Cracked Teeth

Cracked Teeth
Posted on 05/07/2018
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Cracked Teeth

Cracked teeth. Inevitably, our teeth will develop cracksinlay onlay with time.  For most, it is simply the accumulation of a lifetime of normal wear and tear.  Others may develop more serious cracks due to parafunction: clenching and grinding habits, chewing on ice, pens, etc.  Some teeth are also more susceptible to developing cracks due to prior fillings or root canal treatment that undermine the structural integrity of teeth even though these procedures are necessary to treat dental decay or toothaches.

The guidelines on how to treat cracked teeth are not very well defined. Hairline fractures within teeth for the most part require no treatment.  However, when crack lines correspond with symptoms such as sensitivity to chewing, or in the context of existing large fillings, then early intervention may prevent future disaster.

Inlays and onlays are ways to replace or protect weakened parts of teeth while minimizing sacrifice of structurally sound tooth structure.  They are traditionally made from gold, but with advances in dental materials and adhesive bonding technology, ceramic inlays and onlays have become very popular and very predictable.

I had an idea during my Prosthodontics residency to find out if intervention with bonded ceramic inlays and onlays reinforces the tooth ie.  Prevents the tooth from fracture, and whether it matters how compromised the tooth was to begin with.  I wrote up a project proposal and received a grant from the Greater New York Academy of Prosthodontics.  The results of the project will be published in an upcoming issue of the Journal of Prosthodontics, titled “Fracture Resistance of CAD/CAMā€Fabricated Lithium Disilicate MOD Inlays and Onlays with Various Cavity Preparation Designs”.

The project showed that regardless of how much of the tooth was cut out and then restored with a ceramic inlay or onlay, all samples had a high resistance to fracture. Granted, it was a bench top study with extracted teeth, so take the results with a grain of salt.  But it is possible that the ceramic material used in the study, when bonded to natural tooth material, can reinforce the tooth and help prolong the longevity of the tooth under functional stress.

When we assess cracked teeth and fractured teeth, it’s important to be able to weigh the risks and benefits of various treatment options and restorative materials. Ceramic inlays and onlays are an excellent addition to the armamentarium of dental restorative procedures and we will no doubt be learning more about them in long term, clinical studies.


Dr. Sharon Jin
Prosthodontist, Needham and Bedford offices