He also described the CTS as odontalgia secondary to cuspal fracture. Cusps weakened by caries, by the shape and size of cavity preparation, and by improper restorations were generally considered the most important causes. Gibbs, 7 who wrote one of the earliest reports on the subject of CTS, listed conditions that promote tooth fracture. 5,6 CTS can affect patients of all ages (Figure 1). Different types of fractures require different approaches for management. With the aging process, more restorations will likely be placed, and teeth will be more susceptible to vertical fracture. If undiagnosed, the fracture will progress with time, and teeth will fail. People are living longer, retaining more teeth during later years of life, but also experiencing more stress. The tooth was nonrestorable.ĭentists can expect to encounter patients with CTS with increasing frequency, and early diagnosis will be essential to saving these teeth. A teenager has a class IV mesiodistal fracture from clenching during weight lifting. Cracked Tooth Syndrome can affect patients of different ages. As a result, lack of treatment, or inappropriate treatment, will not resolve the symptoms, often causing the patient to seek help from another clinician.įigure 1. Because the CTS is a vital pulp condition, the periapical radiograph is of limited value as a diagnostic test for CTS. A patient reports pain, and often the dentist relies on a periapical radiograph to determine the origin of the pain. It is important to note that the CTS is a frequent reason that patients will change dentists. Therefore, it becomes essential to have guidelines for treatment. Subsequently, the clinician must be able to advise the patient about the specifics of the treatment plan which, of course, is based on clinical findings. Consequently, patients should be clearly advised of all potential outcomes in the treatment plan and accept the plan before treatment begins. Pretreatment diagnosis of the severity of the problem is nearly impossible. 2,3 In 1993 Christensen presented a pragmatic treatment approach that discussed types of cracks, and noted that certain more complex cracks involved the dental pulp or intraradicular portion of the tooth. 1 The condition of CTS was originally described by Cameron in 1964, and he revisited the subject in 1976. ![]() In 1993 Williams presented a classification of specific diagnostic symptoms of CTS as well as guidelines for predictable treatment. This article will present a classification system for CTS and discuss how to accurately diagnose and treat this clinical condition.Ī MedLine search reveals that more than 150 articles have been published about the CTS during the past 25 years. Diagnosis of CTS can be difficult, appropriate treatment is necessary to prevent further damage to the tooth, and the failure to diagnose this condition can result in the eventual loss of the affected tooth. The Cracked Tooth Syndrome (CTS) is both a transient and progressive condition.
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