Longevity is not only about prevention and longer survival. It is also about recognizing age-related conditions early, before they silently disrupt quality of life and health. This paper focuses on one such condition: cracked tooth syndrome. The challenge is that some affected teeth can still appear clinically and radiographically normal while causing atypical facial pain. This review shows why early recognition and timely cuspal protection matter — before a subtle crack becomes a restorative and biologic disaster.
Abstract: The aim of this paper is to synthesize current research regarding the risk factors, diagnostic modalities, and therapeutic outcomes for cracked teeth, utilizing evidence from clinical trials, cohort studies, and experimental models. The review utilises 88 references. The evidence map suggests that cracked tooth is best understood as a mechanically driven condition in which cusp morphology, occlusal loading, and parafunctional or masticatory habits interact with existing structural compromise to influence crack initiation and progression. Across treatment-focused studies, cuspal coverage and other full-coverage approaches emerged as the most consistent restorative signal, with occlusal veneers showing 92.6% success at a mean 22.4 months and glass-ceramic crowns showing 95% survival at 10 years, while direct bonded stabilization also appeared useful in selected cases. Diagnostic evidence supports a multimodal clinical approach: bite testing and transillumination remain practical frontline tools, whereas quantitative light-induced fluorescence and cone-beam computed tomography add value for estimating crack extent, pulpal risk, and possible radicular involvement. Endodontic management was generally associated with favorable tooth retention when combined with definitive coronal protection, but prognosis was consistently worse in teeth with deep periodontal probing, more extensive crack patterns, or pulpal-floor involvement. Overall, the mapped literature supports early recognition, stabilization, and timely cuspal protection as the most practical clinical message, while future research should standardize diagnostic thresholds and crack classification and prospectively validate imaging- and fluorescence-based prognostic models in routine care.
Final search date and database lock: 2026-04-09 18:58:25 CEST
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Source: PubMed
Total Abstracts/Papers: 342
Downloaded Abstracts/Papers: 342
Included original and non-original Abstracts/Papers (all): 156
Included original Abstracts/Papers (Vote counting by direction of effect): 139
Reference Index (links used in paper): 88
Total participants (topic deduplicated ΣN): 102432
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[14] Automatic Detection of Cracks in Cracked Tooth Based on Binary Classification Convolutional Neural Networks. — https://doi.org/10.1155/2022/9333406
[27] Correlation between cuspal inclination and tooth cracked syndrome: a three-dimensional reconstruction measurement and finite element analysis. — https://doi.org/10.1111/j.1600-9657.2012.01160.x
[28] Impact of cusp inclinations on dental fractures in cracked tooth syndrome model and relevant risk evaluation. — https://doi.org/10.3892/etm.2017.5285
[30] Success and Survival of Endodontically Treated Cracked Teeth with Radicular Extensions: A 2- to 4-year Prospective Cohort. — https://doi.org/10.1016/j.joen.2019.03.015
[31] Occlusal stress distribution and remaining crack propagation of a cracked tooth treated with different materials and designs: 3D finite element analysis. — https://doi.org/10.1016/j.dental.2021.01.020
[33] The Effectiveness of a Quantitative Light-induced Fluorescent Device for the Diagnosis of a Cracked Tooth: A Case Report. — https://doi.org/10.1016/j.joen.2021.08.007
[40] A multi-centred clinical audit to describe the efficacy of direct supra-coronal splinting--a minimally invasive approach to the management of cracked tooth syndrome. — https://doi.org/10.1016/j.jdent.2014.02.017
