Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China.
Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, Zhejiang, China.
J Dent. 2024 Mar;142:104843. doi: 10.1016/j.jdent.2024.104843. Epub 2024 Jan 24.
The aim of this review was to analyze the clinical treatment outcomes of cracked teeth (CT) retaining vital dental pulp (CT-VDP) or undergoing root canal treatment (CT-RCT).
A systematic search was conducted in Medline, Embase, PubMed, and Cochrane Library databases.
Studies evaluating tooth survival rate (TSR), pulp survival rate (PSR), and success rate (SR) with at least a one-year follow-up were included. The risk of bias was evaluated with the Newcastle-Ottawa scale.
Twenty-seven studies underwent qualitative analysis, 26 of which were included in the meta-analysis. SR of monitoring without restorative treatments was 80 % at three years. TSR of CT-VDP was 92.8-97.8 % at 1‒6 years, PSR of CT-VDP was 85.6‒90.4 % at 1‒3 years, and SR of CT-VDP was 80.6‒89.9 % at 1‒3 years; TSR of CT-RCT was 90.5‒91.1 % at 1‒2 years, and SR of CT-RCT was 83.0‒91.2 % at 1‒4 years. Direct restorations without cuspal coverage for CT-VDP increased the risk ratio (RR) of pulpal complications (RR=3.2, 95 % CI: 1.51-6.82, p = 0.002) and tooth extraction (RR=8.1, 95 % CI: 1.05-62.5, p = 0.045) compared with full-crown restorations. The CT-RCT without full-crown restorations had an 11.3-fold higher risk of tooth extraction than the CT-RCT with full-crown restorations (p < 0.001).
Monitoring without restorative treatments might be an option for the CT without any symptoms. Direct restorations without cuspal coverage for the CT-VDP could significantly increase the RR of pulpal complications and tooth extraction compared with full-crown restorations. Full-crown restorations are strongly recommended for the CT-RCT.
Monitoring without restorative treatments could be a viable option for the CT without any symptoms. Full-crown restorations are strongly recommended for the CT with any symptoms and the CT-RCT.
本综述旨在分析保留活髓的牙隐裂（CT-VDP）或行根管治疗的牙隐裂（CT-RCT）的临床治疗效果。
系统检索 Medline、Embase、PubMed 和 Cochrane Library 数据库。
纳入至少随访 1 年、评估牙存活率（TSR）、牙髓存活率（PSR）和成功率（SR）的研究。采用纽卡斯尔-渥太华量表评估偏倚风险。
27 项研究进行了定性分析，其中 26 项研究纳入了荟萃分析。未行修复治疗的监测成功率为 3 年时 80%。1-6 年时 CT-VDP 的 TSR 为 92.8%-97.8%，1-3 年时 CT-VDP 的 PSR 为 85.6%-90.4%，1-3 年时 CT-VDP 的 SR 为 80.6%-89.9%；1-2 年时 CT-RCT 的 TSR 为 90.5%-91.1%，1-4 年时 CT-RCT 的 SR 为 83.0%-91.2%。CT-VDP 行无牙尖覆盖的直接修复会增加牙髓并发症（RR=3.2，95%CI：1.51-6.82，p=0.002）和拔牙（RR=8.1，95%CI：1.05-62.5，p=0.045）的风险比（RR），而全冠修复则会降低风险。CT-RCT 未行全冠修复时，拔牙风险比行全冠修复的 CT-RCT 高 11.3 倍（p<0.001）。
无任何症状的 CT 患者不进行修复治疗而仅行监测可能是一种选择。与全冠修复相比，CT-VDP 行无牙尖覆盖的直接修复会显著增加牙髓并发症和拔牙的 RR。对于 CT-RCT，强烈推荐行全冠修复。
无任何症状的 CT 患者不进行修复治疗而仅行监测可能是一种可行的选择。对于有任何症状的 CT 和 CT-RCT，强烈推荐行全冠修复。
