You’ve been told your tooth is cracked. Now comes the harder question: what do you do about it?
The answer depends entirely on what kind of crack you have, how deep it goes, and whether the nerve inside the tooth is involved. A crack that one patient needs a simple crown for might require a root canal in another patient — or extraction in a third.
I evaluate cracked teeth every day at our Torrance office. Here’s the decision framework I actually use.
The 5 Types of Cracks — and What Each One Needs
Not all cracks are equal. The type of crack determines whether your tooth needs a crown, a root canal, or has to come out. Here’s the breakdown from simplest to most serious:
1. Craze Lines — No Treatment Needed
What it is: Tiny, superficial cracks in the outer enamel only. Look closely at any adult’s front teeth and you’ll see them.
Symptoms: None. These don’t hurt and don’t cause problems.
Treatment: Nothing. Craze lines are cosmetic and completely harmless. If a dentist mentions them, don’t worry about it.
2. Fractured Cusp — Crown Only
What it is: A piece of the chewing surface breaks off, usually around a large existing filling. The crack doesn’t reach the nerve.
Symptoms: Sensitivity to temperature, discomfort when chewing on that side. Usually a clear “something broke” moment.
Treatment: Crown. The crown holds the remaining tooth together and prevents the crack from spreading. No root canal needed because the nerve isn’t involved.
Prognosis: Excellent. The tooth should last as long as a normal crowned tooth.
Cost: $1,200–$1,800 for the crown (placed by your general dentist).
3. Cracked Tooth — Crown or Root Canal + Crown
This is the tricky one — and the most common type I see as an endodontist.
What it is: A crack that starts at the chewing surface and extends downward toward the root. It may or may not have reached the nerve. The depth of the crack determines the treatment.
Symptoms: Sharp pain when biting (especially on release), temperature sensitivity that comes and goes, pain that’s hard to localize. The classic “lightning bolt” zing.
Treatment depends on crack depth:
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Crack stays above the nerve → Crown only. If I can confirm with the microscope that the crack hasn’t reached the pulp, a crown can stop the crack from progressing. The nerve stays alive and healthy.
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Crack reaches the nerve → Root Canal + Crown. Once the crack extends into the pulp chamber, the nerve becomes inflamed and infected. Root canal removes the compromised nerve, and the crown holds the tooth together afterward.
Prognosis: Good to excellent if caught early. The key factor is how far down the root the crack extends. A crack that stays in the crown portion has a much better prognosis than one extending into the root.
Cost: Crown only: $1,200–$1,800. Root canal + crown: $2,100–$3,500.
Timing matters. A cracked tooth that needs only a crown today might need a root canal next month if the crack spreads. And a tooth I can save with a root canal today might become unsaveable if you wait too long. Don’t sit on a symptomatic cracked tooth.
4. Split Tooth — Partial Save or Extraction
What it is: A cracked tooth that was never treated, and the crack has propagated all the way through, splitting the tooth into two distinct segments.
Symptoms: Obvious pain, possible swelling, difficulty biting. Often a dramatic event — the tooth literally comes apart.
Treatment:
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Partial save (rare): If the split only involves one root of a multi-rooted molar, I can sometimes remove the damaged root and save the rest. This is called a hemisection. It requires root canal treatment on the remaining portion.
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Extraction (more common): If the split divides the tooth in a way that leaves no restorable structure, extraction is the only option. Replacement with an implant or bridge follows.
Prognosis: Poor for the tooth as a whole. This is a preventable outcome — it’s what happens when a cracked tooth isn’t treated in time.
5. Vertical Root Fracture — Extraction
What it is: A crack that starts in the root and works upward. These are sneaky — they often develop in teeth that have already had root canal treatment, sometimes years later.
Symptoms: Chronic low-grade pain, localized swelling, a deep narrow pocket on one side of the tooth. Can mimic a failed root canal or periodontal disease.
