UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
CASE REPORT DOI: https://doi.org/10.4322/bds.2024.e4329
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Braz Dent Sci 2024 July/Sept;27 (3): e4329
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
Desfechos clínicos da síndrome do dente trincado após 3 anos de tratamento: uma série de casos
Karen Cristina Kazue YUI1 , Jefferson Pires da SILVA JÚNIOR2 , Cauã Santiago FIGUEIREDO1 , Rafael Pinto de MENDONÇA1 ,
Felipe Nogueira ANACLETO1 , Hércules Bezerra DIAS3 , Eduardo BRESCIANI1 , Sérgio Eduardo de Paiva GONÇALVES1
1 - Universidade Estadual Paulista “Júlio de Mesquita Filho”. São José dos Campos, SP, Brazil.
2 - Universidade Nilton Lins. Manaus, AM, Brazil.
3 - Universidade Federal do Pará. Belém, PA, Brazil.
How to cite: Yui KCK, Silva Júnior JP, Figueiredo CS, Mendonça RP, Anacleto FN, Dias HB, et al. Clinical outcomes of cracked tooth
syndrome after 3 years of treatment: a case series. Braz Dent Sci. 2024;27(3):e4329. https://doi.org/10.4322/bds.2024.e4329
ABSTRACT
Background: Diagnosis of cracked tooth syndrome (CTS) requires clinical experience and scientic knowledge.
Even providing an effective resolution of the symptoms, clinicians must inform their patients that cracks may
progress and induce tooth separation. Thus, follow-up is essential. Case-report: This study describes the treatment
of patients with cracked tooth syndrome through a series of three cases. It also includes their long-term follow-
ups over three years, through clinical probing and radiography. The ndings highlight the importance of periodic
check-ups to manage potential complications. Regular follow-ups can help control undesirable responses that
may cause pain or make future treatments unfeasible. On all the scenarios presented, an endodontic treatment
was needed. On the rst successful case the radiolucent lesion regressed with no discomfort or pain. The second
case was an unsuccessful one. The patient returned to the dental ofce after 3 years when probing revealed
a 10-mm pocket at the distal aspect of the tooth. The radiography showed distal bone loss. The tooth was
extracted to prevent bone loss from progressing. The third report documented the treatment of a patient who
declined follow-up care and only returned after 3 years. At that point, a severe mobility was apparent. The
radiography revealed a large periapical radiolucency with extensive bone loss, and the tooth extraction became
necessary. Conclusion: These cases underscore the importance of informing patients about the potential for
crack progression and tooth separation and emphasizes the crucial role of regular follow-up care, as well as
discussing the possibilities of restorative treatment.
KEYWORDS
Clinical evolution; Cracked tooth syndrome; Diagnosis, oral; Permanent, dentistry, operative; Tooth crown.
RESUMO
Contexto: O diagnóstico da síndrome do dente trincado (SDT) requer experiência clínica e conhecimento cientíco.
Mesmo com a resolução dos sintomas, os clínicos devem informar seus pacientes que as trincas podem progredir
e induzir a fratura dos dentes. Assim, o acompanhamento é essencial. Relato do caso: Este estudo descreve o
tratamento de pacientes com síndrome do dente trincado através de uma série de três casos e acompanhamento
a longo prazo, durante três anos, por meio de sondagem clínica e radiograa (RX). Os resultados destacam a
importância dos controles periódicos para gerir potenciais complicações, o que pode ajudar a controlar respostas
indesejáveis dolorosas ou inviabilização de tratamentos futuros. Em todos os cenários, foi necessário tratamento
endodôntico. No primeiro caso bem-sucedido, a lesão radiolúcida regrediu sem qualquer desconforto ou dor.
O segundo caso foi de insucesso. O paciente voltou ao consultório dentário após 3 anos, quando a sondagem
revelou uma bolsa de 10 mm na distal do dente, com perda óssea detectada no RX, sendo indicada a extração. O
terceiro relatório documentou o tratamento de um paciente que recusou o acompanhamento e só regressou após
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Braz Dent Sci 2024 July/Sept;27 (3): e4329
Yui KCK et al.
Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
INTRODUCTION
Painful symptomatology is a routine
problem in the clinical challenge of the dentist,
where identifying the cause and origin can be
difcult [1]. In addition, pain can be odontogenic
or non-odontogenic, and these classications can
be challenging for professionals [2]. Diagnosis is
the key to identifying the cause and establishing
treatment, requiring both clinical skill and
accurate scientic knowledge [1,2].
When identifying the problem, the clinical
aspect should be associated with complementary
exams [2]. In dentistry, when the patient
reports pain symptoms associated with their
complaint, hypotheses suggestive of common
conditions such as dentoalveolar trauma, pulpitis,
cracks and fractures, dentine hypersensitivity,
orofacial pain, or even atypical toothache
can be highlighted [3-5]. Clinical conduct for
each condition will depend exclusively on the
identication of the cause during the diagnostic
stage [1].
The development of cracks in dental tissues
occurs physiologically in enamel due to aging,
often associated with some type of local trauma.
This can lead to cracked tooth syndrome (CTS),
which typically presents and intense and localized
pain that worsens during chewing [5]. CTS can
develop with or without restorative materials,
and depending on the extent of the crack and
its involvement with the dentin, it can cause
pulpal and/or periodontal damage, potentially
leading to pathological changes [5,6]. Treatments
include a variety of procedures which can involve
direct or indirect procedures, involving or not
cuspal protection and adhesion, with or without
endodontic treatment. In more extreme cases,
if left untreated, the crack can spread and even
result in tooth loss [7].
A diagnosis requires careful analysis of the
clinical characteristics alongside complementary
exams [2]. The main complementary methods
include periapical and/or interproximal
radiographs, transillumination, CT scans, and
stimulus tests such as bite response on each cusp
and cold pulp vitality [8]. The location and extent
of the crack determine the most appropriate
treatment, which may vary between dentistry
specialties according to the type of involvement,
including enamel only, enamel and dentin, pulp
and periodontal involvement [6,7].
This study aims to describe the treatment
of three different cases of CTS and its long-
term follow-ups after 3 years, highlighting the
importance of periodic follow-ups, which can help
to prevent undesirable responses such as pain
or difculty with future treatments, while also
discussing other possibilities of CTS treatment.
CASES REPORTS
Case report 1
A healthy 55-year-old man was referred to
the Restorative Dentistry Department at ICT-
UNESP for a restorative evaluation. A clinical
and radiographic examination of the patient’s
mandibular right rst molar revealed a defective
amalgam restoration with microleakage and
mesial secondary caries, but no periodontal or
periapical disease. The pulp responded normally
to testing (Figure 1A). The proposed treatment
was to remove the amalgam restoration from
the first molar and replace it with a Class II
direct adhesive restoration. After the amalgam
was removed, microcracks were detected in the
mesiodistal direction with an unclear extent
(Figure 1B). The selected treatment at that
time was to place the most conservative direct
adhesive resin restoration possible.
The protocol started with cleaning of the
cavity with an oil-free prophylaxis paste, by means
of a robinson brush, followed by a detergent
(Tergencal, Biodinâmica, Ibiporã, PR, Brazil)
applied actively by means of a microbrush for 10s,
followed by a washing and drying with absorvent
paper. After, etching was performed with a
3 anos. Nessa altura, era notável uma intensa mobilidade. O RX revelou uma grande radiolucência periapical com
extensa perda óssea, sendo necessária a extração do dente. Conclusão: Estes casos destacam a importância de
informar os pacientes sobre o potencial de progressão da ssura e separação do dente e enfatiza o papel crucial
do acompanhamento regular, além de discutir as possibilidades de tratamento restaurador.
PALAVRAS-CHAVE
Evolução clínica; Síndrome de dente quebrado; Diagnóstico bucal; Dentística operatória; Coroa dentária.
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Yui KCK et al.
Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
35% phosphoric acid (Ultra-Etch, Ultradent,
Indaiatuba, SP, Brazil) for 30s on enamel, and
15s on dentin, followed by intense washing for
20s, and gentle dry with absorvent paper, to keep
the dentin moist. A double layer of 2-step etch-
and-rinse adhesive system (Adper Single Bond 2,
3M do Brasil Ltda, Sumaré, SP, Brazil) was then
applied in active mode, photopolymerized with
a 1200mW/cm2 LED photocuring device (Demi
Plus, Kerr, Orange, CA, EUA) for 20s, followed by
2mm layers of composite resin (Filtek Z350, 3M
do Brasil Ltda., Sumaré, SP, Brazil), individually
photopolymerized for 20s each, until the full
lling of the cavity.
