I treated a patient today with cracked tooth syndrome due to an incomplete crown fracture that occurred last Friday evening after the patient was clenching overnight. The tooth had an exaggerated, nonlingering response to cold and a barely visible crack emanating from the lingual groove to the lingual gingival margin. The tooth had an existing MOD amalgam that was in good shape with no evidence of recurrent caries. I decided to treat the tooth with a high noble crown versus attempting to prep out the crack and replace the filling with a composite or bonded amalgam restoration because I was concerned over the longevity of the bond and the possibility of a communication through the crack from the oral cavity to the pulp chamber.

After I was done prepping, impressing and privisonalizing, I was called out bu a fellow provider who was of the opinion that I overtreated the patient. He recommended a cuspal coverage amalgam or removal and replacement of the restoration. His concern is that I will induce irreversible pulpitis due to the crown prep that could have been avoided with a more conservative restoration. After looking at the research, it seems that one study that followed patients with the same diagnosis for the same reasons saw 20% of those patients needing a root canal within six months so I am feeling a bit guilty right now in thinking that I was overly aggressive with this patient.

My question is whether or not a crown is a good option to treat cracked tooth syndrome in teeth with incomplete crown fractures and reversible pulpitis. If not, have you had good success with more conservative treatments like prepping through the crack or splinting with a bonded restoration?