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Survival and prognostic factors of managing cracked teeth with reversible pulpitis: A 1- to 4-year prospective cohort study

 Junghoon Lee  ;  Sunil Kim  ;  Euiseong Kim  ;  Kyung-Ho Kim  ;  Seong Taek Kim  ;  Yoon Jeong Choi 
 INTERNATIONAL ENDODONTIC JOURNAL, Vol.54(10) : 1727-1737, 2021-10 
Journal Title
Issue Date
crack splinting ; crack tooth ; mechanical allodynia ; root canal treatment ; tooth restoration
Aim: This prospective clinical study evaluated the clinical performance of managing cracked teeth with reversible pulpitis through a combination of internal and external splinting and investigated factors that can affect pulp survival after splinting.

Methodology: Thirty-four teeth diagnosed with cracks and reversible pulpitis were enrolled and treated with bidirectional crack splinting: 1) immediate splinting with a stainless-steel band, 2) internal splinting with crack line removal and resin filling and 3) external splinting with a temporary crown followed by final crown placement. If the symptoms remained/recurred, root canal treatment was performed. Patients were followed up at 3, 6 and 12 months, then annually thereafter. Kaplan-Meier survival analysis to calculate the survival of the treated teeth and Cox univariate proportional hazards regression model to investigate prognostic factors were performed.

Results: Twenty-nine (97%) teeth were followed up for up to 4 years. The pulp survival rate was 72% after banding and 91% after final crown cementation. No tooth was extracted (100% tooth survival rate). In the univariate Cox proportional hazard test, pain on percussion was the only statistically significant factor (hazard ratio = 11.77). Teeth with pain on percussion at the first visit had a pulp survival rate of 46% during the follow-up period. In comparison, their counterparts without pain had a 94% pulp survival rate.

Conclusions: Bidirectional splinting successfully managed cracked teeth with reversible pulpitis. Pain on percussion (mechanical allodynia) may be an important factor in deciding whether to attempt root canal treatment on symptomatic cracked teeth. A step-by-step approach with bidirectional crack splinting should be encouraged for a cracked tooth with a vital pulp without mechanical allodynia rather than pre-emptive root canal treatment.
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Appears in Collections:
2. College of Dentistry (치과대학) > Dept. of Conservative Dentistry (보존과학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Orofacial Pain and Oral Medicine (구강내과학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Orthodontics (교정과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Ho(김경호) ORCID logo https://orcid.org/0000-0002-8154-2041
Kim, Sun Il(김선일) ORCID logo https://orcid.org/0000-0002-8889-9844
Kim, Seong Taek(김성택)
Kim, Eui Seong(김의성) ORCID logo https://orcid.org/0000-0003-2126-4761
Lee, Junghoon(이정훈)
Choi, Yoon Jeong(최윤정) ORCID logo https://orcid.org/0000-0003-0781-8836
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