The cracked tooth conundrum: terminology, classification, diagnosis, and management

To provide an overview of the clinical features, diagnosis, classification and management of cracked teeth which may be a diagnostic challenge in clinical practice.

Cracks may initiate from coronal tooth structure or from within the root and affect healthy or root treated teeth. There are many terminologies and classifications in the literature for cracked teeth that can be as confusing as the array of clinical symptoms which are associated with this condition. The term "cracked tooth syndrome" is misleading as there are a range of symptoms that do not form a distinct and reliable pattern. Symptoms will vary with teeth that have healthy pulps, for teeth with inflamed or necrotic pulps, and for teeth that have been root treated. The American Association of Endodontists have classified five specific variations of cracked teeth; craze line, fractured cusp, cracked tooth, split tooth, and vertical root fracture. The importance of differentiating dentin, pulpal and periodontal pain for diagnosis and treatment for these specific entities will be elaborated. A decision flow chart indicating the treatment options available is presented.