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Word of Mouth
Official Newsletter of the Aardent Dental Centre

Treatment for the Cracked Tooth Syndrome

Cracked teeth have been reported as a problem for the last 30 years and because the signs and symptoms occur together as a complex, it is referred to as cracked tooth syndrome, CTS.

The most obvious symptom of CTS is sudden lancing pain caused by the micromovement of the cracked dentin surfaces as biting forces are increased and then released during chewing. The movement caused by the chewing force causes stimulation of the fine tubules inside the dentin. The syndrome is a set of signs and symptoms emanating from an incomplete crack into the dentin of a vital tooth without exposing the pulp (nerve). A biting force of sufficient strength and direction initiates a greenstick fracture of the dentin. A crazing. The pulp will be involved if the crack is near the center of the tooth, deep or present for a long time, allowing it to deepen.

Lower molars have the highest incidence of CTS. The most prevalent age is 30 to 60 years.

Extensive fillings and pin-retained fillings predispose teeth to cracks. Treatment modalities may include: adjusting the pressure on the tooth by reducing contact areas, replacement and repair with large pinned restorations or part crowns… treated by stabilizing the crack and preventing its extension by using the circumference of the tooth and protecting the biting surface. The full coverage crown best satisfies these objectives.

Research Method

Full coverage plastic crowns were placed immediately a crack was diagnosed. If asymptomatic in 2 weeks, a full cast crown was placed.

Research Results

Of 31 patients, 15 had lower molar cracks, 10 had upper molar cracks and 6 had premolar cracks. Of the 28 treated patients, 25 became asymptomatic and three of the 28 required root canal therapy because they had persistent symptoms after the temporary crown was placed.

The difficulties in managing patients with CTS occurs in the diagnosis and early treatment phase. Adjustment of the bite and refilling procedures can be ineffective because they do not protect the cracked tooth from the pressure transmitted by food during chewing.

With a full coverage crown the crack is splinted after it is cemented to place. The internal surface of the crown transmits forces evenly, minimizing stresses on the cracked segments. The rigidity prevents micromovement when biting forces are released after the chewing cycle. Summary 89% became asymptomatic at one year, eleven had persistent symptoms requiring root canal therapy. The interim time allows evaluation of symptoms. The full coverage cast crown provides long term solution to the problems associated with cracked tooth symptoms.

By Peter Difiore and Craig Guthrie.

Dr. Difiore is Chief of Endodontics U.S. Army Dental Alabama; Dr. Guthrie is Chief Restorative Dentistry, Hanau Dental Clinic Germany.

This article first appeared in Journal of American Dental Association, September Vol. 122

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