Cracked teeth with radicular extension: an update on restorative procedures for endodontically treated deeply cracked teeth.

Cracked teeth with radicular extension have traditionally been considered nonrestorable; however, recent evidence supports a conservative treatment approach with favorable outcomes. This article outlines a protocol involving microscope-assisted endodontic therapy, placement of an intraradicular barrier, and timely full-coverage restoration for endodontically treated deeply cracked teeth. When proper case selection guidelines are followed, these teeth show high survival and success rates comparable to those of noncracked teeth. The outlined protocol emphasizes preserving pericervical dentin, sealing the internal aspects of the crack to prevent bacterial contamination, and minimizing occlusal and parafunctional stresses. Although crack-associated isolated periodontal pocketing may persist, studies show these defects may remain stable and asymptomatic over time. A team approach for this protocol is recommended, with endodontists and restorative dentists each playing a role. This article encourages reconsideration of extraction as the default solution to deeply cracked teeth and highlights the importance of preserving natural dentition whenever possible.