Prevalence and clinical characteristics of cracked posterior teeth among adult patients referred to selected endodontic centres in Saudi Arabia: a cross-sectional study

Cracked posterior teeth represent a persistent diagnostic and therapeutic challenge in dental practice. When undetected, crack propagation may result in pulpal and periapical complications. Epidemiological data on cracked teeth in Saudi and Middle Eastern populations remain limited, particularly in referral-based clinical settings. This cross-sectional observational study included consecutive adult patients (≥ 18 years), each referred for endodontic evaluation of one index posterior tooth, at selected endodontic referral centres in Saudi Arabia. The recorded variables included age group, gender, tooth type, pulpal status, restoration status and type, cavity classification, treatment type, and crack presence and extension. Cracks were assessed using methylene blue staining dye and direct visualisation under a dental operating microscope. Associations between demographic and clinical variables and crack presence were analysed using chi-square tests and logistic regression, with statistical significance set at p < 0.05. A total of 625 adult patients contributed 625 referred index posterior teeth. Cracks were identified in 40 index teeth, corresponding to a prevalence of 6.4%. Most cracks were confined to the cavosurface margin (33/40; 82.5%). Most examined teeth were restored (459/625; 73.4%). Amalgam restorations were significantly associated with crack presence (OR = 3.66; 95% CI: 1.36–9.90; p = 0.010), whereas no significant associations were observed with age group, gender, tooth type, pulpal status, or treatment type. In this referral-based sample, cracks were identified in 6.4% of referred index posterior teeth. Amalgam restorations were significantly associated with crack presence. These findings support careful microscopic assessment of structurally compromised posterior teeth in endodontic referral settings.