Characteristics of Cracked Teeth with Reversible Pulpitis After Orthodontic Banding—A Prospective Cohort Study

Published:September 20, 2022DOI:



      Cracked teeth with reversible pulpitis can be managed with orthodontic bands in the interim before definitive restorations. The aim of this study was to determine short-term outcomes of these teeth following orthodontic band placement. The time taken for definitive pulp diagnoses after orthodontic band placement and associated prognostic factors was also analyzed.


      One hundred twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative data including patient and tooth factors were collected. Cracked teeth were banded and reviewed until symptoms resolved before referral for coronal coverage. Kaplan-Meier and Cox analyses were performed to analyze pulp survival of these teeth. Prognostic factors were investigated using Pearson's chi-square and Student's t-test.


      One hundred twenty-two cracked teeth were analyzed. One hundred thirteen (92.6%) teeth had the pulpitis resolved within 2 months (median 40.0; interquartile range 28–61). The median time taken for progression to irreversible pulpitis or pulp necrosis for teeth that required root canal treatment was 3 months (median 90.0; interquartile range 68–110). No prognostic factors were associated with the resolution of pulpal symptoms. However, higher preoperative triggered pain scores (P < .05, hazards ratio 1.547) and absence of a distal marginal ridge crack (P < .05, hazards ratio 0.638) were correlated with a longer duration before definitive pulp diagnoses.


      Following orthodontic band placement, a normal pulp diagnosis was achieved in 92.6% of cracked teeth with preoperative reversible pulpitis. Definitive pulp diagnoses could be determined in approximately 2 months. Teeth with higher preoperative triggered pain scores may require a longer review period.

