Cracked Tooth Syndrome – CTS



Author: Dr. Boban Fidanoski, DMD





Cracked Tooth Syndrome is a group of symtoms characterized from incomplete fracture (infraction) of a vital tooth that involves the both enamel and dentin and occasionally extends into

the pulp. It is also known as green stick fracture. Mostly occurs in posterior teeth, especially in mandibular second and first molars. Sharp pain with no visible signs of problem with the teeth are the hallmarks of CTS.




- Trauma
- Bruxism
- Masticatory habits of chewing hard foods such as ice, popcorn cernels, nuts or unespected hard objects.
- History of other cracked teeth
- occlusal adjustments for relief of the discomfort, sensitivity or pain
- existence of pre-occlusive areas due to higher position of conservative restorations
- large fillings (most occurent at MOD or I and II class with thin walls), especially in amalgam because they tend to exponentially expand as they age, and instantly expand and contract  with temperature changes.




Unique simptom characterized for CTS: Erratic pain on mastication, particulary on release (disclusion), rather then with increased masticatory force, because when applying force crack widens and there is less amount of pain at that moment in comparison with disclusion when crack closes quickly causing larger amounts of pain. It is due to a disruption of the fluid within crack. Upon disclusion, fluid is driven towards the nerve chamber through dentinal tubules and elicites pain.


Other symptoms:

- Pain on cold application ( as well as on heat and sweet)

- Unsolicited pain ( usually due to a leakage of sugar into the crack)

Patient has difficulty in identifying the affected tooth; there are no
proprioreceptive fibers in the pulp chamber.






- Visual verification of the crack
- No radiographic evidence except im small cases when x-ray beam is parallel to the crack in order to _penetrate ( or crack is perpendicular to the film).
- No dental decay
- If crack is extended into the root, in some cases there is periodontal pocket or defect



- examination with sharp explorer (tip of the working end)
- visual check for fracture using transillumination with magnigying glasses or other magnifying _intraoral system
- use biting plastic tabs (tooth slooth) for selective bite of each tooth or cusp of the tooth


Differential Diagnosis:


Craze enamel lines: infractions of the enamel only. They are painless parts of normal anatomy as we get older, generally are vertical and most noticable in the anterior teeth. Have effect on the cosmetic appearance of the tooth.This lines allow transillumination light to pass through the to light up the whole crown.If there is a deeper crack (CTS) a light will not pass through.




The pain will increase when crack progresses into the pulp causing pulpal inflammation (pulpitis)


The pain will stop when:
                                         - a piece of tooth breaks off relieving the pain (fracture of the tooth)
                                         - the nerve dies as result of repeated assault (necrosis of the pulp)




1. Restorative: if crack is localized in the crown, treatment is effective with:
                        - filling
                        - inlay
                        - crown

2. Endodontic: if crack affects pulp and progresses in pulpal inflammation, endodontic treatment is required following by restorative placement of crown.


3. Surgical:
                      - if crack is localized in the root apical third, treatment is apicotomy
                      - if crack is localized in the middle and cervical third only treatment is tooth extraction




author: Dr. Boban Fidanoski, DMD
© December, 2006