Consequences of posterior cusp fracture

Although posterior cusp fracture occurs frequently, its consequences are not well-delineated. This study recorded short-term outcomes (distribution of fractured teeth and cusps, fracture severity, and treatment received up to two years postfracture) for 517 fractured teeth from 498 subjects at a large group practice. Maxillary and mandibular tooth fractures occurred with similar frequency. In the maxillary arch, first and second molars and premolars fractured with roughly the same frequency; premolar fractures were more severe. In the mandible, first molars accounted for approximately 50% of all fractures and were most likely to be severe fractures. Nonholding cusps were more likely to fracture in both arches. Proportions of fractured teeth receiving "catastrophic" treatment were low (3% extraction; 4% endodontic treatment) and the large majority of fractured teeth were treated in a single visit using direct restorative materials. A knowledge of the relatively small proportions of fractured teeth that suffer serious consequences and the tooth-specific distributions of cusp fracture should help dentists and patients to make informed decisions regarding preventive restorative intervention prior to fracture.