Predictable management of cracked teeth with reversible pulpitis

BACKGROUND: The aims of this study were to assess symptoms and signs caused by cracks in teeth and to assess a conservative management protocol. METHODS: The symptoms and signs of 100 consecutive teeth that had reversible pulpitis associated with cracks were compared to findings from other reports. Teeth were managed with a conservative protocol which involved removal of cracks, caries and restorations, followed by placement of a sedative lining and interim restoration unless there were pulp exposures or insufficient tooth structure remaining. Teeth were monitored for pulp healing after three months and for up to five years. RESULTS: Eighty teeth did not require endodontic treatment. One tooth had an uncertain pulp status at review appointments. Fifteen teeth required endodontic treatment at the initial appointment because of carious pulp exposures (4 teeth), cracks extending into the pulp (2), and posts required (9). Four other teeth required endodontic treatment later following conservative pulp treatment due to continued pulpitis under the temporary restoration (1), pulpitis after core restoration (2), and pulp necrosis diagnosed at the review (1). CONCLUSIONS: Provided there is an accurate diagnosis of the pulp status and its cause, teeth with reversible pulpitis due to cracks can be treated conservatively without endodontic treatment in about 80 per cent of cases.