portion is very large or involves the pulp, the tooth should be stabilized immediately with an orthodontic stainless steelband . Stabilization, along with occlusal adjustment , can lead to immediate relief of symptoms. Care should betaken to prevent microleakage along the crack line, as this could result in pulpal necrosis . A high success rate has been reported when full-coverage acrylic provisional crowns were used to stabilize the compromised tooth . The tooth should be examined after 2 to 4 weeks and if symptoms ofirreversible pulpitis are evident, endodontic treatmentshould be performed .

Figure 1. Cracked tooth syndrome treatment flowchart

[Source ]

Ultimately the tooth needs to be restored with protection and permanent stabilization in mind . This can be achieved with an adhesive intracoronal restoration (e.g., bonded amalgam, adhesive composite restorations) or a cast extracoronal restoration1 (e.g., full-coverage crown,onlay or three-quarter crown with adequate cuspal protection) to bind the remaining tooth components together . While there has been a lot of interest in the benefits of such adhesive restorations, there is, as yet, little clinical evidence in the literature to support their use. As for extracoronal restorations, certain modifications of tooth preparation have been suggested for cracked teeth, such as including additional bracing features in the area of the crack, i.e.,extending the preparation in a more apical direction, bevelling the cusps of the fractured segment more than usual to minimize damaging forces, using bases to prevent contactwith the internal surface of the casting, and using boxes andgrooves on the unfractured portion . Cracks extendingsubgingivally often require a gingivectomy to expose themargin;3however, an unfavourable crown–root ratio may render the tooth unrestorable.

Where vertical cracks occur or where the crack extendsthrough the pulpal floor or below the level of the alveolarbone, the prognosis is hopeless and the tooth should beextracted .

It is worth remembering that it is possible for a crack to progress after placement of an extracoronal metal restoration or crown, when occlusal forces are particularly strong.

Cracked Tooth Syndrome Crown Before And After

If you think you grind your teeth at night, ask your dentist if a nightguard or a splint will be of use to you.

References [ + ]

Porcelain Cracked Tooth Crown