External Splinting Shows Promise for Cracked Teeth with Reversible Pulpitis: Study

Researchers have found in a new study that External splinting yields a favorable one-year pulpal survival rate in cracked teeth with reversible pulpitis, despite variations in treatment protocols. However, due to high heterogeneity and low-quality evidence, further high-quality comparative studies are needed to establish a standardized treatment approach.

This systematic review and meta-analysis aimed to assess the pulp survival rate of cracked teeth with normal pulp or reversible pulpitis managed using external splinting. A comprehensive literature search was conducted across PubMed, Scopus, LILACS, EMBASE, Web of Science, and Google Scholar up to January 31, 2025. Clinical studies evaluating pulp survival in permanent mature cracked teeth diagnosed with normal pulp or reversible pulpitis, with a minimum follow-up period of 12 months, were included. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), while the quality of evidence (QoE) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Publication bias was analysed through funnel plots and Begg’s test.

A random-effects model was utilized to estimate the pooled pulp survival rates. Results: A total of ten studies comprising 711 cracked teeth with varying management protocols met the inclusion criteria. The weighted pooled pulp survival rate at 12 months was 85% (95% CI: 79–91%), with considerable heterogeneity (I2 = 82.6%). Sensitivity analysis confirmed the reliability of these findings. Funnel plot analysis revealed no publication bias. Subgroup analysis indicated that teeth managed without interim orthodontic banding exhibited a higher pulp survival rate (89%, 95% CI: 83–95%) than with orthodontic banding (79%, 95% CI: 67–90%). Survival was also greater with the direct approach [89% (95% CI, 82–97%)] than the stepwise approach [81% (95% CI, 72–90%)]. The overall risk of bias was moderate, and the QoE was categorized as very low.

For cracked teeth with reversible pulpitis, external splinting has demonstrated favourable pulpal survival rate at one year, albeit with considerable variation in treatment protocols. However, given the substantial heterogeneity and overall low quality of evidence, there remains a need for rigorous, high-quality comparative studies to establish a standardized treatment approach.