Treatment: Extraction. A vertical root fracture can’t be repaired. The crack acts as a permanent highway for bacteria, and no amount of retreatment or surgery will fix it.
Prognosis: The tooth cannot be saved. The good news: this can be definitively diagnosed with CBCT 3D imaging and microscope examination before committing to any treatment path.
Cost: Extraction ($200–$600) + implant ($4,000–$6,000+) or bridge ($2,500–$5,000).
The Decision Matrix
| Crack Type | Treatment | Root Canal? | Prognosis | Approximate Cost |
|---|---|---|---|---|
| Craze lines | None | No | N/A | $0 |
| Fractured cusp | Crown | No | Excellent | $1,200–$1,800 |
| Cracked tooth (shallow) | Crown | No | Very good | $1,200–$1,800 |
| Cracked tooth (deep) | Root canal + crown | Yes | Good | $2,100–$3,500 |
| Split tooth | Extraction (or rare hemisection) | Sometimes | Poor | $4,000–$6,000+ with implant |
| Vertical root fracture | Extraction | No | Not saveable | $4,000–$6,000+ with implant |
Why Diagnosis Is Everything
Here’s the problem with cracked teeth: you can’t determine the treatment without knowing the crack depth. And you can’t determine crack depth without the right tools.
A general dentist looking at your tooth with standard lighting might see the crack on the surface but can’t tell you how deep it goes. A standard X-ray won’t show most cracks at all. So you might be told “it’s cracked, you need a crown” when you actually need a root canal — or told “it needs to come out” when it’s actually saveable.
What a specialist evaluation reveals
At our office, I use three tools that change the diagnosis completely:
CBCT 3D imaging shows the tooth from every angle. I can see root fractures, the extent of any infection, and bone loss patterns that indicate where the crack goes. It’s not perfect for every crack, but it catches things standard X-rays completely miss.
Surgical microscope at 20x magnification lets me directly visualize crack lines on the tooth surface and inside the canal system. I can trace a crack and see exactly where it ends. This is the single most important tool for cracked tooth diagnosis.
Bite testing isolates which cusp is involved. By having you bite down on a small device one cusp at a time, I can pinpoint which part of the tooth is cracked and reproduce the symptoms in a controlled way.
This is why cracked teeth are an endodontist problem. The diagnosis requires specialist equipment. Without a microscope and CBCT, you’re guessing at the treatment — and guessing wrong means either overtreating (root canal or extraction when a crown was enough) or undertreating (crown when you needed a root canal).
What If I’m Not Sure My Tooth Is Cracked?
Cracked tooth pain is distinctive but confusing. It comes and goes. It’s hard to pinpoint. Some days it’s fine. Here’s what makes me suspect a crack:
- Sharp pain when releasing a bite (not when biting down)
- Temperature sensitivity that’s brief — a quick flash, not lingering pain
- Pain that’s positional — it hurts when you bite on one side but not the other
- Symptoms that started gradually and have been getting slowly worse
- The tooth has a large existing filling (which weakens the remaining structure)
If any of these sound familiar, a cracked tooth should be on the list. And the only way to know for sure is a specialist evaluation.
The Bottom Line
Not all cracked teeth need the same treatment. A surface crack might need nothing. A cusp fracture needs a crown. A deep crack needs root canal + crown. A split tooth or root fracture needs extraction. The treatment depends entirely on the depth and direction of the crack — and determining that requires a microscope and 3D imaging.
The most important thing you can do is get evaluated early. The sooner a crack is diagnosed, the more conservative (and less expensive) the treatment options.
Think You Might Have a Cracked Tooth?
If you have unexplained tooth pain — especially the kind that comes and goes with biting — we can figure out what’s going on. At Phan Endodontic Partners, every cracked tooth evaluation includes CBCT 3D imaging and microscope examination. You’ll leave knowing exactly what the crack looks like and what your treatment options are.
Call (310) 378-8342 to schedule a consultation at our Torrance office. Same-day emergency appointments available for patients in pain.