Clinical Management and Treatment of Cracked Teeth
Fractured teeth present both diagnostic and restorative challenges to the dentist. A fractued tooth may present with variable signs and symptoms depending on the location of the tooth and the status of the pulp. An orthodontic band or temporary crown is often proposed if the pulp is normal or reversibly inflamed. This temporary diagnostic procedure can allow us to observe any pulpal changes. Root canal treatment followed by a permanent crown is always indicated if the pulp is or becomes irreversibly inflamed.
The prognosis of a fractured tooth is highly dependent on the extent of the fracture into the enamel, dentin, and or pulp. Also, the prognosis is dependent on whether it extends apically into the root and whether a periodontal pocket has already developed. Fractures that propagate through the pulpal floor and beyond the alveolar bone level are deemed hopeless. Long term studies regarding the prognosis of cracked teeth are not prevalent in the literature which makes it difficult to communicate success rates with patients.
Below are some articles that hopefully will give you a better perspective on clinical management and treatment of cracked teeth. As always, please feel free to email either of us with comments or questions.
Decision Making for Retention of Endodontically Treated Posterior Cracked Teeth: A 5-year Follow Up Study
Sim et al. JOE 2016
This study aimed to investigate the 5 year survival rate of root filled posterior teeth and it’s related factors. Two hundred patients who had root canal treated posterior cracked teeth at the National Dental Centre were recalled for a 5-year review. The 5-year survival rate of the absence versus presence of cracked extension onto the pulpal floor was 99% an 88%,respectively. Conclusions: Coronal cracks may be predictably treated, whereas radicular cracks increased the odds of a tooth being extracted.
SIM et al.
Opdam et. al 2008
The purpose of this study was to investigate the long-term clinical effectiveness of treating painful, cracked teeth with a direct bonded composite resin restoration. Forty-one patients attended a dental practice with a painful, cracked tooth that was restored with a direct composite resin restoration. Mean annual failure rate of restorations without cuspal coverage was 6%. No failures occured in restorations with cuspal coverage. Therefore, a direct bonded composite resin restoration can be a successful treatment for a cracked tooth.
OPDAM et. al
A Six Year Evaluation of Cracked Teeth Diagnosed with Reversible Pulpitis: Treatment and Prognosis
The purpose of this investigation was to report on the clinical outcomes of cracked teeth diagnosed with reversible pulpitis. The study examined 8,175 patients that were referred for evaluation and treatment during a 6-year period. All the patients had medical and dental histories, radiographs, pulpal and periapical diagnosis, periodontal probings, direct identification of crack(s) with transillumination, and biting responses on various cusps recorded. The results indicated that cracks were identified in 9.7% of all cases (796 of 8175) . Of 127 patients specifically diagnosed with reversible pulpitis, 27 converted to irreversible pulpitis in 58 daysor to pulpal necrosis in 149 days.
The outcomes of this study suggest that if a marginal ridge crack is identified early enough in teeth with a diagnosis of reversible pulpitis and a crown is placed immediately there afterwards, then root canal treatment will be necessary in only about 20% of these cases within a 6-month period.
Krell, Rivera JOE
George and Geoffrey