Can a Cracked Tooth Be Saved? Exploring the Options

The name of our game is to save as many teeth as possible, right? But can a cracked tooth be saved? When it comes to a cracked tooth, how do we know when you should persevere and when to extract it?

To answer this question we’ll travel back to 2009 for a tooth story.

Cracked Tooth vs. Fractured Tooth vs. Split Tooth

But before we dig into the tooth story, let’s clarify terminology.

Not all cracks are the same.

A cracked tooth usually refers to an incomplete fracture that begins in the crown and may extend toward the pulp. These teeth often have a chance at being saved, depending on how far the crack extends.

A vertical root fracture runs down the root structure. When a fracture extends into the root in this way, extraction is often the appropriate treatment.  However, there are times when we can still save the tooth.  

A split tooth describes a complete separation of the tooth into distinct segments. Once that separation occurs, the tooth cannot be saved.

So when someone asks:

• Can you save a cracked tooth?
  
• Can a fractured tooth be saved?
  
• Can a split tooth be saved?
  
• Can a cracked molar be saved?

The answer depends entirely on the extent and location of the fracture.

So, Can a Cracked Tooth Be Saved? Let’s Dig In…

As an endodontist, I see cracked teeth multiple times a day (in fact I’m pretty sure most teeth have a crack somewhere). So I didn’t think much of it when in 2009 a referred patient came to me with a mandibular second molar, that was cracked on the distal marginal ridge. Nothing new or noteworthy there.

But what’s important here is not just the condition of the tooth when the patient came in, but how we decided as a team (the patient and I) to approach treatment.

The Diagnosis

Due to pain levels, the tooth had been opened by the referring dentist. Here’s what I discovered:

1. All probings were normal (about a 4mm depth on the distal).
2. No probing alongside the crack.
3. The tooth did not respond to cold, and it was slightly tender to percussion.  

So I diagnosed tooth #31 as Previously Initiated and Symptomatic Apical Periodontitis.

Would you have diagnosed the same?

But here’s the real question I had to ask myself, and I’d love for you to think this through: Can this cracked tooth be saved? How would you have approached treatment here?

A faint crack was traveling vertically from the distal marginal ridge, a common crack that can become a bacterial doorway. And that, my friends, means those bugs are headed STRAIGHT for the pulp, not to mention also create super painful symptoms. Not good.

Yet, there was no probing alongside the crack (one of the main criteria I look for when deciding whether to save or extract).

So, you know me. I wanted to save this tooth!

I had a totally candid conversation with the patient about what his options were and what the likelihood of success was, and he was in agreement. He wanted to save his tooth just as much as I did!

Here is the immediate postoperative radiograph. Just FYI, this case was done early in my career, so I wasn’t placing an orifice barrier at the time like I do now. It’s amazing how we evolve as clinicians right?

Fast Forward 2 Years …

… and the tooth is doing great! 

I was so happy to see the tooth recovering at his recall. But, in actuality, the story doesn’t end there.

Get ready for the plot twist!

When the patient came back in 2020, the crack had progressed. Darn it.

He now had a deep probing on the distal and pain while biting. The diagnosis this time?

Tooth #31 was a Previously Treated and Symptomatic Apical Periodontitis.

The CBCT scans showed bone loss, suggestive of a vertical root fracture in between the cortical plate and the root surface.

Sadly, the time had come to extract the tooth.

Again, you can see more bone loss in the sagittal image here, on both the mesial and distal sides of the tooth. 

What This Case Teaches About Diagnosing Cracked Teeth

Looking back, this case highlights what really determines whether a cracked tooth is saveable.

Imaging alone rarely gives you the full picture. Diagnosis requires combining clinical testing with radiographic interpretation — and revisiting those findings over time.

Here’s what matters:

• Probing depths: An isolated, deep, narrow probing next to a crack may indicate the fracture has extended into the root.
  
• Cold testing: Is the pulp vital, reversibly inflamed, or necrotic?
  
• Percussion and bite response: Pain on loading can signal crack progression.
  
• Patient history: Is this a high-stress area? Is there a history of fractured teeth?
  
• Bone patterns on imaging: Bone loss tracking along the root surface may suggest a vertical root fracture.

In 2009, the normal probing depths gave this tooth a chance. In 2020, the development of a deep isolated probing changed the prognosis entirely.

When Does a Crack Cross the Line?

Cracks can evolve over time.

A tooth that initially presents with a coronal crack and normal probing depths may remain functional for years. However, new clinical findings can indicate progression.

Signs that a crack may have transitioned into a vertical root fracture include:

• Development of a deep, narrow probing defect
  
• Persistent pain with biting pressure
  
• Bone loss that follows the contour of the root
  
• Worsening symptoms after a period of stability

This distinction is critical.

A cracked tooth may be saved.
A fractured tooth that extends into the root typically cannot (but this depends on the depth of that fracture line).
A split tooth cannot be restored.

Recognizing that turning point helps guide the decision to continue treatment or move toward extraction.

Learning When to Extract, and When Not to

Fortunately, most cracked teeth cases don’t transition into a vertical root fracture or a split tooth. Yet, there are many lessons to take from this over-a-decade-long tale.

Most importantly, an upfront discussion with the patient helps them make the most empowered decision for themself. That means they can take charge of their own dental health with a clear picture of what the outcomes might be.

This patient opted to invest in treatment on his tooth, knowing he may still lose it eventually. But that doesn’t mean that every patient would have done the same thing.

The outcome of this case is unfortunate, but impressive. I mean, 11 years is a long time to have put off an extraction, and I think treatment exceeded the patient’s expectations! Plus, an implant today is way better than an implant 11 years ago, so I still stand by my decision.

Can a cracked tooth be saved? I’d say yes, even if it is just for an extra decade. That’s some quality tooth time!

What are other treatment options for a cracked tooth?

If your patient has a cracked tooth, there are a number of modification options to explore to diagnose and plan treatment. Here’s what I’d recommend:

1. Change instrumentation to a smaller taper. And more irrigation to clean the tooth. Try to conserve as much dentin as possible.
   
2. Make sure the patient gets their tooth crowned as soon as possible (they shouldn’t wait the typical 2 weeks.). Crowns can prevent future extractions.
   
3. Obturate the canal with the crack in it with MTA. I have done that with several cases, and those teeth are still in the patient’s mouth!
   
4. Take the tooth out of occlusion. To make sure the patient does not bang it too hard while they are waiting to get their crown.
   
5. Look at other areas of the mouth. These things tend to happen in pairs, especially with the same tooth on the other side.
   
6. Recommend a nightguard, especially for patients who are frequent cracked-tooth offenders.

FAQ: Cracked, Fractured, and Split Teeth

Can you save a cracked tooth?
In many cases, yes—especially when the crack is limited to the crown and probing depths remain normal.

Can a fractured tooth be saved?
It depends on the location of the fracture. Coronal fractures may be restorable. Root-level fractures usually require extraction.

Can a split tooth be saved?
No. Once the tooth has separated into distinct segments, extraction is typically necessary.

Can a cracked molar be saved long-term?
Many cracked molars function successfully for years when properly diagnosed, treated, and restored.  

Learning Not to Panic When Cracked Teeth End Up in Your Chair

Inside E-School, I teach you what actually causes cracks to create pulpal problems, the subtle clinical clues that tell you a tooth is truly cracked, and how to arrive at the right diagnosis before you prematurely condemn a tooth to extraction.

– Dr. Sonia Chopra