One cannot separate the segments of a cracked tooth, and they are often very difficult to diagnose. Cracked teeth are often associated with pain on mastication, brief pain to cold, centrally located mesial to distal marginal ridge cracks seen in the dentin as shadows with transillumination and normal to deep probing depths associated with the crack. The third category, cracked teeth, may or may not present with a restoration. Removal of the existing restoration may result in the cusp breaking off. Category one is defined as teeth with craze lines that exhibit no pain, show lines in enamel, but do not block light with transillumination.5 The second category is of teeth with fractured cusps that have mild pain to biting on a specific cusp, usually a marginal ridge and buccal or lingual groove crack in the dentin, which is seen as a shadow with transillumination and a class 2 restoration. The 1997 American Association of Endodontists (AAE) article entitled “Cracking the Cracked Tooth Code” defined five different types of tooth cracks.5 Four out of the five types of defects are generated from chewing and biting events. Cracks that communicate with the pulpal floor or beyond alveolar bone have been deemed hopeless.4 The purpose of this article is to summarize the evidence for survival of cracked teeth, as well as the management to prevent further propagation of cracks. Additional information regarding cracked teeth would provide a better perspective on the clinical management and outcome of these teeth. Long-term data involving cracked teeth is rare in the literature, which makes clinical decisions more difficult. The prognosis of the relevant tooth depends on the extent of the crack and whether the crack has pierced through enamel, dentin, pulp and/or the chamber floor. Previously, stainless steel bands were often used as a temporary and diagnostic tool before a full coverage restoration.1 Root Canal Treatment (RCT), followed by a crown is recommended if the pulp becomes irreversibly inflamed.2 One study reported successful treatment with a bonded composite restoration after six months, with no differences between restorations with or without cuspal coverage.3 Treatment of cracked teeth has been controversial in recent literature. A cracked tooth can present with varied signs and symptoms based on the location and extent of the crack, which can be difficult to determine and visualize. Cracked teeth present both diagnostic and restorative challenges to any dentist.
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