The Challenge of Dental Cracks: Diagnosis, Implications, and Therapeutic Strategies

Objective: To present a narrative review on the diagnosis, biological and mechanical implications, and main therapeutic strategies applied to dental cracks, complemented by illustrative clinical case reports. Methodology: A narrative review of the scientific literature available in the PubMed, Scopus, and SciELO databases was conducted, covering articles in Restorative Dentistry, Prosthetic Dentistry, and Endodontics related to Cracked Tooth Syndrome. Studies that addressed etiology, risk factors, diagnostic methods (anamnesis, sensitivity tests, transillumination, percussion, CBCT, and optical magnification), and conservative therapeutic approaches were included. Clinical cases conducted by the authors were included to demonstrate the practical application of the described adhesive and restorative protocols. Results: Cracked tooth syndrome, defined by Cameron as incomplete and invisible fractures originating in the crown and extending apically, constitutes a relevant clinical challenge, especially in posterior teeth. Diagnosis is complex and requires a multicriteria approach. Treatment is individualized and aims to control bacterial infiltration and limit crack propagation. Immediate adhesive sealing with high-strength cement (4-META/MMA-TBB-based) and fiberglass reinforcement showed expressive clinical results. In cases of deep cracks, bidirectional splinting associated with full-coverage restoration demonstrated success rates above 90%. Conclusion: The current management of cracked teeth has evolved towards conservative and biologically oriented approaches, with emphasis on early diagnosis, adhesive sealing, and structural stabilization. The use of high-performance adhesive cements and optimized restorative techniques expands the possibilities of tooth preservation, even in complex cases.