The cracked tooth conundrum: terminology, classification, diagnosis and management

ABSTRACT: Purpose: To provide an overview of the clinical features, diagnosis, classification and management ofcracked teeth which may be a diagnostic challenge in clinical practice. Results: Cracks may initiate from coronal toothstructure or from within the root and affect healthy or root treated teeth. There are many terminologies and classificationsin the literature for cracked teeth that can be as confusing as the array of clinical symptoms which are associated with thiscondition. The term “cracked tooth syndrome” is misleading as there are a range of symptoms that do not form a distinctand reliable pattern. Symptoms will vary with teeth that have healthy pulps, for teeth with inflamed or necrotic pulps, andfor teeth that have been root treated. The American Association of Endodontists have classified five specific variations ofcracked teeth; craze line, fractured cusp, cracked tooth, split tooth, and vertical root fracture. The importance ofdifferentiating dentin, pulpal and periodontal pain for diagnosis and treatment for these specific entities will be elaborated.A decision flow chart indicating the treatment options available is presented. (Am J Dent 2008;21:275-282).CLINICAL SIGNIFICANCE: A cracked tooth should be considered in the diagnosis of teeth which are sensitive to bite andthermal change. The American Association of Endodontists classification of cracked teeth is useful, though non-vital androot filled cracked teeth and teeth with periapical pathosis should be also considered in forming a diagnosis.