A narrative review of cracks in teeth: Aetiology, microstructure and diagnostic challenges

Rei Chiel Yap; Meshal Alghanem; Nicolas Martin

doi:10.1016/j.jdent.2023.104683

A narrative review of cracks in teeth: Aetiology, microstructure and diagnostic challenges

J Dent. 2023 Nov:138:104683. doi: 10.1016/j.jdent.2023.104683. Epub 2023 Sep 13.

Authors

Rei Chiel Yap¹, Meshal Alghanem², Nicolas Martin³

Affiliations

¹ DClinDent student, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK. Electronic address: reichielyap@gmail.com.
² DClinDent student, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK. Electronic address: Doc_alghanem@hotmail.com.
³ Professor of Restorative Dentistry, School of Clinical Dentistry, The University of Sheffield, S10 2TA, UK. Electronic address: n.martin@sheffield.ac.uk.

PMID: 37713950
DOI: 10.1016/j.jdent.2023.104683

Abstract

Objectives: To summarize the available evidence of crack formation in teeth and to discuss the limitations of the current clinical diagnostic modalities for crack detection in teeth.

Background: Cracks are a common clinical finding in teeth and yet clinicians still struggle to identify the full extent and orientation of cracks for their appropriate timely management. The biomechanics of crack development can be due to multiple factors and can differ from an unrestored tooth to a restored or endodontically treated tooth.

Data & sources: This narrative review has been designed following the guidelines published by Green et al. 2006 [1] Published literature in the English language that addresses the objectives of this review up to July 2022 was sourced from online databases and reference lists. The relevance of the papers was assessed and discussed by two reviewers. A total of 101 publications were included in this narrative review.

Conclusions: The initiation and development of cracks in teeth are likely linked to an interplay between the masticatory forces and fracture resistance of the remaining tooth structure. From the identified literature, the quality and quantity of remaining tooth structure in a restored or endodontically-treated tooth affects the biomechanics of crack development compared to an unrestored tooth. The extent, orientation, and size of the cracks do affect a clinician's ability to detect cracks in teeth. There is still a need to develop reliable diagnostic tools that will accurately identify cracks in teeth beneath restorations to enable effective monitoring of their propagation and provide appropriate interventions.

Clinical significance: The development and propagation of cracks in an unrestored tooth differ greatly from a restored and endodontically treated tooth; mainly linked to the quantity and quality of the remaining tooth structure and the forces acting on them. Identifying the extent of cracks in teeth remains challenging for early clinical intervention.

Keywords: Cracked tooth; Cracked tooth syndrome; Dental crack propagation; Fractured tooth.

Publication types

Review

MeSH terms

Cracked Tooth Syndrome* / diagnosis
Cracked Tooth Syndrome* / etiology
Humans
Tooth, Nonvital* / diagnosis