After 17 months, the patient returned
with a buccal sinus tract. Gutta-percha
placed in the sinus tract at the root furcation
demonstrated that there was an endodontic
lesion (Figures 2A, 2B and 2C). Clinically, this
tooth presented with pulpal necrosis. Root canal
treatment (RCT) was performed after the sinus
tract had healed completely and the patient
remained asymptomatic. The crown was opened
using spherical diamond tips, followed by the
removal of necrotic pulp material from the pulp
chamber using dentin curettes. Afterwards,
Figure 1 - (a) Tooth 46 with amalgam restoration and caries; (b)
Tooth 46, after amalgam restoration removing.
Figure 2 - (a) Fistulous tract in adjacent mucosa; (b) Guttapercha placed in the sinus tract at the root furcation; (v) Radiograph image of Gutta-
percha reaching periapical lesion; (d) Radiograph after crown cementation.
a
b
a b
c d
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Braz Dent Sci 2024 July/Sept;27 (3): e4329
Yui KCK et al.
Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
compensatory grinding was carried out with
Gates Glidden tips (1 and 2) to access the root
canals, followed by immediate neutralization with
1% sodium hypochlorite solution. Odontometry
and chemical-mechanical preparation was made
with les (K-Flexole, Dentsply, Charlotte, NC,
EUA) from number 10 to 35, and the irrigation
process with 1% sodium hypochlorite followed
by saline solution. The canals were dried with
sterile absorbent paper cones and irrigated
with 3% liquid Trisodium EDTA (Biodinâmica,
Ibiporã, PR, Brazil) for 3 minutes, with oscillatory
movements of the le inside the canals in the
last minute. A paste made from a mixture of 2%
chlorhexidine gel and P.A. calcium hydroxide
powder (Biodinâmica, Ibiporã, PR, Brazil) was
used as intracanal medication, with a provisional
glass ionomer restoration (Vidrion R, SSWhite,
Rio de Janeiro, RJ, Brazil). The canal was lled
with number #35 gutta-percha cones and AH
Plus cement (Dentsply, Charlotte, NC, EUA)
using the lateral condensation technique.
The access chamber was denitively restored with
resin composite (Filtek Z350, A1, 3M do Brasil
Ltda., Sumaré, SP, Brazil) and then received a
full-coverage metal crown cemented with zinc
phosphate cement (SSWhite, Rio de Janeiro, RJ,
Brazil) (Figure 2D).
The patient was recalled after 1 year (Figures 3A
and 3B) and 3 years (Figures 4A and 4B). Clinical
tests, including percussion, probing depths, biting
stimulation, and periapical radiographs were
performed. After 3 years, the radiolucent lesion
appeared to have regressed. During the follow-up
period, the patient reported no discomfort or pain.
As for the furcal and periapical lesion still present,
despite of the signicative regression on x-ray image
comparing the immediate and the 1- and 3-years
follow-up, considering the absence of symptoms and
the apparent stability after the passing of years, it
was claried with the patient the need of periodical
follow-up with clinical probing and radiograph.
Case report 2
A 44-year-old woman sought treatment in
a private practice for spontaneous pain in her
right mandible. The pain was exacerbated by
chewing and biting on a cotton roll, particularly
on different cusps of the mandibular right
second molar (47). A thermal test elicited an
exaggerated response. This tooth, which had
a Class I amalgam restoration, presented with
a mesiodistal crack line on its occlusal surface
(Figure 5A – red arrows). A periapical radiograph
revealed an apical radiolucency on the distal root
(Figure 5B). Probing was performed for initial
evaluation, but with no significant changes.
Treatment options and their corresponding
prognoses were explained to the patient, who
Figure 3 - (a) Clinical aspect after 1 year; (b) X-ray after 1 year.
a
b
Figure 4 - (a) Clinical aspect after 3 years; (b) X-ray after 3 years.
a
b
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Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
opted to retain the tooth instead of extraction.
The restorative materials were removed, and
endodontic treatment was performed with the
same material of case 1 (Figure 5C).
The access chamber was denitively restored
with composite resin with the same protocol used
in case 1, to serve as an adhesive lling material,
and then the tooth was prepared for a full-
coverage metal crown. After taking impressions,
a dental laboratory technician fabricated a
temporary crown, which was cemented with zinc
phosphate cement (SSWhite, Rio de Janeiro, RJ,
Brazil).
