A split tooth represents one of the most severe forms of longitudinal tooth fracture and is generally considered the terminal stage of a previously cracked tooth. In this condition, the fracture line extends from the occlusal surface toward the root, resulting in complete separation of the tooth into two distinct segments.
A split tooth is characterized by a complete longitudinal fracture extending through the crown and into the root structure, causing the tooth to divide into two movable fragments. Unlike incomplete cracks, a true split tooth exhibits definitive and independent segment mobility.
A split tooth typically evolves from an untreated or progressive crack. Contributing factors include:
Excessive or repetitive occlusal forces
Large restorations weakening the remaining tooth structure
Parafunctional habits (e.g., bruxism or clenching)
Sudden traumatic biting on hard objects
Age-related changes such as dentin fatigue
The fracture often initiates on the occlusal surface, usually in a mesiodistal orientation, and propagates cervically or apically along the root.
A complete longitudinal fracture creates a direct pathway for microbial contamination, leading to:
Pulp inflammation or necrosis
Periapical pathosis
Isolated deep periodontal probing defects
Vertical bone loss along the fracture line
Combined endodontic–periodontal lesions in advanced cases
These changes significantly worsen the prognosis and complicate therapeutic options.
Mobility of the separated segments is the most definitive diagnostic indicator.
Cracked Tooth: Little to no separation; segments remain structurally unified.
Split Tooth: Clear, independent movement between portions of the tooth is detectable clinically or with probing.
Sharp pain on biting or release (bite test sensitivity)
Narrow, deep periodontal pocket adjacent to the fracture
Visualization of the fracture under magnification
Radiographic characterization, including CBCT evaluation
Thermal sensitivity depending on pulpal status
The prognosis of a split tooth is generally poor, primarily influenced by the extent and direction of the fracture.
A split tooth cannot be preserved as a fully intact structure due to the irreversible loss of tooth integrity.
If the fracture extends beyond the cervical third of the root, the recommended treatment is complete extraction, as functional restoration is not feasible.
In rare and carefully selected cases—typically when the fracture is confined to the cervical area—partial retention may be possible.
This involves:
Removal of the smaller fractured segment
Endodontic treatment of the remaining tooth structure (if indicated)
Definitive restoration to maintain function
Success depends heavily on periodontal support, hygiene status, and preservation of adequate sound tooth structure.
A split tooth represents the most advanced and destructive stage of longitudinal tooth fractures. Key characteristics include:
Complete separation of tooth segments
Pathways for microbial invasion leading to pulpal and periodontal breakdown
Typically poor prognosis
Extraction as the primary treatment choice
Limited situations in which partial preservation may be considered
Early diagnosis and management of cracked teeth remain the best preventive strategy against progression into a split tooth.