Cracks! The term conjures up a feeling of uneasiness or concern. Rightfully so! For instance, a craông xã in a wood chair: Is the chair going to break when someone sits in it? A craông xã in a floor: is someone going khổng lồ trip & fall? Or a crack in a tree branch: is the branch going lớn break off?


All are possibilities and valid questions regarding the cracks described. They are all concerning questions, but all manageable situations. The chair may be glued and repaired. The floor maybe sealed và smoothed. And the branch may be trimmed. Disasters avoided!

What about tooth cracks? Again, a very uneasy feeling. But this situation carries a much greater amount of concern. Depending upon the craông chồng position and degree, the result may be catastrophic. A tooth may be lost! This can represent a complete disaster that can include emotional, financial and functional considerations.

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The question is: could the tooth craông xã be recognized, & could the outcome from the crachồng have sầu been predicted in order to lớn avoid a dental catastrophe? This article is written to help dentists recognize & categorize tooth cracks. Having an understanding of crachồng origin, etiology, symptomology và prognosis can provide better diagnosis & patient communication & may save sầu a catastrophe from happening khổng lồ our patients.

Tooth cracks are a common occurrence in dentistry. We see tooth cracks each day in our patient treatment. Diagnosing cracks & treatment planning for tooth longevity are critical factors for helping patients maintain their teeth.

One of the main considerations regarding an observed tooth crack is the question of when to lớn intervene. Should the tooth be restored, crowned or extracted? All are possible treatments. Identifying and classifying cracks will provide some guidance as khổng lồ treatment planning và treatment outcome. Many teeth with cracks can be saved! The keys are identification, understanding signs và symptoms & early detection.

The American Association of Endodontists has identified five sầu types of tooth cracks. These types are:

Craze linesFractured cuspCracked toothSplit rootVertical root fracture

Understanding and identifying these five types can provide guidance for treating cracked teeth. The vertical order of these cracks, from top khổng lồ bottom, signifies the general prognosis for a particular craông chồng. That is, craze lines have a good prognosis, whereas a vertical root fracture has a very poor prognosis.


Craze lines

Craze lines are micro-fractures of the enamel only. They may also be termed enamel infractions. The micro-fractures are contained within the enamel only. They bởi vì not penetrate inlớn the dentin layer.

All teeth have sầu craze lines. They are more often seen in anterior teeth as vertical striations within the enamel. They are also seen on marginal ridges. Trans-illumination provides clear observation of craze lines.

Tooth trauma can contribute to craze lines. This trauma can be the result of blunt force or more recurrent functional forces, such as bruxism và parafunction.

There are typically no symptoms with craze lines. Treatment can be for esthetic reasons only và the prognosis is very good. Prevention of bruxism, parafunction & excessive sầu trauma from occlusal forces is recommended


Fractured cusp

Fractured cusp is defined as a complete or incomplete fracture of the crown of the tooth extending subgingivally. The extent & degree of the fractured cusp is variable. The most common cuspal areas lớn fracture are the lingual cusps of the lower molars & the buccal cusps of the upper molars.

The fracture originates on the occlusal surface và extends gingivally along a buccal or lingual groove sầu and the mesial or distal marginal ridge. Occlusal trauma/ force plays an integral role in the propagation of the fracture line. Undermined cusps from existing restorations are also a contributing factor.

The fractured cusp may break và separate entirely at the time of a traumatic event. The resultant tooth segment may be attached to the gingival tissues & be required lớn be removed.

The remaining exposed tooth area may be sensitive lớn temperature until it is restored. Alternatively, the patient may have sầu complaints of biting or temperature sensitivity prior to the complete cuspal fracture. The biting complaints are typically pain upon compression and/or pain upon release of biting pressure. Once the fractured cusp is removed, the biting pain is relieved.

Transillumination can be helpful in fractured cusp identification. The transilluminated light will not penetrate beyond the fractured segment inlớn the rest of the tooth. Depending on the degree of the fracture, there is a good prognosis for retaining the tooth. Root canal therapy or crown lengthening procedures may be needed if the extent of the fractured cusp is significant. Cuspal coverage is recommended for those teeth that exhibit early fractured cusp symptoms.

Maintaining tooth integrity using crowns or onlays may prsự kiện crack propagation & fracture. Continued and recurrent patient observation is recommended long-term.


Cracked tooth

A cracked tooth is defined as an incomplete fracture initiated from the crown và extending subgingivally. The crachồng is usually in a mesial-distal direction. The crack may extkết thúc through one marginal ridge or may extover through both proximal surfaces. The vertical depth of the crachồng is also variable.

The crack may be entirely contained within the crown of the tooth, or it may extover vertically into lớn the root portion of the tooth. A cracked tooth is more centered, occlusally, than a fractured cusp. Also, because a cracked tooth may progress apically, rather than laterally, there is a greater chance of pulpal and periapical pathosis.

