Review of Cracked Tooth Syndrome: Etiology, Diagnosis, Management, and Prevention

Abstract

Cracked tooth syndrome refers to a series of symptoms caused by cracked teeth. This article reviews the current literature on cracked tooth syndrome from four aspects, etiology, diagnosis, management, and prevention, to provide readers integrated information about this. The article begins with an introduction to the odontiatrogenic factors and then covers the noniatrogenic factors that induce cracked tooth syndrome. While the former discusses inappropriate root canal therapy and improper restorative procedures, the latter covers the topics such as the developmental and functional status of cracked tooth syndrome. This is then followed by the description of common clinical diagnosis methods, the prospects of new technologies, and summaries of current clinical management methods, including immediate management and direct and indirect restoration. In the final section, preventive methods and their importance are proposed, with the aim of educating the common population.

Figure 1

(a) Visible fracture lines within the enamel suggestive of craze lines; (b) fractured cusp terminating in the cervical part of the tooth; (c) cracked tooth extending from the occlusal tooth surface without separation of tooth fragments; (d) separated tooth fragments suggestive of a split tooth; and (e) vertical root fracture [4].

Figure 2

Clinical image of enamel crack lines (arrows) in patients affected by HNRT [35].

Figure 3

Tooth Slooth tool for the bite test [13].

Figure 4

SS-OCT image of the dentin crack. The crack extended beyond the DEJ and displayed as a bright white line [68].

Figure 5

A DCS restoration utilized as a diagnostic aid: (a) upper view of the restoration; (b) lower view of the restoration [83].

Figure 6

Restoration of a fractured right mandibular second molar using a gold onlay. (a) A cracked tooth prepared for restoration via onlay bonded with resin; (b) 22 months after restoration via bonded type III gold alloy inlays with Panavia Ex cement [110].