The patient returned to the dental office
after 3 years. Probing revealed a 10-mm pocket
on the distal aspect of the tooth. A radiograph
showed distal bone loss (Figure 6A – red arrow).
At this point, the tooth was extracted to prevent
further bone loss. A crack line was evident on
the distal root, extending to the apical third and
splitting into two separate lines running buccally
and lingually (Figure 6B – red arrows).
Case report 3
A 68-year-old female patient presented with
a cracked tooth syndrome in her mandibular left
rst molar (Figure 7A). Symptoms involved pain
when bitting and cold temperature. The tooth
received endodontically treatment with the same
protocol used on case 1, and was restored with a
conventional glass ionomer (Vidrion R, SSWhite,
Rio de Janeiro, RJ, Brazil) as a pulp chamber
lling, and a denitive metal crown procedure
was performed with the same protocol reported
on the previous cases. After treatment for the
cracked tooth, the patient declined follow-up
care and only returned after 3 years, which made
impossible a rigorous control and documentation
of the case. At this time, a severe mobility was
readily apparent, and a radiograph revealed a
large periodontal radiolucency (Figure 7B – red
arrows), with extensive bone loss and furcal
involvement. The tooth was then extracted.
Figure 5 - (a) Mesiodistal crack line; (b) Initial case tooth 47; (c) X-ray after 1 year.
a
b c
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Yui KCK et al.
Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
DISCUSSION
Cracked teeth pose an initial challenge
to both diagnosing the need for endodontic
treatment and selecting the appropriate
restorative procedure [2,9]. The location of
the crack can further complicate diagnosis and
treatment planning, as it inuences the signs and
symptoms that manifest [10]. Cracks present on
the inner surface of the crown often extend to the
pulp chamber and may even reach the entrance
of the root canal orices [2,5].
Cracks that remain within the dentin without
contacting the external surface of the root
generate a more favorable clinical situation
for the success of endodontic and restorative
treatment. In this scenario, there is a more
incomplete fracture indication, which makes
restorative treatment more predictable in terms
of damage control [11,12]. In contrast, when
cracks are present on the external surface of
the crowns, identifying their end is essential
for planning [7,13]. Cracks that remain above
Figure 6 - (a) Periodontal disease and bone lose are evidenced radiographically; (b) A crack line was present on the distal aspect of the tooth,
extending all the way to the apical third. At this point, it bifurcated into two separate crack lines running to the vestibular and lingual aspects
of the distal root.
b
a
Figure 7 - (a) The mandibular left first molar has been diagnosed with CTS symptoms. It was further endodontically treated and restored with
definitive metal crown; (b) Tooth 36 after 3 years, presenting a large periodontal radiolucency.
ba
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Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
the gingival sulcus can be incorporated into the
prosthetic restoration, but cracks that invade
the junctional epithelium are more complex and
have a dubious prognosis [6]. This is because
local inammation in the periodontal ligament
caused by the presence of microorganisms
leads to sensitivity during chewing and vertical
percussion, and the presence of microorganisms
in the area accelerates bone resorption, forming
a localized periodontal pocket [14], which
happened on case 2.
Dental procedures, such as preparation with
burs, extensive tooth preparation, insufcient
protection of weakened cusps, larger amalgam
restorations, and an inappropriate incremental
technique during restorative procedures with
composite resin, can initiate microcracks [9,11].
The cracked mandibular rst molar described
in the first clinical report may have resulted
from the “wedging effect” of occlusion with the
prominent mesiopalatal cusp of the maxillary
rst molar [10,12]. Pacquet et al. [13], reported
that this tooth is the second most commonly
affected tooth, and cracks occur because the
masticatory force is increased close to the
temporomandibular joint. The three patients in
this article illustrate that the mandibular molars
are the most commonly affected teeth [15].
Diagnosing a cracked tooth can be difcult.
During clinical examination, visualizing a crack
is challenging, and the radiographic examination
typically remains inconclusive [1,8]. Authors
have suggested that removing restorations and
using contrasting color of a rubber dam can
improve visualization of the crack [6,16]. Patients
with cracked tooth syndrome report brief pain
while chewing, sensitivity to cold stimuli, and
pain after biting hard food [7].
