What is the prognosis for a cracked tooth?

  1. The prognosis for a cracked tooth is always going to be questionable (Rivera & Walton 2008).
  2. The prognosis is always better if the crack does not extend to the pulp chamber floor (Turp & Gobetti 1996; Sim et al. 2016).
  3. Vital is better than necrotic (Turp & Gobetti 1996).
  4. The quality of the restoration and whether a full coverage crown may cover the crack and other defects are considerations (Rivera & Walton 2008), as is whether an abscess or radiographic rarefaction is present prior to treatment.
  5. These two factors would lower the prognosis of the tooth in question (Berman & Kuttler 2010).
  6. One study found that cracked teeth had a two-year survival rate of 85.5% (Tan et al. 2006).
  7. Another study found that after five years, the survival rate of root-filled cracked teeth was 92%, with the odds of extraction increasing if the cracks were in the root (Sim et al. 2016).
  8. Finally, a recent study from Korea showed a 90%, two-year survival rate for a cracked tooth, probing depths greater than 6 mm being a signifi- cant factor in the prognosis (Kang et al. 2016).

What are the types of cracks one may see in a suspected tooth fracture?

According to the American Association of Endodontics (Rivera & Walton 2008), there are five categories of crack:

  • Craze lines: Only involving the enamel;
  • Split tooth: Complete fracture through the tooth, usually centered mesial to distal;
  • Fractured cusp: Usually non-centered and affect- ing one cusp;
  • Cracked tooth: An incomplete fracture that extends from the crown to the subgingival area of the tooth; and
  • Vertical Root Fracture (VRF):This may be sympto- matic or non- symptomatic.The majority of the VRFs are associated with root-filled teeth. It may be a complete or an incomplete fracture.

How is a fractured tooth diagnosed?

  1. There are multiple ways to determine whether or not a tooth is fractured. It is important to start with a good dental history of the tooth.
  2. A clinical exam should include a bite stick, ice for vitality testing, and a periodontal probing to check for deep narrow pockets.
  3. A radiographic exam is important to check for periapical rarefactions or possibly to reveal a fracture itself if it is large enough.
  4. Finally, a stain (methylene blue), or trans-illumination may be used to visualize the fracture.
  5. Sometimes the tooth may be mobile or a sinus tract may have developed due to fracture necrosis.
  6. If a tooth is non-vital with minimal or no restorations, suspect a crack or fracture (Berman & Kuttler 2010).
  7. The older the tooth, the more susceptible it is to fracture (Berman & Kuttler 2010).
  8. Cracked teeth are more commonly found in lower molars, followed by maxillary pre- molars (Cameron 1976).
  9. Another study found that lower 2nd molars were more likely to have cracks after root canal treatment (Kang, Kim & Kim 2016).

Cracked tooth syndrome

  • It is characterized by sharp pain on chewing without any reason.
  • It caused by hidden crack of teeth.
  • These are incomplete fractures that are too small to be seen on radiographs.

Symptoms

  • Sharp fleeting pain
    • because when biting down,segments move apart. low pressure in nerves of pulp.
  • Bite release
    • segments snap back together sharply increasing the pressure causing pain.
  • Pain- which is inconsistent.

Causes

  • Attrition
  • Bruxism
  • Trauma
  • Accidental biting on hard object.
  • Presence of large restoration.
  • Improper endodontic treatment.
  • Craze line
  • Fractured cusp
  • Cracked tooth split tooth
  • Vertical root fracture

Treatment

  • Stabilization with stainless steel band.
  • Crown placement
  • Endodontic treatment
  • Restoration.

Fundamentals of tooth preparation:(quick notes)

Ref: Sturdvant textbook.

  • NEED FOR RESTORATION :
  • To treat a teeth with carious lesion
  • To treat defective restoration
  • To treat fracture tooth
  • For esthetics
  • For prophylaxis.
  • OBJECTIVE OF TOOTH PREPARATION
  • Remove all defects,protect pulp
  • Extend restoration as conservatively as possible so as to protect natural tooth
  • Preparation to be done in such a way that tooth cannot be displaced under masticatory forces.
  • Form, structure function and esthetics to be considered while tooth preparation.