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 is involved. A crack one patient needs a simple crown for might mean a root canal in another — or extraction in a third. I evaluate cracked teeth every day. Here's the decision framework I actually use.
Five cracks, five verdicts.
The harmless ones.
Tiny superficial cracks in the outer enamel only — look closely at any adult's front teeth and you'll find them. No symptoms, no problem, no treatment. If a dentist mentions them, don't worry.
The clean break.
A piece of the chewing surface breaks off, usually around a large filling — a clear "something broke" moment. The crack doesn't reach the nerve, so a crown holds the tooth together and no root canal is needed.
The tricky one.
The most common type I see: a crack starting at the chewing surface, extending toward the root. The classic "lightning bolt" zing when biting — especially on release. Depth decides everything: if the microscope confirms the crack stays above the nerve, a crown stops it. Once it reaches the pulp, the nerve is compromised — root canal first, then the crown.
Timing matters. A crack that needs only a crown today might need a root canal next month — and a saveable tooth can become unsaveable. Don't sit on a symptomatic cracked tooth.
The preventable ending.
An untreated crack that propagated all the way through, splitting the tooth in two. If only one root of a molar is involved, a hemisection can sometimes save the rest. More often, extraction and replacement. This is what happens when a cracked tooth waits too long.
The one we can't save.
A crack starting in the root and working upward — sneaky, often appearing years after a root canal, mimicking failed treatment or gum disease. It can't be repaired; the crack is a permanent highway for bacteria. The good news: CBCT and the microscope can diagnose it definitively before you commit to any treatment path.
The decision ledger, at a glance.
| CRACK TYPE | TREATMENT | ROOT CANAL? | PROGNOSIS |
|---|---|---|---|
| Craze lines | None | No | — |
| Fractured cusp | Crown | No | Excellent |
| Cracked tooth (shallow) | Crown | No | Very good |
| Cracked tooth (deep) | Root canal + crown | Yes | Good |
| Split tooth | Extraction (rare hemisection) | Sometimes | Poor |
| Vertical root fracture | Extraction | No | Not saveable |
Why diagnosis is everything.
You can’t choose the treatment without knowing the crack’s depth — and you can’t know the depth without the right tools. Surface lighting shows the crack but not where it ends; standard X-rays miss most cracks entirely. Guess wrong and you either overtreat (a root canal that a crown could have prevented) or undertreat (a crown over a crack that’s already reached the nerve).
Three tools settle it: CBCT 3D imaging reveals root fractures and the bone-loss patterns that trace a crack’s path. The surgical microscope lets me follow the crack line directly and see exactly where it stops — the single most important tool for this diagnosis. Bite testing isolates the involved cusp, reproducing your symptom on demand.
"Without a microscope and CBCT, you're guessing at the treatment — and guessing wrong costs a tooth."
Not sure your tooth is even cracked?
Cracked-tooth pain is distinctive but confusing — it comes and goes, and it’s hard to point to. These are the tells:
- Sharp pain when releasing a bite, more than biting down
- A brief flash of temperature sensitivity — not lingering ache
- Pain on one side only, in one position
- Symptoms that crept in gradually and keep slowly worsening
- A large existing filling in the suspect tooth
Not all cracked teeth need the same treatment — the verdict lives in the crack's depth and direction, and only a microscope and 3D imaging can read it. The earlier the evaluation, the more conservative (and less expensive) your options.
Every cracked-tooth evaluation here includes both. You leave knowing exactly what the crack looks like — and what it needs.