Table 1.
Clinical studies relevant to restorative approaches for cracked teeth with baseline normal pulp or reversible pulpitis
| Study | No of teeth | Management of crack lines | Interim treatment (for multiple‐stage approaches) | Definitive treatment | Follow‐up | Outcome |
|---|---|---|---|---|---|---|
| Interventional studies (n = 3) | ||||||
| Davis and Overton (2000) | 40 | N/S+ | N/A+ | Bonded amalgam (20 teeth), pin‐retained amalgam (20 teeth) | 1 year | Bite pain resolved for both groups, cold sensitivity resolved only for bonded group |
| Opdam and Roeters (2003) | 40 | N/S | N/A | Direct composite with (20) or without (20) cuspal coverage | 6 months –preliminary report of Opdam et al. (2008) | Only 50% of teeth symptom‐free, no significant difference between groups |
| Opdam et al. (2008) | 41 | N/S | N/A | Direct composite with (21) or without (20) cuspal coverage | 7 years | 93% pulp survival (no significant difference between groups), higher failure rate for restorations without cuspal coverage |
| Observational studies (n = 15) | ||||||
| Abbott (2001) | 100 | Complete crack elimination | Sedative liner and glass ionomer restoration | N/A | 3 months – preliminary report of Abbott and Leow (2009) | 81% pulp survival, 100% tooth survival |
| Abbott and Leow (2009) | 100 | Complete crack elimination | Sedative liner and glass ionomer restoration | Crowns or onlays | Up to 5 years | 80% pulp survival (recall rate was 54%), 100% tooth survival |
| Banerji et al. (2014) | 151 | N/S | Supra‐coronal direct composite splint (DCS) | Direct (74%) or indirect (1.6%) composite onlays, gold onlays (10%), crowns (14%) | 3 months (for DCS), no follow‐up for definitive restorations | 93% pulp survival, another 5% had DCS failure or intolerance |
| Chana et al. (2000) | 6 | N/S | N/A | Metal onlays | 4 years | 100% pulp and tooth survival |
| de Toubes et al. (2022)± | 26 | N/S | Direct composite | Crowns or onlays | 3.3 years | 88% pulp survival, 1 tooth was lost after endodontic treatment |
| Guthrie and DiFiore (1991) | 28 | N/S | Provisional crown | Crowns | 1 year (definitive), 2 weeks (interim) | 89% pulp survival |
| Homewood (1998) | 62 | N/S | Orthodontic bands (8 teeth initially and 3 further teeth after symptoms persistence with definitive treatment) | Single‐stage: Amalgam or composite cuspal coverage or crowns, | 15 months | 94% overall pulp survival (83% for teeth that received orthodontic bands), 98% tooth survival |
| Multiple‐stage: Crowns or onlays, | ||||||
| 1 tooth extracted | ||||||
| Kanamaru et al. (2017)± | 44 | N/S | Occlusal adjustment (25 cases) | For pulp‐preserved group: Crowns (70.4%), occlusal adjustment (14.8%), composite resin (7.4%), monitoring (7.4%) | 1–3 years | 61% overall pulp survival (pulp complications occurred before definitive restoration) |
| Eugenol‐sedation (9 cases) | ||||||
| Resin coating for dentine hypersensitivity (3 cases) | ||||||
| Restoration (2 cases) | ||||||
| Monitoring (5 cases) | ||||||
| Kang et al. (2016)± | 58 | N/S | Provisional crowns (38 teeth) | Crowns (27 teeth from those that received provisional crowns), direct composite (10 teeth), inlays (10 teeth) | Not specified | 71% pulp survival after interim treatment |
| Kim et al. (2013)± | 21 | N/S | Provisional crowns | Crowns | Not specified | 58% pulp survival after interim treatment |
| Krell and Rivera (2007) | 127 | Previous restorations and cracks were not removed | N/A | Crowns | 6 months | 79% pulp survival |
| Lee et al. (2021a) | 29 | Cracks were removed until a shallow crack remained close to the pulp and were lined the crack with flowable composite | Bidirectional splinting | Crowns | 2.6 years | 72% pulp survival (91% after definitive restoration), 100% tooth survival |
| Marchan et al. (2013) | 6 | N/S | N/A | Metal onlays | 3.5 years | 100% pulp and tooth survival |
| Signore et al. (2007) | 43 | N/S | N/A | Indirect composite onlays | 6 years | 93% pulp survival |
| Wu et al. (2019) | 199 | N/S | Orthodontic bands | Crowns (18 teeth remained with bands) | 3 years (3 months of interim treatment) | 71% overall pulp survival (81% 5‐year estimated survival with crowns, 37% with bands), 3 teeth extracted |
| Case reports/series (n = 9) | ||||||
| Batalha‐Silva et al. (2014) | 1 | Complete crack elimination (after banding phase) | Bidirectional splinting | Direct composite | 5 weeks (for interim treatment) | The tooth remained vital and asymptomatic |
| Bearn et al. (1994) | 4 | N/S | N/A | Bonded amalgam | 15–26 months | All cases remained vital and asymptomatic |
| de Toubes et al. (2020)± | 1 | Crack lines were disinfected with chlorhexidine | Intra‐coronal direct composite | Crown | 5 years | The tooth remained vital |
| Ehrmann and Tyas (1990) | 3 | N/S | Orthodontic bands | Crowns | 30 months to 14 years | All cases remained vital and asymptomatic |
| Griffin (2006) | 2 | Cracks removed until no separation of the tooth could be felt with a sharp probe | N/A | Ceramic onlays | 2 years | Both teeth remained vital and asymptomatic |
| Ito et al. (1998)± | 2 | Cracks partially removed to identify their relation to the pulp | Intra‐coronal direct composite | Crowns | 2 years (6 months of interim treatment) | One of the teeth required endodontic treatment after the 6‐month interim treatment, the other tooth remained vital |
| Liebenberg (1996) | 2 | Cracks removed until they diminished to a fine craze | N/A | Ceramic onlays | 20 months | Both teeth remained vital and asymptomatic |
| Ritchey et al. (1957)± | 3 | N/S | Zinc‐oxide eugenol liner (case 3) | Crowns (Cases 11, 12) | 2 years (Cases 11, 12) | Cases 11,12 remained vital and asymptomatic, Case 3 developed irreversible pulpitis and was extracted due to crack extending to pulpal floor |
| 3 days (Case 3) | ||||||
| Yap (1995) | 1 | N/S | N/A | Metal onlay | 1 year | The tooth remained vital and asymptomatic |
● +: N/S = not specified, N/A = not applicable.
● ±: Data from these studies are also included in Table 2 since they provide information regarding treatment of cracked teeth that received endodontic treatment.