Can a Cracked Tooth Be Saved? Modern Treatments to Repair Cracked Teeth

By Greg Vigoren, DDS

Sharp pain when you bite, or sudden sensitivity to hot and cold, can be warning signs of a cracked tooth. The good news: many cracked teeth can be preserved with the right diagnosis and treatment. At Vigoren Restorative Dentistry in Newport Beach, CA, we use high-magnification microscopes and conservative techniques to find cracks early and stabilize teeth so you can keep your natural smile.

TL;DR

• Many cracked teeth are savable. Recent reviews show favorable outcomes after root canal therapy (when needed) and full-coverage restoration. Systematic review, 2024; J Endod, 2019

• Early stabilization matters. Crowns/onlays protect weakened cusps; timely definitive restoration improves survival in endodontically treated teeth. J Endod, 2018

• Microscopes help us see more, cut less. AAE recognizes the operating microscope as integral to modern endodontics and crack detection. AAE Position; PMC

• Prognosis depends on crack extent and periodontal depth. Shallow cracks (<5 mm probing) show markedly better outcomes than deep splits. J Endod, 2025

Understanding Cracked Teeth: Causes & Early Signs

Cracks often arise from chewing hard foods, clenching/grinding, large fillings, or age-related fatigue. Symptoms can be intermittent: sharp bite pain, thermal sensitivity, or pain on release. Under magnification, we can distinguish craze lines from true cracks and map the crack’s direction and depth—key to choosing the least invasive, most durable fix (PMC review on cracked tooth diagnosis).

Modern Treatment Pathways

1) Bonding/Partial-Coverage Restorations for Limited Cracks

When the pulp is healthy and the crack is confined, a bonded onlay (or, in smaller cases, a composite repair) can splint cusps and seal interfaces. Early restoration is associated with high short-to-mid-term survival; in one cohort of cracked teeth restored early, estimated survival was high at 1 and 5 years, with later decline tied to disease progression—underscoring the value of timely stabilization (J Endod, 2022).

2) Root Canal Therapy (When the Pulp Is Involved) + Full-Coverage Crown

If the crack reaches the pulp or symptoms show irreversible pulpitis/necrosis, root canal treatment removes inflamed tissue and disinfects the canals. We then place a full-coverage crown to distribute forces and guard against propagation. Multiple studies report that cracked teeth treated with endodontics and definitive full-coverage can achieve outcomes comparable to other endodontically treated teeth (J Endod, 2019). Survival of endodontically treated teeth improves with timely coronal coverage—e.g., ~96% at 3 years and ~84% at 10 years after crown placement in a large dataset (J Endod, 2018).

3) When the Crack Is Too Deep

Vertical root fractures and cracks extending deep beneath the gum line have a guarded prognosis. Updated guidance notes that cracked teeth with shallow periodontal probing (<5 mm) show far better success/survival than those with deeper probing depths; thorough evaluation informs whether preservation or extraction is most predictable (Prognostic analysis, J Endod 2025; long-term cracked tooth survival in practice).

Why Microscopes Change the Game

The dental operating microscope (DOM) provides coaxial illumination and up to 20–25× magnification. AAE considers the microscope an integral device for modern endodontics, improving detection of cracks and secondary anatomy and enabling more conservative, precise preparations (AAE Position Statement; AAE clinical resources).

What the Evidence Says About Saving Cracked Teeth

• Cracked teeth can often be saved: A 2024 systematic review found favorable outcomes after treatment in both vital and root-canal-treated cracked teeth (PubMed 2024).

• Comparable outcomes to general endodontic cases: Prospective data suggest cracked teeth with radicular extensions can perform similarly to other endodontically treated teeth when properly restored (J Endod, 2019).

• Timely crowns matter: Survival after RCT improves significantly with definitive coronal coverage (J Endod, 2018).

• Prognosis varies with depth: Favorable success/survival when probing <5 mm; deeper defects reduce predictability (J Endod, 2025).

FAQs

Can a cracked tooth heal on its own?

No. Enamel/dentin cracks don’t “heal.” Stabilizing the tooth (onlay/crown) and treating the pulp if involved are key to preventing propagation (AAE: Cracked Teeth).

What determines if my cracked tooth can be saved?

Extent and direction of the crack, periodontal probing depth, pulp status, and remaining tooth structure. Shallow cracks and early stabilization do best (J Endod, 2025).

Do microscopes actually improve outcomes?

They improve detection and precision and are recognized by AAE as integral to modern endodontics (AAE Position).

When is extraction necessary?

Typically for vertical root fractures or cracks extending deep below the gum line where predictable sealing isn’t possible (see ESE position statement, 2025).

Next step: If you suspect a crack, early evaluation is critical. Schedule a consultation or call (949) 760-1152.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual results may vary. Please consult a licensed dentist for diagnosis and treatment.

Author Bio

Greg Vigoren, DDS is a restorative dentist in Newport Beach, CA. For nearly 50 years he has used high-magnification techniques and conservative, evidence-based protocols to preserve natural teeth and deliver long-lasting restorations.