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. 2021 Oct;54(10):1727-1737.
doi: 10.1111/iej.13597. Epub 2021 Jul 22.

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

Junghoon Lee  1 , Sunil Kim  1 , Euiseong Kim  1   2 , Kyung-Ho Kim  3   4 , Seong Taek Kim  5 , Yoon Jeong Choi  3   6
Affiliations

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

Junghoon Lee et al. Int Endod J. 2021 Oct.

Abstract

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.

Keywords: crack splinting; crack tooth; mechanical allodynia; root canal treatment; tooth restoration.

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References

REFERENCES

    1. Abbott, P. & Leow, N. (2009) Predictable management of cracked teeth with reversible pulpitis. Australian Dental Journal, 54, 306-315.
    1. Alkhalifah, S., Alkandari, H., Sharma, P.N. & Moule, A.J. (2017) Treatment of cracked teeth. Journal of Endodontics, 43, 1579-1586.
    1. Banerji, S., Mehta, S.B. & Millar, B.J. (2010) Cracked tooth syndrome. Part 1: aetiology and diagnosis. British Dental Journal, 208, 459-463.
    1. Banerji, S., Mehta, S.B., Kamran, T., Kalakonda, M. & Millar, B.J. (2014) A multi-centred clinical audit to describe the efficacy of direct supra-coronal splinting-a minimally invasive approach to the management of cracked tooth syndrome. Journal of Dentistry, 42, 862-871.
    1. Berman, L.H. & Hargreaves, K.M. (2021) Cohen's pathways of the pulp [electronic resource], Berman, L.H. & Kenneth, M. (edited by). Hargreaves: Elsevier.

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