Longitudinal tooth cracks and fractures: an update and review

Abstract

The purpose of this updated review is to further discuss the diagnostic and treatment challenges related to tooth cracks and fractures that occur primarily in the vertical plane, that is, the long axis of the crown and/or root. This includes when and how to identify and determine the category and the extent of the fracture, when a coronally reinforcing restoration should be placed, when root canal treatment is needed, and when a tooth or root should be extracted based on the location and extent of the fracture. The term “longitudinal” is used because they usually represent vertical extensions of cracks or fractures over distance and time. These often present problems with diagnosis and treatment, but should be considered as findings and not as a diagnosis per se. They are pathways for bacteria that may induce pulpal and periapical inflammation or disease. Longitudinal fractures are divided into five definitive classifications from generally least to most severe: (i) craze line; (ii) fractured cusp; (iii) cracked tooth; (iv) split tooth; and (v) vertical root fracture. These differ but have frequently been confused or combined in clinical articles, creating misunderstanding and resulting in incorrect diagnosis and inappropriate treatment. These classifications have been devised to provide global definitions that researchers and clinicians can use to eliminate this confusion. This review is subdivided into these five classifications as to incidence, pathogenesis, clinical features, etiologies, diagnosis, treatment, prognosis, and prevention.

Microtissue engineering root canal dentine with crosslinked biopolymeric nanoparticles for mechanical stabilization

“…On the contrary, in root filled teeth, higher degree of functional stress/strain is distributed towards the apical aspect of the root resulting in increased root flexure. This altered biomechanical response at the apical root dentine with root canal treatment has been previously implicated as one of the risk factors for vertical root fracture in root filled teeth (Kishen , Rivera & Walton ).…”

Restoration of endodontically treated cracked maxillary teeth: A case series

“…This type of fracture may occur in all teeth and has a high prevalence. It occurs as the result of application of wedging occlusal forces or some dental procedures . In this paper, we mainly focus on longitudinal fractures causing cracks, which are classified under group III.…”

“…However, such teeth often have questionable to poor prognosis. A cracked tooth is defined as presence of an incomplete crack originating from the tooth crown and extending subgingivally in mesiodistal direction …”

“…It occurs as the result of application of wedging occlusal forces or some dental procedures. 1,2 In this paper, we mainly focus on longitudinal fractures causing cracks, which are classified under group III. The location of type III fractures is mainly in the tooth crown, and these cracks extend from the crown toward the root with variable depths.…”

Impact of apical extent of root canal filling on vertical root fracture: a case–control study

“…, Walton ). Although VRF may be caused by excessive wedging forces that exceed the binding strength of root dentine (Rivera & Walton ), there may be multiple risk factors for fracture initiation and propagation in a root filled tooth (Kishen , Tamse ). Increased loss of radicular dentine (Wilcox et al .…”