Eighty percent of cracked teeth with reversible pulpitis don't need endodontics, researchers from the University of Iowa and the University of North Carolina, Chapel Hill report in the December issue of the Journal of Endodontics.
The question is growing in urgency because people are living longer, which means there are more old teeth around, many of them weakened by past or present caries.
To find out how all these cracks affect the long-term viability of pulps, the researchers identified 796 patients with cracked teeth. After excluding cusp fractures, split teeth or vertical root fractures, they were left with 127 cracked teeth that had reversible pulpitis.
The teeth got the pulpitis diagnosis if the patients hadn't experienced spontaneous pain, pain from cold went away in less than five seconds, and x-rays showed no pathosis.
The researchers put crowns on these teeth, then watched to see what happened. Those patients who didn't come back on their own within a year were recalled at the end of that time. Of the 127, the researchers eventually diagnosed only 27 as needing root canal treatment: 21 with irreversible pulpitis and another six with necrotic pulp. Over half of the teeth requiring root canal treatment had the crack in the distal marginal ridge.
The crowns seemed to protect against interproximal periodontal defects as well; such defects progressed in only five of the 127 teeth.
Overall, the study suggested that dentists can skip doing root canal treatments before putting crowns on most cracked teeth.
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