Saving the split: An umbrella review on therapeutic approaches for cracked tooth syndrome

Cracked tooth syndrome (CTS) has become a therapeutic dilemma due to a lack of consolidated evidence guiding its management. This umbrella review synthesized evidence from published systematic reviews of therapeutic interventions in CTS.

The protocol was registered in PROSPERO (CRD420250648720), and it was conducted according to PRISMA 2020 guidelines. The searches were conducted up to June 15, 2025, in PubMed, Cochrane Library, Scopus, and EMBASE. Two reviewers screened and extracted data independently. A Measurement Tool to Assess Systematic Reviews 2 was used to measure methodological quality, and a citation matrix and Corrected Covered Area (CCA) to measure overlap of primary studies.

Ten systematic reviews were identified, and four of them satisfied the inclusion criteria; they included 30 separate primary studies (45 study entries). The CCA was 17%, indicating high overlap. Endodontic therapy followed by full cuspal coverage demonstrated the highest prognosis with 84%-96% survival, 82%-84% success rate, and a lower chance of extraction by 11.3 times. On the other hand, there was an association of noncrowned teeth with pulpal problems, failure of restoration, and recurring symptoms, particularly in the presence of deep periodontal pockets.

Endodontic therapy followed by full cuspal coverage provides the most predictable outcome in CTS. More evidence ought to be augmented using standardized measures, patient-reported outcomes, and cost-effectiveness calculations.