Some authors have suggested using stains
such as gentian violet or methylene blue to
improve visualization of cracks [10]. During
diagnosis, important aspects to consider for
treatment planning include the direction of
fracture propagation, the characteristics of the
bone tissue around the suspected fracture or
crack, and the pulpal condition [1,7]. An early
diagnosis can lead to successful restorative
treatment with a good prognosis [17]. Relevant
aspects such as dental history and patient habits,
such as chewing ice, hard candy, pencils or other
things that might lead to cracked teeth, should
be identied [10,17].
To solve the problem of incomplete
posterior tooth fracture, various treatment has
been advocated, including directly bonded
intracoronal restorations, directly bonded
extracoronal restorations, and indirect extra-
coronal restorations, with or without endodontic
treatment [4,18]. The rst patient was initially
treated with a conservative class II restoration,
which seems to have been successful in terms
of prevent the crack spread along the months.
However, as no biological protection was used,
such as with glass ionomer cement, as reported in
the literature [19], the direct adhesive restoration
on the dentin may have led to irreversible pulp
involvement.
Due to the endo-perio lesion installed, an
indirect cuspal-coverage was necessary to keep
the protection to the remaining tooth after
the endodontic treatment. This treatment can
leave the tooth dry and increase susceptibility
to fracture due to the internal wear necessary
for endodontic access. The other two patients
were also treated with indirect cuspal-coverage
restorations due to the extension and location of
the cracks in their posterior teeth [19-22]. After a
longitudinal evaluation, Batalha-Silva et al. [12]
reported satisfactory results with no symptoms
when the teeth were restored with composite
resin bonded directly with cusp coverage. This
is in agreement with others who proposed
complete cuspal coverage to treat cracked
teeth [5,14,19-23].
In this sense, there are controversial results
in the literature regarding the need for prior
endodontic treatment. While some authors such as
Leong et al. [21] argue that endodontic treatment
leads to more predictable tooth maintenance
results, others such as de Toubes et al. [19] have
reported success with cusp protection treatments
performed without prior endodontic treatment.
Another important point of discussion is
the type of material used and the restorative
technique [7]. Adhesive restorations are now
preferred to promote better union between the
cracked parts [23]. However, ceramics can pose
a risk by transmitting the masticatory load [14].
In the cases presented, metallic restorations with
cusp coverage and conservative wear were used
after an endodontic treatment to preserve of the
dental remnant to a greater extent. This is in
agreement with the literature, which indicates
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Yui KCK et al.
Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
better prognostic for teeth treated with minimally
invasive restorations [14,21,23].
Krell and Rivera [24] reported that 20% of
127 cracked teeth with reversible pulpitis treated
with complete crowns required endodontic
treatment after 6 months, while the other
teeth remained vital for 6 years of evaluation.
Endodontic treatment of cracked teeth has been
considered an appropriate treatment with a
2-year survival rate of 90.0% [6,21]. Monitoring
is essential, as cracks can remain intact or
evolve into a complete fracture. Furthermore,
high probing depth indicates the presence of
a periodontal pocket, which predisposes to the
progression of cracks in the root and affects
the qualities of the periodontium [21,22].
The extensive bone involvement in the third
case could have been avoided if the patient had
returned within the recommended periods [6].
Krell and Caplan [17] identied pocket depth
exceeding 5 mm and a crack across the distal
marginal ridge as the key factors most associated
with failure (Figures 5C and 6A). Additionally,
cracks harbor biofilms, allowing bacteria to
propagate and reach the pulp and periodontal
ligament [24,25]. Clinicians have a responsibility
to inform patients that cracks can progress,
potentially leading to tooth separation, and offer
treatment options [13,21]. The owchart below
outlines a protocol for treating cracked teeth
based on their pulp and periapical condition
(Figure 8).
CONCLUSION
This study highlights to clinicians the
necessity to inform their patients that cracks
may progress and lead to tooth separation, and
that follow-up is essential to prevent further
damage. This clinical report also suggests
clinicians to carefully consider the protocol for
treating cracked teeth with different pulp and
periapical conditions. In cases where endodontic
treatment is not an option and pulp vitality
is maintained, a cement with biocompatible
Figure 8 - Flow-chart: protocol for treating cracked teeth presenting different pulp and periapical conditions.
