The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 5 ( May, 2019 ) > List of Articles


Treatment Decision-making of Cracked Teeth: Survey of American Endodontists

Ayman M Abulhamael, Radhika Tandon, Ziyad T Alzamzami, Loai Alsofi, Rafael A Roges, Ilan Rotstein

Keywords : Cracked tooth, Probing depth, Root canal treatment, Tooth survival

Citation Information : Abulhamael AM, Tandon R, Alzamzami ZT, Alsofi L, Roges RA, Rotstein I. Treatment Decision-making of Cracked Teeth: Survey of American Endodontists. J Contemp Dent Pract 2019; 20 (5):543-547.

DOI: 10.5005/jp-journals-10024-2554

License: CC BY-NC 4.0

Published Online: 01-04-2015

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: The aim of this study is to survey the opinion of endodontists in the United States regarding their approach to treatment of cracked teeth. Materials and methods: A survey assessing the opinions of 3,500 endodontists in the United States was administered over a 4-week period. It consisted of a hypothetical clinical case and eight different treatment scenarios. Participants were asked to select one of the two treatment options: (A) informing the patient of the presence of a crack, reinforcing the tooth, and continuing with endodontic treatment; and (B) extraction of the tooth followed by replacement with an implant supported crown or fixed partial denture. Results: When the crack extended across the distal marginal ridge with no associated probing depths, 92.65% endodontists preferred to continue with endodontic treatment and reenforcing the tooth. When the crack extended across the distal marginal ridge and was associated with a probing depth of 6 mm, 80% preferred extraction of the tooth. When the crack extended across the mesial marginal ridge up to the orifice of the mesiolingual canal with no associated probing depth, 82.78% preferred to continue with the treatment. When the crack was associated with a 6-mm probing depth, 83.79% preferred tooth extraction. When the crack extended across the mesial marginal ridge and down into the mesiolingual canal with/without associated probing depth, 91.13% and 63.54% preferred tooth extraction, respectively. When the crack involved both mesial and distal marginal ridges and extended across the pulp chamber, 79.74% preferred tooth extraction. When a split tooth was presented, 98.48% preferred tooth extraction. Conclusion: It appears that the presence of a 6-mm periodontal pocket is considered an important factor by most American endodontists when deciding whether to preserve the cracked tooth or extract it. Clinical significance: There is no consensus among dentists regarding the best approach to treat cracked teeth. Conclusive studies evaluating clinical approaches of endodontists regarding treatment of cracked teeth are lacking. Therefore, surveyed opinion of endodontists in the United States regarding their approach to treatment of cracked teeth was done to try to reach the best clinical decision regarding this dilemma.

PDF Share
  1. Cameron CE. Cracked-tooth syndrome. J Am Dent Assoc 1964;68: 405–411.
  2. Rivera EM, Walton RE. Cracking the cracked tooth code: detection and treatment of various longitudinal tooth fractures. In: Colleagues for Excellence. Chicago: American Association of Endodontists; 2008.
  3. Abbott P, Leow N. Predictable management of cracked teeth with reversible pulpitis. Aust Dent J 2009;54:306–315.
  4. Ailor JE Jr. Managing incomplete tooth fractures. J Am Dent Assoc 2000;131:1168–1174.
  5. Brynjulfsen A, Fristad I, et al. Incompletely fractured teeth associated with diffuse longstanding orofacial pain: diagnosis and treatment outcome. Int Endod J 2002;35:461–466.
  6. Homewood CI. Cracked tooth syndrome-incidence, clinical findings and treatment. Aust Dent J 1998;43:217–222.
  7. Lynch CD, McConnell RJ. The cracked tooth syndrome. J Can Dent Assoc 2002;68:470–475.
  8. Berman LH, Kuttler S. Fracture necrosis: diagnosis, prognosis assessment, and treatment recommendations. J Endod 2010;36:442–446. DOI: 10.1016/j.joen.2009.12.018.
  9. Eakle WS, Maxwell EH, et al. Fractures of posterior teeth in adults. J Am Dent Assoc 1986;112:215–218.
  10. Kang SH, Kim BS, et al. Cracked teeth: distribution, characteristics, and survival after root canal treatment. J Endod 2016;42:557–562. DOI: 10.1016/j.joen.2016.01.014.
  11. Tan L, Chen NN, et al. Survival of root filled cracked teeth in a tertiary institution. Int Endod J 2006;39:886–889. DOI: 10.1111/j.1365- 2591.2006.01165.x.
  12. Sim IG, Lim TS, et al. Decision making for retention of endodontically treated posterior cracked teeth: a 5-year follow-up study. J Endod 2016;42:225–229. DOI: 10.1016/j.joen.2015.11.011.
  13. Suksaphar W, Banomyong D, et al. Survival rates from fracture of endodontically treated premolars restored with full-coverage crowns or direct resin composite restorations: a retrospective study. J Endod 2018;44:233–238. DOI: 10.1016/j.joen.2017.09.013.
  14. Krell KV, Caplan D. 12-month success of cracked teeth treated with orthograde root canal treatment. J Endod 2018;44:543–548. DOI: 10.1016/j.joen.2017.12.025.
  15. Krell KV, Rivera EM. A six-year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. J Endod 2007;33:1405–1407. DOI: 10.1016/j.joen.2007.08.015.
  16. Opdam NJ, Roeters JJ, et al. Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration. J Endod 2008;34:808–811. DOI: 10.1016/j.joen.2008.04.011.
  17. McLeod CC, Klabunde CN, et al. Health care provider surveys in the United States, 2000–2010: a review. Eval Health Prof 2013;36:106–126. DOI: 10.1177/0163278712474001.
  18. Funkhouser E, Fellow JL, et al. Supplementing online surveys with a mailed option to reduce bias and improve response rate: the national dental PBRN. J Pub Health Dent 2014;74:276–282. DOI: 10.1111/jphd.12054.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.