[41] Assessing Endodontic Treatment Feasibility for Cracked Teeth Using Quantitative Light-Induced Fluorescence: A Retrospective Clinical Study. — https://doi.org/10.1016/j.joen.2025.01.013
[43] Mechanical properties of cracked teeth with different dental materials and crown parameters: An in vitro proof-of-concept. — https://doi.org/10.1016/j.jmbbm.2023.106045
[44] Effect of different restorative design and materials on stress distribution in cracked teeth: a finite element analysis study. — https://doi.org/10.1186/s12903-024-05122-8
[49] Outcome and Survival of Endodontically Treated Cracked Posterior Permanent Teeth: A Systematic Review and Meta-analysis. — https://doi.org/10.1016/j.joen.2020.01.006
[50] Correlation between symptoms and external characteristics of cracked teeth: Findings from The National Dental Practice-Based Research Network. — https://doi.org/10.1016/j.adaj.2016.12.023
[52] The Effect of Single versus Multiple-stage Restorative Approaches on the Pulp Outcomes of Symptomatic Vital Cracked Teeth: A Systematic Review and Meta-analysis. — https://doi.org/10.1016/j.joen.2025.06.013
[57] 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. — https://doi.org/10.1016/j.jdent.2017.12.014
[60] Investigation of validity and inter examiner agreement of quantitative light induced fluorescent images in diagnosing cracked teeth. — https://doi.org/10.1038/s41598-024-83803-8
[65] Pulp Survival of Cracked Teeth with Reversible Pulpitis after Orthodontic Banding and Coronal Coverage - A Prospective Cohort Study with One Year Follow Up. — https://doi.org/10.1016/j.joen.2024.05.006
[67] Clinical applications of a quantitative light-induced fluorescent (QLF) device in the detection and management of cracked teeth: A case report. — https://doi.org/10.1016/j.pdpdt.2023.103735
[69] The Correlation of Crack Lines and Definitive Restorations with the Survival and Success Rates of Cracked Teeth: A Long-term Retrospective Clinical Study. — https://doi.org/10.1016/j.joen.2021.10.010
[74] Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network. — https://doi.org/10.1016/j.adaj.2020.09.023
[77] CBCT Patterns of Bone Loss and Clinical Predictors for the Diagnosis of Cracked Teeth and Teeth with Vertical Root Fracture. — https://doi.org/10.1016/j.joen.2022.06.004
[80] A retrospective clinical study to compare the ability of cone-beam computed tomographic images and periapical radiographs to reveal cracked teeth, split teeth, and teeth with vertical root fractures. — https://doi.org/10.1016/j.adaj.2024.04.009
[81] Evaluation of Correlation Between Development of Multiple Cracks in Nonendodontically Treated Tooth and Placement of Dental Implants with Prosthesis. — https://doi.org/10.4103/jpbs.jpbs_77_24
[84] Survival and prognostic factors of managing cracked teeth with reversible pulpitis: A 1- to 4-year prospective cohort study. — https://doi.org/10.1111/iej.13597
[85] Symptom changes and crack progression in untreated cracked teeth: One-year findings from the National Dental Practice-Based Research Network. — https://doi.org/10.1016/j.jdent.2019.103269
[105] Onset and resolution of pain among treated and untreated posterior teeth with a visible crack: Three-year findings from the national dental practice-based research network. — https://doi.org/10.1016/j.jdent.2022.104078
[118] Effects on different full-coverage designs and materials of crack propagation in first mandibular molar: an extended finite element method study. — https://doi.org/10.3389/fbioe.2023.1222060
[121] Infrared Clinical Enamel Crack Detector Based on Silicon CCD and Its Application: A High-Quality and Low-Cost Option. — https://doi.org/10.3390/jimaging7120259
[128] Observable characteristics coincident with internal cracks in teeth: Findings from The National Dental Practice-Based Research Network. — https://doi.org/10.1016/j.adaj.2018.06.013
[135] Dental implant placement is a possible risk factor for the development of multiple cracks in non-endodontically treated teeth. — https://doi.org/10.1038/s41598-020-65408-z
[149] Validity of quantitative values of quantitative light-induced fluorescent (QLF) device for pulp diagnosis of teeth with cracks. — https://doi.org/10.1016/j.jdent.2025.105579
