Managing Cracked Teeth: An Enigma Wrapped Up Inside a Riddle Asking Questions

Without a doubt, one of the most significant challenges facing the preventive restorative dentist today is how to manage a cracked tooth. If you put any group of dentists in a room and pose a single question about how a tooth with a crack should be managed, you will no doubt end up with a spirited discussion with no resolve.

Further complicating the problem, it is difficult to determine a prognosis for a cracked tooth. In fact, if any interested dentist reading this article is honest with him/herself, they will acknowledge that they have lost at least one (and probably several) patients from their practice due to how he proposed to manage a cracked tooth.

I am no different. I can recall this particular case that presented to my office several years ago: a 45-year-old healthy and active woman with the chief complaint of “My upper right teeth are all sensitive whenever I eat.”

There was neither periapical nor periodontal pathology; the joints could be loaded without pain with a leaf gauge and the muscles were asymptomatic. But there was a shift from a stable and reproducible condylar position to maximum intercuspation of approximately 0.5mm toward the right during a clinical exam consistent with eccentric “stripes” on the buccal cusps made with articulating ribbon, measured at the midline.

What would you have recommended?

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