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      1. American Association of Endodontists glossary of endodontic terms. American Association of Endodontists.
        (Accessed September 11, 2022)
      2. Cracking the cracked tooth code: detection and treatment of various longitudinal tooth fractures. American Association of Endodontics.
        (Accessed September 11, 2022)
        • Kruger B.F.
        Cracked-cuspsyndrome. Letter to the editor.
        Aust Dent J. 1984; 29: 55
        • Ehrmann E.H.
        • Tyas M.J.
        Cracked tooth syndrome: diagnosis, treatment and correlation between symptoms and post-extraction findings.
        Aust Dent J. 1990; 35: 105-112
        • Seo D.G.
        • Yi Y.A.
        • Shin S.J.
        • Park J.W.
        Analysis of factors associated with cracked teeth.
        J Endod. 2012; 38: 288-292
        • Geurtsen W.
        The cracked-tooth syndrome: clinical features and case reports.
        Int J Periodontics Restorative Dent. 1992; 12: 395-405
        • Yang S.E.
        • Jo A.R.
        • Lee H.J.
        • Kim S.Y.
        Analysis of the characteristics of cracked teeth and evaluation of pulp status according to periodontal probing depth.
        BMC Oral Health. 2017; 17: 1-6
        • Qian Y.
        • Zhou X.
        • Yang J.
        Correlation between cuspal inclination and tooth cracked syndrome: a three-dimensional reconstruction measurement and finite element analysis.
        Dent Traumatol. 2013; 29: 226-233
        • Nuamwisudhi P.
        • Jearanaiphaisarn T.
        Oral functional behaviors and tooth factors Associated with cracked teeth in asymptomatic patients.
        J Endod. 2021; 47: 1383-1390
        • Qiao F.
        • Chen M.
        • Hu X.
        • et al.
        Cracked teeth and poor oral masticatory habits: a matched case-control study in China.
        J Endod. 2017; 43: 885-889
        • Ricucci D.
        • Siqueira Jr., J.F.
        • Loghin S.
        • Berman L.H.
        The cracked tooth: histopathologic and histobacteriologic aspects.
        J Endod. 2015; 41: 343-352
        • Wu S.
        • Lew H.P.
        • Chen N.N.
        Incidence of pulpal complications after diagnosis of vital cracked teeth.
        J Endodontics. 2019; 45: 521-525
        • Krell K.V.
        • Rivera E.M.
        A six year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis.
        J Endodontics. 2007; 33: 1405-1407
        • Ricucci D.
        • Loghin S.
        • Siqueira Jr., J.F.
        Correlation between clinical and histologic pulp diagnoses.
        J Endod. 2014; 40: 1932-1939
        • Pigg M.
        • Nixdorf D.R.
        • Nguyen R.H.
        • Law A.S.
        • National Dental Practice-Based Research Network Collaborative G
        Validity of preoperative clinical findings to identify dental pulp status: a National Dental Practice-Based Research Network Study.
        J Endod. 2016; 42: 935-942
        • Abbott P.
        • Leow N.
        Predictable management of cracked teeth with reversible pulpitis.
        Aust Dent J. 2009; 54: 306-315
        • Pane E.S.
        • Palamara J.E.
        • Messer H.H.
        Stainless steel bands in endodontics: effects on cuspal flexure and fracture resistance.
        Int Endod J. 2002; 35: 467-471
        • Warfvinge J.
        • Bergenholtz G.
        Healing capacity of human and monkey dental pulps following experimentally-induced pulpitis.
        Endod Dent Traumatol. 1986; 2: 256-262
        • Bergenholtz G.
        • Warfvinge J.
        Migration of leukocytes in dental pulp in response to plaque bacteria.
        Scand J Dent Res. 1982; 90: 354-362
        • Lee J.
        • Kim S.
        • Kim E.
        • et al.
        Survival and prognostic factors of managing cracked teeth with reversible pulpitis: a 1- to 4- year prospective cohort study.
        Int Endod J. 2021; 54: 1727-1737
        • VanVoorhis C.R.W.
        • Morgan B.L.
        Understanding power and rules of thumb for determining sample sizes.
        Tutorials Quantitative Methods Psychol. 2007; 3: 43-50
        • Abbott P.V.
        • Yu C.
        A clinical classification of the status of the pulp and the root canal system.
        Aust Dent J. 2007; 52: S17-S31
        • American Association of Endodontists
        Endodontic Diagnosis.
        2013 (Accessed October 4, 2022)
        • Patel S.
        • Wilson R.
        • Dawood A.
        • et al.
        The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography - part 2: a 1-year post-treatment follow-up.
        Int Endod J. 2012; 45: 711-723
        • Friedman S.
        • Azarpazhooh A.
        • Bruder G.A.
        Guidelines for the Methodology of Cracked Tooth Studies.
        American Association of Endodontists, Chicago2016
      3. American Association of Endodontists consensus conference recommended diagnostic terminology.
        J Endod. 2009; 35: 1634
        • Kang S.H.
        • Kim B.S.
        • Kim Y.
        Cracked teeth: distribution, characteristics, and survival after root canal treatment.
        J Endod. 2016; 42: 557-562
        • Lee T.Y.
        • Yang S.E.
        • Kim H.M.
        • Kye M.J.
        Characteristics, treatment, and prognosis of cracked teeth: a comparison with data from 10 years ago.
        Eur J Dent. 2021; 15: 694-701
        • Brown W.S.
        • Jacobs H.R.
        • Thompson R.E.
        Thermal fatigue in teeth.
        J Dent Res. 1972; 51: 461-467
        • Trushkowsky R.
        Restoration of a cracked tooth with a bonded amalgam.
        Quintessence Int. 1991; 22: 397-400
        • Lynch C.D.
        • McConnell R.J.
        The cracked tooth syndrome.
        J Can Dent Assoc. 2002; 68: 470-475
        • Park S.
        • Wang D.H.
        • Zhang D.
        • et al.
        Mechanical properties of human enamel as a function of age and location in the tooth.
        J Mater Sci Mater Med. 2008; 19: 2317-2324
        • Owatz C.B.
        • Khan A.A.
        • Schindler W.G.
        • et al.
        The incidence of mechanical allodynia in patients with irreversible pulpitis.
        J Endod. 2007; 33: 552-556
        • Wolters W.J.
        • Duncan H.F.
        • Tomson P.L.
        • et al.
        Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs.
        Int Endod J. 2017; 50: 825-829
        • Kahler W.
        The cracked tooth conundrum: terminology, classification, diagnosis, and management.
        Am J Dent. 2008; 21: 275-282
        • Krell K.V.
        • Caplan D.J.
        12-month success of cracked teeth treated with orthograde root canal treatment.
        J Endod. 2018; 44: 543-548
        • de Toubes K.M.S.
        • Soares C.J.
        • Soares R.V.
        • et al.
        The correlation of crack lines and definitive restorations with the survival and success rates of cracked teeth: a long-term retrospective clinical study.
        J Endod. 2022; 48: 190-199