Cracked tooth syndrome in an unrestored maxillary premolar: a case report

Cracked tooth syndrome is known to occur most frequently in heavily restored teeth. Nevertheless, when the symptoms occur in intact teeth, there is difficulty in obtaining a correct diagnosis because it is difficult for the dentist to find where the crack is located. This clinical report describes the diagnostic procedures and the direct bonded composite restoration used to restore an incompletely fractured unrestored maxillary premolar in a 22-year-old female patient. To achieve a correct diagnosis, the following were performed: periapical and bitewing radiographs, percussion and thermal vitality tests, a bite test, and the placement of a stainless steel band. Once the symptoms ceased with band placement, cone beam computed tomography, transillumination, macro photographs, and isolation with a rubber dam helped to visualize the crack line along the occlusal surface involving distal and mesial marginal ridges. The crack was traced using a high-speed tungsten carbide bur until the fracture line was not visible. The tooth was restored with a direct composite resin, associated with a total-etch adhesive system, and the symptoms were immediately eliminated.