“Teeth are fracturing in record numbers. Cracked and fractured teeth are now the 3rd leading cause of tooth loss in industrialized nations. Posterior teeth with conservative amalgams and com-posites are splitting and losing cusps. Crowned teeth, both posterior and anterior, are fracturing off at tissue level. Endodontically treated teeth are splitting, snapping off, and simply imploding. Additionally, endodontists are reporting that cracked teeth are now replacing carious teeth for causative etiology in numbers of patients referred for endodontic treatment.
We assume that the causes of this pervasive and growing problem are (a) we are living longer; (b) our stress levels are rising, and clenching and bruxism are also more prevalent; (c) the advent of the high-speed handpiece spawned billions of iatrogenic “G.V. Black” cavity preparations that have weakened posterior teeth deep axial crown preparations in the name of porcelain aesthetics; and (e) aggressive “crown-down” endodontic shapes in delicate, non-round roots.
Dentistry’s last great mystery, fracturing, is a poorly understood process. A dramatic change in the focus of continuing dental education toward cosmetic dentistry, bleaching, and implants has shifted our attention away from some of the most integral aspects of the healing art of dentistry, and cracks top that list. We now find our profession faced with a monumental problem that will require a significant commitment and reallocation of resources to address appropriately. There is no need to assess blame; we must simply roll up our sleeves and get to work.”