R. C RAIG G U TH R IE , D.D.S.; PETER M. DIFIO R E, D .D .S ., M .S .
( | racked teeth have been problematic for more than three decades.1'20Because this dental condition has a set of signs and symptoms that occur together as a complex, it has been referred to as cracked tooth syndrome.4 The primary symptom of CTS is momentary lancinating pain1,3'6'8'11 caused by the micro movement of the cracked dentin surfaces as occlusal forces are initiated and released during chewing. Such movement causes pulpal stimulation through the dentinal tubules and a pain response.1'3'5,6,13 This syndrome can be defined as the set of signs and symptoms emanating from an incomplete crack into the dentin of a vital tooth without pulp exposure15'812'14 A masticatory force of sufficient strength and direction initiates a greenstick dentin fracture.21 Pulpal involvement occurs if the crack is centrally located, deep and long-standing.2-4'7'10'11'15'17How ever, with pulpal involvement, the clinical signs and symptoms are those of pulpitis and of apical periodontitis rather than dentinal sensitivity.1'2'4'713'15 Mandibular molars have the highest incidence of CTS, followed by maxillary molars and first
ABSTRACT
Twenty-eight teeth diagnosed as having a crack w ere im m ediately treated with full coverage acrylic resin crowns. Twenty-five o f these teeth becam e asym ptom atic after full coverage acrylic crown placem ent and continued to be asym ptom atic one year after restoration. premolars.4'6'16The most prevalent age range for cracked teeth is 30 to 60 years.4'6'10,11 Extensive intracoronal and pin retained restorations predispose teeth to cracks.1^'912However, cracks can occur in teeth along developmental fissures with or without an occlusal restoration.1'6'7'11'12'17 Credible treatment modalities include: occlusal adjustment,812'20 copper or orthodontic band placement,1319amalgam restorations and repairs,3'10pinretained amalgams18and threequarter crowns.1'4'717'19 Ten typical clinical findings of CTS are:
■» a sudden sharp pain when chewing; “ sensitivity to thermal changes, especially to cold; ■* continual symptoms from weeks to months; “ the patient’s inability to localize the offending tooth; ■* pain on lateral cuspal pressure; ■■ no pain on vertical tooth percussion; *“ a vital response to pulp testing; ■■ negative radiographic findings; ■® weakened coronal tooth structure; and
( | racked teeth have been problematic for more than three decades.1'20Because this dental condition has a set of signs and symptoms that occur together as a complex, it has been referred to as cracked tooth syndrome.4 The primary symptom of CTS is momentary lancinating pain1,3'6'8'11 caused by the micro movement of the cracked dentin surfaces as occlusal forces are initiated and released during chewing. Such movement causes pulpal stimulation through the dentinal tubules and a pain response.1'3'5,6,13 This syndrome can be defined as the set of signs and symptoms emanating from an incomplete crack into the dentin of a vital tooth without pulp exposure15'812'14 A masticatory force of sufficient strength and direction initiates a greenstick dentin fracture.21 Pulpal involvement occurs if the crack is centrally located, deep and long-standing.2-4'7'10'11'15'17How ever, with pulpal involvement, the clinical signs and symptoms are those of pulpitis and of apical periodontitis rather than dentinal sensitivity.1'2'4'713'15 Mandibular molars have the highest incidence of CTS, followed by maxillary molars and first
ABSTRACT
Twenty-eight teeth diagnosed as having a crack w ere im m ediately treated with full coverage acrylic resin crowns. Twenty-five o f these teeth becam e asym ptom atic after full coverage acrylic crown placem ent and continued to be asym ptom atic one year after restoration. premolars.4'6'16The most prevalent age range for cracked teeth is 30 to 60 years.4'6'10,11 Extensive intracoronal and pin retained restorations predispose teeth to cracks.1^'912However, cracks can occur in teeth along developmental fissures with or without an occlusal restoration.1'6'7'11'12'17 Credible treatment modalities include: occlusal adjustment,812'20 copper or orthodontic band placement,1319amalgam restorations and repairs,3'10pinretained amalgams18and threequarter crowns.1'4'717'19 Ten typical clinical findings of CTS are:
■» a sudden sharp pain when chewing; “ sensitivity to thermal changes, especially to cold; ■* continual symptoms from weeks to months; “ the patient’s inability to localize the offending tooth; ■* pain on lateral cuspal pressure; ■■ no pain on vertical tooth percussion; *“ a vital response to pulp testing; ■■ negative radiographic findings; ■® weakened coronal tooth structure; and