Source: Provided by the authors.
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Yui KCK et al.
Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
characteristics such as glass ionomer cement
should be preferred to direct adhesion with
methacrylate-based materials (cytotoxic). After
endodontic treatment, however, minimally
invasive restorations with cuspal protection, such
as metal ones, are preferable.
Acknowledgements
We would like to express our gratitude to
Aline Júnia Oliveira and Thamires Custódio
de Matos for the collaboration in the clinical
procedures of the rst case reported.
Author’s Contributions
KCKY: Formal Analysis, Data Curation,
Writing – Original Draft Preparation. JPSJ:
Conceptualization, Investigation, Software,
Writing – Original Draft Preparation. CSF:
Investigation, Software, Writing – Original
Draft Preparation. RPM: Data Curation,
Writing – Original Draft Preparation. FNA:
Conceptualization, Methodology. HBD: Writing
– Review & Editing, Methodology. EB: Writing
– Review & Editing, Supervision. SEPG:
Visualization, Supervision.
Conict of Interest
The authors have no proprietary, nancial,
or other personal interest of any nature or kind
in any product, service, and/or company that is
presented in this article.
Funding
The authors declare that there was no
funding for the execution of this project.
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies: Free
consent was signed by the patients.
REFERENCES
1. Koh SWC, Li CF, Loh JSP, Wong ML, Loh VWK. Managing tooth
pain in general practice. Singapore Med J. 2019;60(5):413.
PMid:31187144.
2. De Laat A. Differential diagnosis of toothache to prevent
erroneous and unnecessary dental treatment. J Oral Rehabil.
2020;47(6):775-81. http://doi.org/10.1111/joor.12946.
PMid:32061108.
3. Santos PS, Barasuol JC, Moccelini BS, Magno MB, Bolan M,
Martins-Junior PA,etal. Prevalence of toothache and associated
factors in children and adolescents: a systematic review and
meta-analysis. Clin Oral Investig. 2022;26(2):1105-19. http://
doi.org/10.1007/s00784-021-04255-2. PMid:34791550.
4. Costa NC, Abreu MHNG, Pinto RS, Vargas-Ferreira F, Martins RC.
Factors associated with toothache in 12-year-old adolescents in a
southeastern state of Brazil. Braz Oral Res. 2022;36:e057. http://
doi.org/10.1590/1807-3107bor-2022.vol36.0057. PMid:36507744.
5. Longridge NN, Youngson CC. Dental pain: dentine sensitivity,
hypersensitivity and cracked tooth syndrome. Prim Dent J.
2019;8(1):44-51. http://doi.org/10.1177/205016841900800101.
PMid:31122331.
6. Gill T, Pollard AJ, Baker J, Tredwin C. Cracked tooth
syndrome: assessment, prognosis and predictable management
strategies. Eur J Prosthodont Restor Dent. 2021;29(4):209-17.
PMid:33770422.
7. Li F, Diao Y, Wang J, Hou X, Qiao S, Kong J,etal. Review of
cracked tooth syndrome: etiology, diagnosis, management, and
prevention. Pain Res Manag. 2021;2021:3788660. http://doi.
org/10.1155/2021/3788660. PMid:34956432.
8. Guo J, Wu Y, Chen L, Long S, Chen D, Ouyang H, etal. A
perspective on the diagnosis of cracked tooth: imaging
modalities evolve to AI-based analysis. Biomed Eng Online.
2022;21(1):36. http://doi.org/10.1186/s12938-022-01008-4.
PMid:35706023.
9. Özer SY. Detection of vertical root fractures of different
thicknesses in endodontically enlarged teeth by cone beam
computed tomography versus digital radiography. J Endod.
2010;36(7):1245-9. http://doi.org/10.1016/j.joen.2010.03.021.
PMid:20630309.
10. Kang SH, Kim BS, Kim Y. Cracked teeth: distribution,
characteristics, and survival after root canal treatment. J Endod.
2016;42(4):557-62. http://doi.org/10.1016/j.joen.2016.01.014.
PMid:26944835.
11. Matsushita-Tokugawa M, Miura J, Iwami Y, Sakagami T, Izumi
Y, Mori N,et al. Detection of dentinal microcracks using
infrared thermography. J Endod. 2013;39(1):88-91. http://doi.
org/10.1016/j.joen.2012.06.033. PMid:23228263.
