Survival of Endodontically Treated Cracked Teeth: A 10- to 15-Year Retrospective Study

Pei Yuan Chan; Rachel Fangying Seet; Seyed Ehsan Saffari; Stella Jinran Zhan; Nah Nah Chen

doi:10.1016/j.joen.2025.11.010

Survival of Endodontically Treated Cracked Teeth: A 10- to 15-Year Retrospective Study

J Endod. 2025 Nov 21:S0099-2399(25)00716-2. doi: 10.1016/j.joen.2025.11.010. Online ahead of print.

Authors

Pei Yuan Chan¹, Rachel Fangying Seet², Seyed Ehsan Saffari³, Stella Jinran Zhan⁴, Nah Nah Chen⁵

Affiliations

¹ Senior Consultant, Endodontic unit, Department of Restorative Dentistry, National Dental Centre Singapore, Singapore. Electronic address: chan.pei.yuan@singhealth.com.sg.
² Associate Consultant, Endodontic unit, Department of Restorative Dentistry, National Dental Centre Singapore, Singapore.
³ Assistant Professor, Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore.
⁴ Research Fellow, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
⁵ Senior Consultant, Endodontic unit, Department of Restorative Dentistry, National Dental Centre Singapore, Singapore.

PMID: 41276249
DOI: 10.1016/j.joen.2025.11.010

Abstract

Introduction: To investigate long-term (10- to 15-year) survival and success rates of endodontically treated cracked teeth and to identify possible prognostic factors related to their survival and success.

Methods: Patients who had endodontically treated cracked teeth were seen for a 10- to 15-year review. Preoperative and intraoperative treatment records were retrieved. Clinical and radiographic evaluations were performed. Two outcomes were investigated: survival (tooth present) and success (asymptomatic with complete radiographic healing). The 10- and 15-year tooth survival and success rate were estimated. Cox proportional hazards regression assessed the impact of various factors on the time to tooth extraction and time to complete healing.

Results: Data from 196 patients with 204 endodontically treated cracked teeth were analyzed. The 10- and 15-year survival rates were 66% (95% confidence interval [CI]: 60%-73%) and 55% (95% CI: 48%-63%), respectively. Success rates declined from 64% at 10 years to 37% at 15 years. Preoperative probing depth (PD) was the primary statistically significant factor for survival. Teeth with no preoperative PD (<4 mm) had higher survival rates of 76% at 10 years and 64% at 15 years. Multivariable analysis revealed significantly increased risk for teeth with PD of 4-5 mm (adjusted hazard ratio [aHR] = 2.48, 95% CI: 1.41-4.38, P = .002) and ≥6 mm (aHR = 3.19, 95% CI: 1.56-6.54, P = .002) for survival analysis. Older age was a modest independent risk factor (aHR = 1.03 per year, 95% CI: 1.00-1.05, P = .026) for survival.

Conclusions: Endodontic treatment of cracked teeth with favorable preoperative PDs demonstrates long-term survival comparable to noncracked teeth and is a viable long-term treatment option which should be recommended.

Keywords: Cracked teeth; prognosis; root canal treatment; survival; treatment outcome.