Cracked tooth syndrome — ORE Part 1 MCQ

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HardRestorative DentistryCracked tooth syndromeORE Part 1

A 41-year-old patient describes sharp pain on release after chewing crusty bread on a heavily restored upper first molar. Cold testing is normal, probing depths are within normal limits, and a periapical radiograph is unremarkable. The pain is difficult to reproduce with routine percussion. What is the most appropriate investigation?

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Correct answer: A — Bite testing on individual cusps with transillumination

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

Cracked tooth syndrome is diagnosed by reproducing the patient's symptoms and visualising the crack. Bite testing on individual cusps is the key clinical test—loading the fractured segments causes sharp pain on release as the crack opens and closes. Transillumination (fibre-optic or near-infrared) is the highest-accuracy non-invasive imaging modality for crack detection, with sensitivity and specificity superior to conventional radiography, which cannot resolve cracks due to the narrow width and orientation of the fracture. This combination (A) aligns with authoritative diagnostic protocols. Option B is incorrect because electric pulp testing is normal in cracked tooth syndrome and testing incisors is anatomically irrelevant. Option C fails because panoramic radiography is low-resolution and cannot visualise cracks. Options D and E are adjunctive investigations that do not diagnose the crack itself.

Reference: Kindaro V, Molland H, Shirbegi S, Renner P, Krishnan U. Diagnostic Accuracy of Methods Used to Detect Cracked Teeth. Clinical & Experimental Dental Research. 2025 Apr 30. https://pubmed.ncbi.nlm.nih.gov/40304312/