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Title Root Canal Treatment Is a Predictable and Successful Option for Patients with Cracked Teeth
Clinical Question For healthy patients presenting with cracked teeth, does root canal treatment with subsequent coronal restoration represent a predictable option for retention of the natural tooth?
Clinical Bottom Line Endodontic with subsequent coronal coverage treatment of cracked teeth is a predictable procedure with high success rates that should be offered to patients as an alternative to extraction. While the success rate varies by study, collectively the literature supports a 5-year survival approaching 90%. Poorer outcomes are expected when periodontal probing is found to be greater than 6mm, particularly associated with mobility. Considering the increased risk of fracture exhibited by terminal dental arch teeth, particularly mandibular molars, and the importance molars have in maintaining occlusal function; these studies provide the evidence to support endodontically treating and restoring structurally compromised teeth to prolong the longevity of the natural dentition.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 31797172Leong/2020585 patients from 4 studiesMeta-Analysis
Key resultsThis systematic review and meta-analysis revealed that across 4 studies meeting inclusion criteria, cracked teeth receiving root canal treatment and subsequent coronal restoration had a 60-month survival rate of 84.1% (reported 95%CI, 72.3-91.5%). The authors reported no statistically significant risk factors for extraction but noted a tendency for teeth containing a single crack or cracks contained within the crown to be a good clinical sign and teeth containing probing depths >3mm or terminal abutments to be poorer clinical signs of outcome.
#2) 29429822Krell/2018363 cracked teethRetrospective clinical study
Key resultsA retrospective study of 3038 root canals completed on cracked teeth in a single private practice over a 25-year period. Of these cases, 363 teeth met inclusion criteria for multivariate analysis. The 1-year success rate was 82%, higher than previously thought, and the analysis found that probing depth, distal marginal ridge cracks and periapical diagnosis were poor prognostic factors. These results were used to generate the Iowa Staging Index which can aid clinicians in treatment planning for cracked teeth.
#3) 26944835Kang/201688 cracked teeth Prospective Cohort Study
Key resultsThis was a prospective study that included 88 teeth meeting inclusion criteria requiring RCT treatment. Extensive diagnostic measurements were taken prior to treatment and patients were followed for 2-years to perform Kaplan-Meier survival analysis and multivariate regression to identify potential risk factors. In this study, the overall 2-year survival rate was 90% and the most significant prognostic factor was the presence of a pocket depth of >6 mm which resulted in statistically different 2-year survival (96.8% for <6 mm and 74.1% for >6 mm probing depth).
Evidence Search “Cracked teeth AND root canal AND success”
Comments on
The Evidence
Leong et al in 2020 performed a systematic review and meta-analysis of 4 studies and found a 60-month survival of 84.1%. Olivieri et al also published a meta-analysis in 2020 finding similar results although with some overlap in included studies and a slightly different outcome measure (88% survival at 1 year follow up). Taken together these meta-analyses strongly support an acceptable survival rate for root canal treated fractured teeth spanning up to 5 years. The next two articles are useful to consider along with the meta-analyses in terms of aiding the clinician in the prognosis of a case. Both Krell and Kang et al identify increased pocket depths as a poor prognostic indicator for outcome of endodontically treated fractured teeth. Meta-analysis has supported this finding as a poor prognostic factor. The study conducted by Kang et al is particularly compelling due to its prospective design allowing the reviewer to note the decrease in survival for teeth with a pre-existing probing depth >6mm versus those without. A limitation of these studies still is a relatively small number of patients.
Applicability These findings apply to all dentists who frequently encounter patients presenting with cracked teeth. Even if the original provider will not be administering the endodontic treatment, it is essential that the restorative dentist can identify cracked teeth that should be restored and not be immediately extracted.
Specialty/Discipline (Endodontics) (General Dentistry) (Periodontics) (Prosthodontics)
Keywords cracked teeth, fractured crown, endodontics, root canal
ID# 3475
Date of submission: 12/08/2021spacer
E-mail hargreavesnd@livemail.uthscsa.edu
Author Nicholas Dybdal-Hargreaves, DDS, PhD
Co-author(s) Jon Hartley, DMD
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DDS, MS, PhD
Faculty mentor/Co-author e-mail diogenes@uthscsa.edu
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