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Pulp Survival of Cracked Teeth with Normal Pulp or Reversible Pulpitis After External Splinting: A Systematic Review
Fiyaz Ghan A S1, Arunakshi Krishnan1, Sidhartha Sharma1
1Division of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
Introduction:
This systematic review and meta-analysis aimed to assess the pulp survival rate of cracked teeth with normal pulp or reversible pulpitis managed using external splinting.
Methods:
A comprehensive literature search was conducted across PubMed, Scopus, LILACS, EMBASE, Web of Science, and Google Scholar up to January 31, 2025. Clinical studies evaluating pulp survival in permanent mature cracked teeth diagnosed with normal pulp or reversible pulpitis, with a minimum follow-up period of 12 months, were included. The risk of bias was assessed using the Newcastle-Ottawa Scale, while the quality of evidence (QoE) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Publication bias was analyzed through funnel plots and Begg's test. A random-effects model was utilized to estimate the pooled pulp survival rates.
Results:
A total of 10 studies comprising 711 cracked teeth with varying management protocols met the inclusion criteria. The weighted pooled pulp survival rate at 12 months was 85% (95% confidence interval [CI]: 79%-91%), with considerable heterogeneity (I2 = 82.6%). Sensitivity analysis confirmed the reliability of these findings. Funnel plot analysis revealed no publication bias. Subgroup analysis indicated that teeth managed without interim orthodontic banding exhibited a higher pulp survival rate (89%, 95% CI: 83%-95%) than with orthodontic banding (79%, 95% CI: 67%-90%). Survival was also greater with the direct approach [89% (95% CI, 82%-97%)] than the stepwise approach [81% (95% CI, 72%-90%)]. The overall risk of bias was moderate, and the QoE was categorized as very low.
Conclusions:
For cracked teeth with reversible pulpitis, external splinting has demonstrated favorable pulpal survival rate at 1 year, albeit with considerable variation in treatment protocols. However, given the substantial heterogeneity and overall low QoE, there remains a need for rigorous, high-quality comparative studies to establish a standardized treatment approach.
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