The management of symptomatic cracked teeth: An international questionnaire-based cross-sectional study among...

To investigate the diagnostic and therapeutic approaches applied by dentists for the management of symptomatic cracked teeth, and the evaluation of factors that influence clinical decision-making.

An international cross-sectional study was conducted using an electronic multiple-choice questionnaire. The questionnaire was assessed for content validity by a panel of six experts and for reliability by a test-retest procedure in 20 dentists. A total of 427 fully completed questionnaires were collected from dentists practicing in Greece, the United Kingdom and other European countries. The questionnaire included demographic data, questions related to the diagnosis and treatment of cracked teeth, and four clinical scenarios. Statistical analysis was performed using descriptive and multivariate methods, at a level of statistical significance P < 0.05.

The majority of participants reported experiencing 1-5 cases of cracked teeth per month. History taking (79.5%), use of magnifying devices (79.5%), clinical examination (75.9%), and tooth slooth bite test (69.6%) were the most frequently used diagnostic methods. Most participants associated cracked teeth with bruxism or occlusal disorders (95.2%) and with the presence of metal restorations (92.4%). Variability in treatment options was observed across clinical scenarios, particularly in cases of uncertain prognosis. Periodontal burden emerged as the most important factor influencing the choice of extraction, increasing the possibility of this treatment decision (P < 0.001). The use of CBCT was not associated with changes in diagnosis or treatment planning (P < 0.05).

The management of symptomatic cracked teeth showed significant heterogeneity among dentists. The periodontal status of the tooth was the most important prognostic and treatment determinant, while clinical experience influenced decision-making in complex cases. The findings suggest that diagnostic accuracy can be achieved through traditional tools, whilst CBCT did not affect decision-making and treatment planning.

Variations in the management of symptomatic cracked teeth highlight the need for evidence-based clinical guidelines to achieve greater uniformity and promote a more consistent, predictable clinical approach to decision-making. Periodontal status remains the critical factor for the survival of cracked teeth, necessitating extraction over complex restoration in cases of high periodontal burden.