Managing the cracked and deeply carious tooth: a case report

An understanding of the immunomodulating activities of the dentine-pulp complex and developments of bioactive materials, such as Biodentine, have shaped vital pulp treatment (VPT) and minimally invasive conservative techniques over recent years. However, a lack of consensus in the management of deep carious lesions remains. Furthermore, cracked teeth pose both a compromised endodontic and restorative prognosis due to deficits in coronal seal, the risk of crack propagation and associated uncertain treatment outcomes. The combination of these two situations, which often arise in teeth with occlusal effect caries, complicates their overall restorative management. There is a paucity of evidence relating to clinical protocols which aim to preserve pulpal vitality when managing deep carious lesions in cracked teeth. This may explain why some clinicians enter more advanced stages of the restorative cycle immediately through elective root canal treatment, or, even more radically, through proceeding to extraction. This clinical case report aims to illustrate the value of VPT and indirect restoration in a cracked tooth.