Diagnosis, treatment, and survival of cracked teeth: a review based on recent scientific evidence

Abstract

Cracked tooth syndrome (CTS) is characterized by the presence of fissures of varying depth and direction, which can compromise the pulp and even the periodontal ligament. Its etiology is multifactorial and includes trauma, bruxism, and extensive restorative procedures. Diagnosis is complex and may require techniques such as transillumination, methylene blue staining, and magnification. This study aimed to review the etiology, diagnosis, and current therapeutic strategies of CTS based on the most recent scientific evidence. A qualitative and descriptive bibliographic search was conducted in Medline, PubMed, ELSEVIER, Scopus, and The Cochrane Library, with no language restriction and an inclusion criterion of studies published in the last decade. It was found that teeth with vital pulp have a higher survival rate compared to those with pulp necrosis. Treatments vary according to the extent of the fissure, ranging from direct or indirect restorations in mild cases to endodontic treatment and crown placement in fissures with pulp involvement, achieving success rates of 55.4 % in restorations with provisional crowns followed by permanent ones. Comparative studies show pulp survival rates of 94-100 % in treatments with metal inlays, crowns, and onlays, while more recent studies indicate a success rate of 72-88 %.