Cracked tooth syndrome is defined as an incomplete fracture of the dentine in a vital posterior tooth. It can be caused by factors like occlusal trauma, restorative procedures, developmental defects, or parafunctional habits. Diagnosis involves examining the tooth for signs of cracking and reproducing the patient's symptoms. Treatment depends on the severity and location of the crack, ranging from restorations to root canal therapy or extraction. While cracks cannot heal, proper treatment can relieve symptoms and slow progression.
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Cracked tooth syndrome
1. CRACKED TOOTH SYNDROME
SAPPORO DENTAL COLLEGE AND HOSPITAL
DEPARTMENT OF CONSERVATIVE DENTISTRY
AND ENDODONTICS
Presented By:
Dr. Mahshina Khanom (IS-25)
Dr. Ha-Meem Fattaha (IS-26)
2. WHAT IS CRACKED TOOTH SYNDROME?
Cracked tooth is defined as an incomplete fracture of
the dentine in a vital posterior tooth that involves
the dentine and occasionally extends into the pulp.
The term “cracked tooth syndrome” (CTS) was first
introduced by Cameron in 1964.
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3. CLASSIFICATION (CONTINUED):
According to American Association of Endodontists -
1.Craze lines
2.Fractured cusp
3.Cracked tooth
4.Split tooth
5.Vertical root fracture
3
5. CLASSIFICATION (CONTINUED):
Classificat
ion
Origin Direction Symptoms Pulp
status
Prognosis
Craze lines Crown Variable None Vital Excellent
Fractured
cusp
Crown M-D or F-L Mild pain
on biting or
cold
Usually
vital
Good
Cracked
tooth
Crown and
root
M-D often
Central
Acute pain
on biting or
cold
Variable Questionab
le
Split tooth Crown and
root
M-D Marked
pain on
chewing
Often root
filled
Poor
Vertical
root
fracture
Root F-L Often
shows no
symptom
Mainly root
filled
Poor
5
6. ETIOLOGY :
Factor Causes Examples
Occlusion 1. Masticatory
accident
2. Damaging
horizontal forces.
3. Functional forces
4. Para function
1. Sudden and
excessive biting
force on a piece of
bone.
2. Eccentric contacts
and interferences
(especially
mandibular second
molars).
3. Large untreated
carious lesions
Cyclic forces.
4. Bruxism
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7. ETIOLOGY:
Factor Causes Examples
Restorative procedure 1. Inadequate design
features
2. Stress
concentration
1.-Over-preparation of
cavities.
-Insufficient cuspal
protection in
inlay/onlay design
-Deep cusp–fossa
relationship
2.-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)
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8. ETIOLOGY:
Factor Causes Example
Developmental Incomplete fusion of
areas
Occurrence of cracked
tooth syndrome in
unrestored teeth
of calcification
Miscellaneous 1.Thermal cycling
2.Foreign body
3.Dental instruments
1.Enamel cracks
2.Lingual barbell
3.Cracking and
crazing associated
with high-speed
handpieces
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9. SYMPTOMS :
Acute pain during
mastication
Sharp , brief pain with
cold.
Spontaneous pain may
occur.
The patient may have
difficulty in identifying
the affected tooth.
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10. DIFFERENTIAL DIAGNOSIS:
Cracked teeth may present with a variety of
symptoms which mimics sinusitis, irreversible
pulpitis, pulp necrosis or apical periodontitis . Even
it may be galvanic pain.
Differentiating symptoms are -
Cracked tooth
syndrome
Apical periodontitis Galvanic pain
Pain starts on
bringing the teeth
closer and increases
on release of
pressure
Pain on biting Pain on closing the
teeth but decreases
as full contact is
made
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11. DIAGNOSIS:
Dental history:
Classic symptom: "Rebound pain” which is sharp,
fleeting pain occurring when the biting force is
released from the tooth.
- Masticatory accidents, such as biting on a hard, rigid
object with unusually high force.
-Excessive removal of tooth structure during cavity
preparation.
-Para functional habits such as bruxism are also
associated with the development of this condition.
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12. Diagnosis (Continued) :
Signs:
- Vitality testing usually gives a positive response.
- Pain can be elicited when pressure into individual cusp
by tooth slooth, rubber cup, cotton roll, wooden stick etc.
Pain increases as the pressure is released.
The results of these “bite tests” are conclusive in forming
a diagnosis.
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13. Diagnosis (Continued) :
Visual inspection:
Following examinations can be done to diagnose
the syndrome -
1.Tactile examination
2.Removal of existing restoration
3.Staining with dyes
4.Transillumination test
13
14. Scratch the surface
of the tooth with the
tip of a sharp
explorer. The tip may
catch in a crack.
Removal of the
remaining
restoration and
examine the
tooth with
magnifying loops or
microscope
Staining with dyes :
Methylene blue or
iodine.
Transillumination is
an important aid in
locating the crack
whether it is
incomplete or a
complete vertical
root fracture. 14
15. TREATMENT PLANNING:
Treatment plan of cracked tooth will vary depending
on the location and extent of the crack.
Even when the crack is located
The extent is difficult to determine 15
16. TREATMENT :
Cracked tooth syndrome
Mild sensitivity or mild pain on
biting
Provisional crown
Symptoms
resolved
Permanent
crown
Review
every 6
months
Symptoms
continued
Root canal
treatment
Symptoms
resolved
Permanent
crown
Symptom
s
continued
Extraction
Severe sensitivity
Spontaneous pain
Pulp necrosis
Chr. Apical periodontitis
Root canal treatment with
provisional crown
Symptom
resolved
Permanent
crown
Review after
every 6
months
Symptoms
continued
Extraction
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17. AFTER TREATMENT , WILL THE TOOTH
COMPLETELY HEALS?
Unlike a broken bone, the fracture in a cracked tooth
will not heal . In spite of treatment, some cracks
may continue to progress and separate, resulting in
loss of the tooth. Placement of a crown on a
cracked tooth provides maximum protection but
does not guarantee success in all case. It will
relieve pain and reduce the likelihood that the crack
will worsen.
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18. PREVENTION FROM CRACKING:
While cracked teeth are not completely preventable,
some steps can make teeth less susceptible to
cracks.
A. Steps by the patient-
-Don't chew on hard objects such as ice, unpoped
popcorn kernels or pens.
-Don't clench or grind teeth.
-If you clench or grind your teeth while you sleep,
talk to your dentist about getting a retainer or other
mouth guard to protect your teeth.
-Wear a mouth guard or protective mask when
playing contact sports. 18
19. Prevention from cracking (Continued):
B. Steps by the practitioner-
- Conservation of the tooth structure during cavity
preparation.
- Prevention of stress concentration during
restoration.
-Prophylactic removal of eccentric contacts.
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20. SUMMERY:
If a crack is suspected, the steps outlined and
detailed, should be taken immediately to confirm
the presence of a crack, determine the type and
formulate an appropriate treatment plan. Quick
action on the part of practitioners can improve the
chances of saving the tooth.
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