12. Batalha-Silva S, Gondo R, Stolf SC, Baratieri LN. Cracked tooth
syndrome in an unrestored maxillary premolar: a case report.
Oper Dent. 2014;39(5):460-8. http://doi.org/10.2341/13-257.
PMid:24517730.
13. Pacquet W, Delebarre C, Browet S, Gerdolle D. Therapeutic
strategy for cracked teeth. Int J Esthet Dent. 2022;17(3):340-55.
PMid:36047890.
14. Kimble P, Corso AM, Beattie M, Campos MS, Cavalcanti B.
Biomimetics and the restoration of the endodontically treated
tooth. Braz Dent Sci. 2023;26(1):e3668. http://doi.org/10.4322/
bds.2023.e3668.
15. Hilton TJ, Funkhouser E, Ferracane JL, Gordan VV, Huff KD,
Barna J,etal. Associations of types of pain with crack-level,
tooth-level and patient-level characteristics in posterior teeth
with visible cracks: findings from the National Dental Practice-
Based Research Network. J Dent. 2018;70:67-73. http://doi.
org/10.1016/j.jdent.2017.12.014. PMid:29289728.
16. Geurrtsen W. The cracked tooth syndrome; clinical features and
case reports. Int J Periodontics Restorative Dent. 1992;12(5):395-
405. PMid:1343011.
10
Braz Dent Sci 2024 July/Sept;27 (3): e4329
Yui KCK et al.
Clinical outcomes of cracked tooth syndr ome after 3 year s of treatment: a case series
Yui KCK et al. Clinical outcomes of cracked tooth syndrome after 3 years of
treatment: a case series
17. Krell KV, Caplan DJ. 12-month success of cracked teeth treated
with orthograde root canal treatment. J Endod. 2018;44(4):543-
8. http://doi.org/10.1016/j.joen.2017.12.025. PMid:29429822.
18. Mathew S, Thangavel B, Mathew CA, Kailasam S, Kumaravadivel
K, Das A. Diagnosis of cracked tooth syndrome. J Pharm Bioallied
Sci. 2012;4(6, Suppl 2):242-4. http://doi.org/10.4103/0975-
7406.100219. PMid:23066261.
19. de Toubes KMS, Soares CJ, Soares RV, Côrtes MIS, Tonelli SQ,
Bruzinga FFB,etal. The correlation of crack lines and definitive
restorations with the survival and success rates of cracked teeth:
a long-term retrospective clinical study. J Endod. 2022;48(2):190-
9. http://doi.org/10.1016/j.joen.2021.10.010. PMid:34752828.
20. Stanley HR. The cracked tooth syndrome. J Am Acad Gold Foil
Oper. 1968;11(2):36-47. PMid:5246217.
21. Leong DJX, Souza NN, Sultana R, Yap AU. Outcomes of
endodontically treated cracked teeth: a systematic review and
meta-analysis. Clin Oral Investig. 2020;24(1):465-73. http://doi.
org/10.1007/s00784-019-03139-w. PMid:31797172.
22. Chen YT, Hsu TY, Liu H, Chogle S. Factors related to the
outcomes of cracked teeth after endodontic treatment. J Endod.
2021;47(2):215-20. http://doi.org/10.1016/j.joen.2020.11.024.
PMid:33275995.
23. Liu HH, Sidhu SK. Cracked teeth treatment rational and case
management: case reports. Quintessence Int. 1995;26(7):485-92.
PMid:8935034.
24. Krell KV, Rivera EM. A six-year evaluation of cracked teeth
diagnosed with reversible pulpitis: treatment and prognosis.
J Endod. 2007;33(12):1405-7. http://doi.org/10.1016/j.
joen.2007.08.015. PMid:18037046.
25. Kimble P, Corso AM, Beattie M, Campos MS, Cavalcanti B.
Biomimetics and the restoration of the endodontically treatment
tooth. Braz Dent Sci. 2023; 26(1): e3668. http://doi.org/10.4322/
bds.23.e3668.
Jefferson Pires da Silva Júnior
(Corresponding address)
Universidade Nilton Lins, Manaus, AM, Brazil.
Email: jefferson.junior@uniniltonlins.edu.br
Date submitted: 2024 Apr 08
Accept submission: 2024 July 30