A crack in a tooth is a serious dental issue. The immediate answer to whether the tooth can be saved is often yes, but this depends entirely on the crack’s location and depth. A fracture provides an opening for oral bacteria to reach the inner pulp, potentially leading to infection and severe pain. Seeking prompt dental evaluation is important because the sooner a crack is diagnosed and treated, the better the chances are for preservation.
Understanding the Severity of the Crack
The prognosis for a cracked tooth is determined by classifying the type of fracture, which ranges from superficial to catastrophic. The least severe type is called a craze line, which is a tiny, vertical hairline crack limited only to the outer enamel layer. Craze lines rarely cause pain and do not require treatment, though they can sometimes be a cosmetic concern.
A fractured cusp occurs when a piece of the tooth’s chewing surface breaks off, often in a tooth with a large filling. This type does not involve the pulp and can be saved with a simple restoration or a crown.
A “cracked tooth” is a more serious fracture that extends from the chewing surface downward toward the root, but the tooth remains in one piece. The prognosis is favorable if the crack is detected early and has not progressed below the gum line or into the pulp chamber.
When a crack progresses and completely separates the tooth into two distinct, movable segments, it becomes a split tooth. Restoration is not possible at this advanced stage, and extraction is necessary. A vertical root fracture begins below the gum line and travels upward toward the chewing surface, often occurring in teeth that have previously had a root canal. These fractures are the most difficult to diagnose and save, requiring specialized surgical intervention or extraction.
Treatment Options Focused on Preservation
When a favorable prognosis is determined, the treatment focuses on sealing the crack and preventing its progression. For minor cracks, such as a small fractured cusp that does not reach the pulp, the dentist may use simple dental bonding or a composite filling. This material is applied directly to the tooth surface to fill the defect, restore the tooth’s shape, and protect the underlying dentin.
For more extensive cracks or a fractured cusp that affects a larger portion of the tooth, a dental crown is the restorative choice. A crown is a custom-made cap that fits entirely over the remaining natural tooth structure, holding the compromised pieces together. This full coverage prevents the crack from spreading further under the forces of chewing, providing long-term protection and stability.
If the crack is deep enough to reach the inner pulp chamber, it exposes the sensitive tissues to oral bacteria, necessitating a root canal procedure. Before placing a crown, the infected or damaged pulp is removed, and the inner canals are cleaned, disinfected, and sealed with a biocompatible material. This procedure eliminates the source of infection and pain, but because the tooth is structurally weakened, it must be protected with a crown afterward to prevent fracture.
When Extraction Becomes Necessary
Some cracked teeth are damaged beyond repair and require extraction. Tooth loss most commonly results from an irreparable vertical root fracture, especially when the crack extends deep into the root or below the gum line. A split tooth, which separates into two segments, is non-restorable because the segments cannot be reliably rejoined.
Extraction is recommended when the damage is so severe that it compromises the surrounding bone or causes chronic infection that cannot be resolved with a root canal. In cases of multi-rooted teeth, a procedure called hemisection or root amputation may be performed to remove only the fractured root, preserving the rest of the tooth. For single-rooted teeth or extensive fractures, complete removal is the only option to prevent further complications.
After a tooth is extracted, the missing structure must be replaced to prevent shifting of neighboring teeth and bone loss in the jaw. The most common and durable replacement options are a dental implant, which replaces the root and crown, or a fixed bridge, which uses adjacent teeth for support. Choosing a replacement is the final step to restore the mouth’s function, appearance, and long-term health after the natural tooth cannot be saved.