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References

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Cracked Tooth Syndrome Management Part 2: Integrating the Old with the New

From Volume 47, Issue 7, July 2020 | Pages 570-582

Authors

Oliver Bailey

BDS(Hons), MFDS RCSEd, PGCert Implant, FHEA

Clinical Fellow, Newcastle University School of Dental Sciences; GDP North East

Articles by Oliver Bailey

Abstract

This article follows on from Part 1 which looked at the pathogenesis and diagnosis of cracked tooth syndrome (CTS). It combines a review of the available evidence with a discussion of established and more modern concepts of management, aiming to provide a clear, rational approach to the predictable management of CTS with the aid of case studies and a decision-tree.

CPD/Clinical Relevance: Allows the clinician to manage CTS predictably.

Article

There are no universally accepted guidelines for managing cracked tooth syndrome (CTS). Contemporary approaches are quite diverse and have included operative crack removal, mechanical encirclement of the tooth, adhesive intra-coronal splinting, or splinting with extra-coronal coverage retained either adhesively or mechanically. In addition, restorations have been fabricated either in the mouth (directly), or in the laboratory (indirectly).1,2,3,4,5 Understandably, choosing the best option can be confusing.

Treatment of CTS aims to predictably restore and maintain a functional asymptomatic tooth, with a vital pulp, by stabilizing the crack, or cracks.

The evidence base on management options for CTS is limited, with much experimental data missing.

A study involving 41 patients with CTS compared direct composite placed either intra-coronally, or overlaying the affected cusp following its reduction.2 In the overlay group (n = 21), 0% required pulpectomy and restoration survival was 100% at 7 years follow-up. In the intra-coronal group (n = 20), three teeth required pulpectomy (15%), two within 6 months and one at 7 years. Two of these teeth subsequently required extraction due to vertical fractures. Eighty-five percent of restorations survived in this group and the failures were non-catastrophic. Excluding the teeth requiring pulpectomy, a minority of teeth suffered from residual thermal sensitivity in both groups, but pain on biting resolved in all teeth.

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