Long-term Survival of Endodontically Treated Cracked Teeth: A Systematic Review and Meta-analysis.

Abstract

Introduction: Previous meta-analyses of endodontically treated cracked teeth emphasized 1- to 5-year cohorts. New long-term data permit a time-anchored reassessment.

Methods: PubMed/Europe PMC, Embase, and Web of Science were searched from inception through October 3, 2026. Longitudinal cohorts of endodontically treated permanent cracked teeth with at least 1 year of follow-up were eligible. Tooth survival was the primary outcome. Two authors independently screened records, assessed full texts, and verified study-level data. Published 4- to 5-year proportions were synthesized on the logit scale using restricted maximum likelihood random effects and modified Knapp-Hartung inference. Longer horizons and prognostic factors were synthesized narratively. Risk of bias was assessed with ROBINS-E-informed domains.

Results: Fifteen studies were included; 9 contributed to time-anchored quantitative synthesis. The pooled 4- to 5-year survival estimate was 82.2% (95% confidence interval [CI], 67.7%-91.1%; I²=89.5%; 7 cohorts). Two independent cohorts reported 10-year survival of 54% and 66%; the latter Singapore cohort reported 55% at 15 years. Deep crack-associated probing was an established adverse marker across multiple cohorts. In the longest cohort, adjusted extraction hazards were 2.48 for 4- to 5-mm probing and 3.19 for probing of at least 6 mm. Radicular extension, periapical disease, multiple cracks, older age, and lack of definitive cuspal coverage were additional risk indicators. All studies were at serious risk of bias; certainty was very low.

Conclusions: Selected endodontically treated cracked teeth frequently remain functional for 4 to 5 years, but survival declines thereafter and varies by setting. Prognosis should be time-dependent and individualized. Deep crack-associated probing is not a newly identified factor; this review quantifies its persistent long-term association with extraction and integrates it with radicular extension and restorative status.