Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome

Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome

I N B R I E F

Includes a consideration of means available to provide acute care for a patient suffering from cracked tooth syndrome. Provides a comprehensive review of the available literature of both direct and indirect restorations/restorative materials to manage an incompletely fractured posterior tooth.

Introduces the concept of the direct coronal splint as a novel approach for the management of this distressing condition.

PRACTICE

S. Banerji,1 S. B. Mehta2 and B. J. Millar3

VERIFIABLE CPD PAPER

The second of this two part series on cracked tooth syndrome will focus on the available methods for the immediate, intermediate and denitive management of patients affected by this condition. Included in this article is a comprehensive account of the relative merits/drawbacks of various restorative materials and their respective techniques of application for the treatment of symptomatic, incompletely fractured posterior teeth.

PRINCIPLES FOR THE MANAGEMENT OF CRACKED TOOTH SYNDROME

It is apparent from the rst article of this series that the diagnosis of cracked tooth syndrome can pose a major challenge to the dental operator. It would also be fair to state that the management of the condition is by no means always a simple straightforward matter.

While it would appear that there is no universally accepted restorative protocol, it is generally agreed that the aim of restorative therapy is to immobilise the segments of the tooth that move on loading. The latter may be achieved in a limited number of cases simply by the removal of the affected cusp and restoring the defect with an appropriate material, or in the majority of cases by the placement of a restoration that prevents independent movement of the tooth segments on either side of the crack, thereby splinting the tooth together.1

The process of splinting should minimise exure of the compromised cusp, therefore not only aiming to alleviate the symptoms of pain on biting but also prevent further

Table 1 Immediate treatment options for CTS

Occlusal adjustment destructive, short term

Remove segment highly destructive

Immobilisation of segment:

Copper ring difcult and periodontally damaging

Orthodontic band

time consuming, possibly not available

Temporary crown

highly destructive, time consuming

Direct composite splint

propagation of the crack and...