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Cracked Tooth Management — ORE Part 1 MCQ

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ModerateRestorative DentistryCracked Tooth ManagementORE Part 1

A 40-year-old patient has a lower molar with a crack visible on transillumination at the mesial marginal ridge. They report a sharp, fleeting pain on biting that is greatest on release of pressure. The tooth responds normally to cold testing and is not tender to percussion. What is the most appropriate initial management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Stabilise the tooth with a band or provisional crown

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E

A is correct. Biting pain, especially on release, with a visible crack and a normal cold response indicates a symptomatic vital cracked tooth. Initial external splinting with a stainless-steel band or provisional full-coverage restoration limits cusp flexure, provides symptom relief and helps confirm that the crack is responsible. If symptoms settle, definitive cuspal coverage, commonly an onlay or crown depending on the remaining tooth structure, can be planned. Root canal treatment is not indicated solely because a crack is present when pulpal tests are normal and there is no percussion tenderness. Extraction is premature for an apparently restorable vital tooth. A marginal-ridge composite alone may not adequately brace the cusps, while observation leaves a symptomatic tooth unsupported.

Reference: Banerji S, Mehta SB, Millar BJ. Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome. British Dental Journal, 2010. https://pubmed.ncbi.nlm.nih.gov/20543791/