The location and extent of the craông chồng may be difficult khổng lồ determine. Some cracks are easily seen with magnification, or because they are stained from bacterial migration. Additionally, some cracks are identified with a dental explorer because they have sầu caused a true separation of the enamel.

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However, the extent of the craông chồng on the surface enamel does not correlate directly lớn the extent of the craông chồng apically. Patient symptoms are variable, as well. Some patients will exhibit temperature and/or biting pain. Others will not exhibit any symptoms.

Excessive sầu occlusal forces are a contributing factor to lớn creating tooth cracks. Weakened tooth structure from existing restorations also contributes lớn tooth cracks. Undermined cusps & marginal ridges create an environment for cracks to lớn occur. Removal of old restorations is recommended for evaluation of craông xã extent và depth.

There are numerous diagnostic tests available for cracked tooth situations. Removing old restorations in the presence of a crachồng is a starting point. Magnification is paramount for aiding in evaluation of the extent of the crachồng.

The craông xã may be visualized extending along the pulpal floor from mesial to lớn distal. Extending the pulpal floor to “follow” the craông xã apically can provide information on depth & nerve proximity.

If the craông chồng extends apically inkhổng lồ the interproximal area, a perio probe may be utilized lớn evaluate for a narrow/ isolated band of bone loss vertically down the root. This is a pathognomonic sign of root fracture (lớn be discussed next). Tooth staining, trans illumination or “wedging” are techniques for assessing the extent of the crack. Pulp vitality và patient symptoms will aid in determining the extent of the craông xã. Tooth cracks are highly variable in extent và symptoms.

Cracked tooth treatment is variable và is dependent on craông xã extent, operator experience, judgment và patient symptoms. There are no definitive sầu restorative sầu recommendations in the literature about treatment of cracked teeth. Proper diagnosis và preventive sầu strategies are recommended for the treatment of cracked teeth.

Obviously, root canal treatment is possible if pulpal và periapical symptoms dictate need. But cracked tooth treatment may be as limited as replacement of a direct restoration to full or partial cuspal coverage. Depending upon the crack extent & depth và structural integrity of the remaining tooth, the restoring dentist must decide what mode of treatment is appropriate. The dentists experience will play a role as khổng lồ whether or not and to what extent the cracked tooth is maintained và restored.

Cracked tooth prognosis is always questionable. There is always the possibility that the crack will progress, even if cuspal coverage is performed. Limiting the amount of tooth flexure is the goal with bite adjustment & cuspal protection.

But the micro-movement of tooth function can contribute khổng lồ craông chồng propagation over the long term. Not all cracked teeth are destined lớn fail. But depending on patient circumstances, occlusal stability and patient cooperation, a cracked tooth may eventually fail. Removing damaging habits (for example, by providing a night guard & controlling bruxism), covering cusps & counseling patents on the variability of cracked tooth treatment are recommended preventive sầu strategies. In cases of cracked teeth, the patient should be informed of the questionable prognosis associated with this condition.


Split Tooth

"Split tooth" is defined as the complete fracture initiated from the crown extending subgingivally. It typically extends through both marginal ridges and the proximal surfaces lớn the proximal root. A split tooth is the over result of a cracked tooth (evolution)! The tooth segments are entirely separated. The split may occur suddenly, but is typically the result of the long-term growth from an incomplete craông chồng.

Again, damaging habits, such as bruxism, parafunction, ice chewing, etc. contribute lớn crachồng propagation &, ultimately, a split tooth. There may be pre-existing pain with mastication, but not always.

The split segments may be visualized or by “wedging” the segments apart, but the tooth prognosis is hopeless in most cases. Sometimes a split may occur where only a single root may be affected (e.g., an upper molar root). In those cases, it may be possible lớn remove sầu the “split root” và salvage the remaining tooth. Once the tooth is removed, tooth replacement may be discussed và initiated.


Vertical Root Fracture

A vertical root fracture is a complete or incomplete fracture of the root in a buccal lingual direction. The fracture may extover the length of the root or as a shorter segment along any portion of the root. There may or may not be patient symptoms associated with the fracture. Many times they are discovered on routine periapical x-rays.

Virtually all vertical root fractures are associated with a history of root canal treatment. Existence of a sinus tract or a narrow, vertical periodontal pocket along the root surface is consistent with vertical root fracture. The prognosis of vertical root fracture is virtually hopeless in all cases.

Prevention of vertical root fracture is important. Minimizing dentin removal during root canal therapy will provide better structural integrity for tooth longevity. Avoid posts and post build-ups if possible. Reduce condensation forces during root canal obliteration. Cuspal coverage following root canal treatment is always advised.

Tooth cracks represent a day-to-day finding in our dental practices. It is our goal to save teeth for a lifetime for all of our patients. Proper diagnosis & crack treatment will provide longevity and predictability of care.

Jeff Bonk, D.D.S., P..C., Spear Faculty & Contributing Author -