Cracked Tooth Cuspal Coverage — ORE Part 1 MCQ

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ModerateRestorative DentistryCracked Tooth Cuspal CoverageORE Part 1

A 45-year-old patient has a posterior tooth with a large MOD amalgam restoration. A crack extending through one cusp is visible on transillumination, and the tooth is painful on biting. The tooth is restorable and has no isolated deep periodontal pocket. What is the most definitive restorative management?

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Reveal the answer and explanation

Correct answer: C — Provide a restoration that covers and splints the cusps

Explanation lettering: C = shown as A · A = shown as C

A is correct. Biting pain with a transillumination-positive cuspal crack in a heavily restored posterior tooth indicates a symptomatic cracked tooth. Definitive treatment should splint the tooth by providing cuspal coverage, for example with a crown or an adhesively bonded cuspal-covering indirect restoration where clinically appropriate. This limits cuspal flexure and reduces propagation of the crack. A recent systematic review found that, in symptomatic cracked teeth, restorations without cuspal coverage were associated with greater risks of pulpal complications and extraction than full-crown restorations. Replacing the amalgam (B) or placing an intracoronal composite without cusp coverage (C) does not adequately splint the cracked cusp. Adhesive alone (D) cannot provide reliable structural reinforcement. Monitoring (E) may be considered only for an asymptomatic crack, not this painful tooth.

Reference: Wang Y, et al. The treatment outcomes of cracked teeth: A systematic review and meta-analysis. Journal of Dentistry, 2024. https://pubmed.ncbi.nlm.nih.gov/34752828/