Zhang S, Xu Y, Ma Y, Zhao W, Jin X, Fu B. The treatment outcomes of cracked teeth: A systematic review and meta-analysis. J Dent 2024; 142: 104843.

Root-filled teeth should receive a full coverage coronal restoration.

Cracked teeth (CT) typically (but not exclusively) manifest in the lower molars of patients aged 45-60 and may exhibit symptoms of sensitivity to cold and to pressure. Treatment options include monitoring only, direct and indirect restorations, root canal treatment and extraction. This review of 27 relevant papers analysed the clinical outcomes of different protocols.

CT with vital pulp, restored with direct restorations, showed tooth survival rates of over 90% after three years. Pulp survival rate fell to around 80% over two and three years. Survival rates for vital teeth restored with full coronal coverage, and pulp survival rate, fell to below 90% after three years. The risk of pulpal complications or extraction increased with direct restorations without cuspal coverage. CT after endodontic treatment without a full crown restoration were 11 times more likely to be extracted than those with a full coverage restoration.

The authors conclude that monitoring CT in the absence of symptoms may be a viable option, that direct restorations without cuspal coverage increase the risk of pulpal complications, and that full coverage is essential after root canal treatment.