The treatment outcomes of cracked teeth: A systematic review and meta-analysis

Sisi Zhang; Yingcai Xu; Yuhan Ma; Weijia Zhao; Xiaoting Jin; Baiping Fu

doi:10.1016/j.jdent.2024.104843

The treatment outcomes of cracked teeth: A systematic review and meta-analysis

J Dent. 2024 Mar:142:104843. doi: 10.1016/j.jdent.2024.104843. Epub 2024 Jan 24.

Authors

Sisi Zhang¹, Yingcai Xu¹, Yuhan Ma¹, Weijia Zhao¹, Xiaoting Jin¹, Baiping Fu²

Affiliations

¹ Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China.
² Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China. Electronic address: fbp@zju.edu.cn.

PMID: 38272437
DOI: 10.1016/j.jdent.2024.104843

Abstract

Objectives: The aim of this review was to analyze the clinical treatment outcomes of cracked teeth (CT) retaining vital dental pulp (CT-VDP) or undergoing root canal treatment (CT-RCT).

Sources: A systematic search was conducted in Medline, Embase, PubMed, and Cochrane Library databases.

Study selection: Studies evaluating tooth survival rate (TSR), pulp survival rate (PSR), and success rate (SR) with at least a one-year follow-up were included. The risk of bias was evaluated with the Newcastle-Ottawa scale.

Data: Twenty-seven studies underwent qualitative analysis, 26 of which were included in the meta-analysis. SR of monitoring without restorative treatments was 80 % at three years. TSR of CT-VDP was 92.8-97.8 % at 1‒6 years, PSR of CT-VDP was 85.6‒90.4 % at 1‒3 years, and SR of CT-VDP was 80.6‒89.9 % at 1‒3 years; TSR of CT-RCT was 90.5‒91.1 % at 1‒2 years, and SR of CT-RCT was 83.0‒91.2 % at 1‒4 years. Direct restorations without cuspal coverage for CT-VDP increased the risk ratio (RR) of pulpal complications (RR=3.2, 95 % CI: 1.51-6.82, p = 0.002) and tooth extraction (RR=8.1, 95 % CI: 1.05-62.5, p = 0.045) compared with full-crown restorations. The CT-RCT without full-crown restorations had an 11.3-fold higher risk of tooth extraction than the CT-RCT with full-crown restorations (p < 0.001).

Conclusions: Monitoring without restorative treatments might be an option for the CT without any symptoms. Direct restorations without cuspal coverage for the CT-VDP could significantly increase the RR of pulpal complications and tooth extraction compared with full-crown restorations. Full-crown restorations are strongly recommended for the CT-RCT.

Clinical significance: Monitoring without restorative treatments could be a viable option for the CT without any symptoms. Full-crown restorations are strongly recommended for the CT with any symptoms and the CT-RCT.

Keywords: Cracked tooth syndrome; Direct restoration; Full crown; Root canal treatment; Success rate; Survival rate.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Cracked Tooth Syndrome*
Crowns
Dental Restoration, Permanent*
Humans
Root Canal Therapy
Treatment Outcome