Treatment of cracked teeth: A comprehensive narrative review

Objectives: The term cracked tooth is used to describe an incomplete fracture initiated from the crown and progressing towards a subgingival direction. Despite the high prevalence of cracked teeth and their frequent association with symptoms and pulpal or periapical pathoses, there is still no consensus in the literature with regard to their restorative and endodontic management. Therefore, the aim of this narrative review was to evaluate the most relevant research and provide an up-to-date comprehensive overview regarding the treatment of cracked teeth. Materials and Methods: An electronic literature search was carried out in MEDLINE (via Ovid), Embase (via Ovid), Scopus, and Web of Science as well as several Grey literature sources up to February 22nd 2022 using a combination of pre-specified 'free-text' terms (keywords) and subject headings. The search process was supplemented by handsearching in relevant dental journals and reference lists. This narrative review focused on clinical follow-up studies (observational or interventional studies, case series/reports), laboratory studies and systematic reviews written in English language that reported data on treatment of permanent cracked teeth. The selection of relevant studies was carried out by two reviewers (AK and DG) working independently in two consecutive stages: title/abstract screening and full-text retrieval. Any discrepancies in the study selection were resolved by discussion between the reviewers. Results: In total, 64 articles were selected for inclusion in this narrative review. Conclusions: Cracked teeth with normal pulp or reversible pulpitis have exhibited high pulp and tooth survival rates by the provision of direct or indirect composite restorations. Besides, recent data favour monitoring, especially in the absence of symptoms or compromised tooth structure. When endodontic intervention is required, current evidence suggests that along with appropriate restorative management, outcomes of cracked teeth may be comparable to those of non-cracked root filled teeth.

Automated summary

There is still no consensus in the literature regarding the restorative and endodontic management of cracked teeth. Cracked teeth with normal pulp or reversible pulpitis have shown high pulp and tooth survival rates with direct or indirect composite restorations. Recent data suggest that monitoring cracked teeth, especially in the absence of symptoms or compromised tooth structure, is a favorable approach.